Research On The Motor And Sensory Dysfunction Of Upper Extremities In Elderly And Non-elderly Patients With Diabetic Peripheral Neuropathy

Objective To analyze the impact of Diabetic peripheral neuropathy(DPN)on sensory and motor functions of upper extremities in elderly and non-elderly patients,and learn about the effect appetite of the DPN and aged on sensory and motor functions of upper extremities.Methods 166 eligible T2 DM patients were included and general data of the participants was collected.Neuro-electrophysiological examination of bilateral extremities was performed.According to the DPN diagnostic criteria and age definition criteria of the elderly,the participants were divided into A-DPN group(n=46),A-non-DPN group(n=43),NA-DPN group(n=35)and NA-non-DPN group(n=42).The touch-pressure sensation,grip strength index,pinch force and dexterity of bilateral upper extremities were evaluated by Semmes-Weinstein monofilament examination,grip dynamometer,pinch gauge and Purdue Pegboard Test.The clinical data,electrophysiological examination outcomes and evaluation data were statistically analyzed to describe the impact of DPN on sensory and motor functions of upper extremities in elderly and non-elderly patients.Results 1.There are significant differences in Hb A1 c among A-DPN group and A-non-DPN group,NA-non-DPN group(P < 0.05).There are significant differences in age and disease course among A-DPN group and NA-DPN group,NA-non-DPN group(P < 0.05).There are significant differences in Hb A1 c between the A-non-DPN group and the NA-non-DPN group.2.There are significant differences in the amplitude of left median motor nerve between the A-DPN group and the NA-DPN group(P < 0.05).There are significant differences in NCV and amplitude of bilateral median motor nerve,NCV and amplitude of left median sensory nerve,amplitude of right median sensory nerve,NCV and amplitude of left ulnar motor nerve,and amplitude of left ulnar sensory nerve between the A-DPN group and the NA-non-DPN group(P < 0.05).There are significant differences in the amplitude of right median sensory nerve between the A-non-DPN group and the NA-non-DPN group(P <0.05).There are significant differences in the amplitude of left median sensory nerve and left ulnar sensory nerve between the NA-DPN group and the NA-non-DPN group(P <0.05).However,there are no significant differences between the A-DPN group and the A-non-DPN group in any nerve conduction function(P > 0.05).3.There are significant differences in SWME-1 to SWME-7 of bilateral hand between the A-DPN group and the NA-non-DPN group(P < 0.05).There are significant differences in SWME-2 and SWME-4 of left hand and SWME-3,SWME-4 and SWME-5of right hand between the A-non-DPN group and the NA-non-DPN group(P < 0.05).There are significant differences in SWME-2 to SWME-7 of left hand and SWME-3,SWME-4,SWME-5 and SWME-7 of right hand between the NA-DPN group and the NA-non-DPN group(P < 0.05).There are no significant differences in monofilaments tactile sensation between the A-DPN group and the A-non-DPN group at any test position of both hands,but also between the A-DPN group and the NA-DPN group(P > 0.05).4.There are significant differences in both hands grip strength index between the A-DPN group and the NA-DPN group(P < 0.05).There are significant differences in both hands grip strength index between the A-DPN group and the NA-non-DPN group(P <0.05).There is significant difference in left hand grip strength index between the A-non-DPN group and the NA-non-DPN group(P < 0.05).There are no significant differences in both hands grip strength index between the A-DPN group and the A-non-DPN group,between NA-DPN group and NA-non-DPN group(P > 0.05).5.There are significant differences in pinch force of left thumb-index finger and thumb-little finger between the A-DPN group and the NA-DPN group(P < 0.05).There are significant differences in pinch force of left thumb-middle finger and thumb-ring finger between the A-DPN group and the NA-non-DPN group(P < 0.05).There are significant differences in pinch force of thumb-index finger,thumb-middle finger,thumb-ring finger and thumb-little finger in left hand and thumb-middle finger in right hand between the A-non-DPN group and the NA-DPN group(P < 0.05).There are significant differences in pinch force of thumb-index finger,thumb-middle finger and thumb-ring finger in both hands between the A-non-DPN group and the NA-Non-DPN group(P < 0.05).There are significant differences in pinch force of right thumb-index fingers between the NA-DPN group and the NA-non-DPN group(P < 0.05).There are no significant differences in the pinch force of both hand between the A-DPN group and the A-non-DPN group(P > 0.05).6.There are significant differences in handedness test,non-handedness test,both-hand test,sum of the first to three tests and assembly test between the A-DPN group and the NA-DPN group,between the A-DPN group and NA-non-DPN group,between the A-non-DPN group and NA-non-DPN group(P < 0.05).There are no significant differences in Purdue pegboard test all tests between the A-DPN group and the A-non-DPN group,between the NA-DPN group and NA-non-DPN group(P > 0.05).7.There are no interactions between DPN factor and aged factor on the SWME,grip strength index and pinch force of both hands,but also on the perdue pegboard test(P > 0.05).There is interaction on the handedness test of perdue pegboard test between DPN factor and aged factor(P < 0.05).There are the main effects of DPN factor on SEME-6 and SWME-7 of the left hand(P < 0.05).There are the main effects of aged factor on bilateral grip strength index,left thumb-index finger pinch force,left thumb-middle finger pinch force,right thumb-middle finger pinch force and Perdue pegboard test(P < 0.05).Conclusion 1.In the non-elderly patients,DPN declined the touch pressure sensation,pinch force and the dominant hand dexterity,rarely affects the grip strength and non-dominant hand dexterity.In the elderly patients,DPN rarely affects the touch pressure sensation,grip strength,pinch force and dexterity of the hands.The present standardized assessment tools may be difficult to distinguish the touch pressure sensation and dexterity of the upper extremities in the elderly DPN patients and the elderly non-DPN patients.More sensitive assessment tools or criteria may need to be developed for elderly DPN patients.2.DPN mainly affects the sensory function of upper extremities.Aged mainly affects the overall muscle strength,fine motor strength and dexterity of upper extremities.DPN and aged jointly affect hand dexterity.