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Mental Arithmetic Stress as a Test for Evaluation of Diabetic Sympathetic Autonomic Neuropathy
Author(s) -
Locatelli A.,
Franzetti I.,
Caviezel F.,
Lepore G.,
Maglio M. L.,
Gaudio E.,
Pozza G.
Publication year - 1989
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/j.1464-5491.1989.tb01215.x
Subject(s) - medicine , heart rate , basal (medicine) , heart rate variability , diabetes mellitus , blood pressure , anxiety , autonomic neuropathy , diabetic neuropathy , autonomic nervous system , cardiology , endocrinology , psychiatry , biology , cell culture , genetics , neuroblastoma
The effects of a 1‐min mental arithmetic stress test on heart rate change were studied in 72 Type 1 diabetic patients, 36 without and 36 with diabetic autonomic neuropathy (mean age 33 and 44 yr, respectively), and in 80 matched normal subjects. Variation in hand skin temperature was also recorded in 25 normal subjects and 30 diabetic patients without and 32 with autonomic neuropathy. While mental arithmetic rapidly reduced skin temperature of normal volunteers and of patients without autonomic neuropathy, no effect was found in autonomic neuropaths (a drop of 0.63 ± 0.05 (± SE), 0.52 ± 0.04 and 0.16 ± 0.02 †C ( p <0.001), respectively). In control subjects and in diabetic patients without and with autonomic neuropathy the heart rate increase was 22.9 ± 6.8 (±SD), 21.4 ± 8.4 and 7.0 ± 3.7 beats min −1 , respectively ( p <0.001). The ratio between maximum mental arithmetic‐induced heart rate and basal heart rate was 1.29 ± 0.10, 1.24 ± 0.10 and 1.07 ± 0.05 ( p <0.001) for healthy subjects, non‐neuropathic patients, and neuropathic patients. Cut‐off values (the low normal limit for these variables) are proposed: skin temperature 0.23 °C, heart rate increase 11.6 beats min −1 and heart rate ratio 1.12. Anxiety state, blood glucose concentration (excluding hypoglycaemia), body position, basal heart rate, and age did not interfere with responses to mental arithmetic stress.