Diabetology International

, Volume 7, Issue 1, pp 83–88 | Cite as

Association between attentional function and postural instability in Japanese older patients with diabetes mellitus

  • Akiko MorimotoEmail author
  • Nao Sonoda
  • Satoshi Ugi
  • Katsutaro Morino
  • Osamu Sekine
  • Ken-ichi Nemoto
  • Mihoko Ogita
  • Yukako Tatsumi
  • Shin Murata
  • Hiroshi Maegawa
  • Naomi Miyamatsu
Short Communication



This study assessed the association between attentional function and postural instability in older Japanese patients with diabetes.


This cross-sectional study included 168 older patients with diabetes who were referred to an outpatient diabetic clinic between June and July 2013. The Trail Making Test-A (TMT-A) was used to evaluate attentional function. Posturography was used to evaluate postural sway. Indices of postural sway were the total length and the enveloped area. Analysis of covariance was used to estimate the multivariable-adjusted means of indices of postural sway according to tertile of TMT-A.


After adjustment for age, sex, regular exercise, diabetic retinopathy, bilateral numbness and/or paresthesia in the feet, hemoglobin A1c level, quadriceps strength, and Mini-Mental State Examination score, patients with lower attentional function had higher postural sway length (tertile 3 vs. tertile 1, p = 0.010) and enveloped area (tertile 3 vs. tertile 1, p = 0.030) levels than those with higher attentional function.


Among older patients with diabetes who did not have dementia, patients with lower attentional function may have more postural instability than those with higher attentional function.


Attentional function Trail making test Postural instability 



This work was supported by the Fund for Care Prevention from NPO Biwako Health and Welfare Consortium and Shiga Prefecture. This work was supported by the Japan Society for the Promotion of Science (JSPS) Grant-in-Aid for Young Scientists (B) (grant no. 25862144, 15K20762).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights statement and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Shiga University of Medical Science, an Ethical Committee) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients included in the study.

Supplementary material

13340_2015_231_MOESM1_ESM.docx (483 kb)
Supplementary material 1 (DOCX 482 kb)


  1. 1.
    Centers for disease control and prevention. injury prevention and control: data and statistics (WISQARS). Accessed 3 April 2015.
  2. 2.
    Yau RK, Strotmeyer ES, Resnick HE, et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care. 2013;36:3985–91.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Schwartz AV, Vittinghoff E, Sellmeyer DE, et al. Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care. 2008;31:391–6.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Cheng G, Huang C, Deng H, et al. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012;42:484–91.CrossRefPubMedGoogle Scholar
  5. 5.
    Sakurai T, Yokono K. Comprehensive studies of cognitive impairment of the elderly with type 2 diabetes. Geriatr Gerontol Int. 2006;6:159–64.CrossRefGoogle Scholar
  6. 6.
    Araki A, Ito H. Glucose metabolism, advanced glycation end products, and cognition. Geriatr Gerontol Int. 2004;4:S108–10.CrossRefGoogle Scholar
  7. 7.
    Mirelman A, Herman T, Brozgol M, et al. Executive function and falls in older adults: new findings from a 5 year prospective study link fall risk to cognition. PLoS One. 2012;7:e40297.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Murata S, Tsuda A, Inatani F. The relationship of physical and cognitive factors with falls in the elderly disabled at home: one year follow-up study. Jpn J Behav Med. 2005;11:32–40 (in Japanese).Google Scholar
  9. 9.
    Smith MA, Else JE, Paul L, et al. Functional living in older adults with type 2 diabetes: executive functioning, dual task performance, and the impact on postural stability and motor control. J Aging Health. 2014;26:841–59.CrossRefPubMedGoogle Scholar
  10. 10.
    Morimoto A, Sonoda N, Ugi S, et al. Association between symptoms of bilateral numbness and/or paresthesia in the feet and postural instability in Japanese patients with diabetes. Diabetol Int. 2015. doi: 10.1007/s13340-015-0214-2.Google Scholar
  11. 11.
    Spreen O, Strauss E. Trail making test. A compendium of neuropsychological tests: Administration, norms and commentary. 2nd ed. New York: Oxford University Press; 1998.Google Scholar
  12. 12.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMedGoogle Scholar
  13. 13.
    Kashiwagi A, Kasuga M, Araki E, et al. International clinical harmonization of glycated hemoglobin in Japan: from Japan diabetes society to national glycohemoglobin standardization program values. J Diabetes Invest. 2012;3:39–40.CrossRefGoogle Scholar
  14. 14.
    Orr R. Contribution of muscle weakness to postural instability in the elderly. A systematic review. Eur J Phys Rehabil Med. 2010;46:183–220.PubMedGoogle Scholar
  15. 15.
    Allet L, Armand S, de Bie RA, et al. The gait and balance of patients with diabetes can be improved: a randomised controlled trial. Diabetologia. 2010;53:458–66.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Hsu YF, Hämäläinen JA, Waszak F. Both attention and prediction are necessary for adaptive neuronal tuning in sensory processing. Front Hum Neurosci. 2014;8:152.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Manchester D, Woollacott M, Zederbauer-Hylton N, et al. Visual, vestibular and somatosensory contributions to balance control in the older adult. J Gerontol. 1989;4:118–27.CrossRefGoogle Scholar

Copyright information

© The Japan Diabetes Society 2015

Authors and Affiliations

  • Akiko Morimoto
    • 1
    Email author
  • Nao Sonoda
    • 1
  • Satoshi Ugi
    • 2
  • Katsutaro Morino
    • 2
  • Osamu Sekine
    • 2
  • Ken-ichi Nemoto
    • 2
  • Mihoko Ogita
    • 1
    • 3
  • Yukako Tatsumi
    • 1
    • 4
  • Shin Murata
    • 5
  • Hiroshi Maegawa
    • 2
  • Naomi Miyamatsu
    • 1
  1. 1.Department of Clinical NursingShiga University of Medical ScienceOtsuJapan
  2. 2.Department of MedicineShiga University of Medical ScienceOtsuJapan
  3. 3.Department of NursingKyoto Koka Women’s UniversityKyotoJapan
  4. 4.Department of Preventive Medicine and Public HealthNational Cerebral and Cardiovascular CenterSuitaJapan
  5. 5.Department of Physical TherapyKyoto Tachibana UniversityKyotoJapan

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