NEUROPATHY DISABILITY SCORE (NDS)

Saldy Yusuf

Griya Afiat Makassar

It has been known that neuropathy strongly associated with risk for development of foot ulcers, that why assessment of neuropathy status can be cornerstone in screening high risk patient.

Neuropathy Disability Score or NDS has been known as the gold standard to detect neuropathy (Ghosal, Stephens, & Mukherjee, 2012). NDS has been using in widely different clinical setting. In Spain NDS has been used in primary care and hospital setting (Compostela, 1998)

There was significant different of NDS score between ulcers and non ulcers, with sensitivity 92 and spasticity 43 as single use, and sensitivity getting higher to be 99 in combination with monofilament test   (Pham et al., 2000) NDS score ≥ 5 has OR 8.1 (Pham et al., 2000). Moreover NDS also can distinguish between no neuropathy, mild neuropathy, moderate neuropathy and severe neuropathy (Caselli, Pham, Giurini, Armstrong, & Veves, 2002).

NEUROLOGICAL DISABILITY SCORE (NDS)
Test	Right	Left
Pinprick test	Present = 0	Present = 0
	Absent = 1	Absent = 1
Vibration test	Present = 0	Present = 0
	Absent = 1	Absent = 1
Temperature sensation	Present = 0	Present = 0
	Absent = 1	Absent = 1
Achilles Tendon Reflex	Present = 0	Present = 0
	Present with Reinforcement = 1	Present with Reinforcement = 1
	Absent = 2	Absent = 2
Interpretations	0-2 normal, 3-5 mild, 6-8 moderate,  9-10 severe.

NDS also useful to distinguish between no peripheral neuropathy, with peripheral neuropathy and presence of ulcers (Tentolouris et al., 2009) or between ulcers and non ulcers (Tentolouris et al., 2010) and increase as the ulcer level increase (Nyamu, Otieno, Amayo, & Mcligeyo, 2003). For every 1 point  of NDS has OR 1.70 (Tentolouris et al., 2009)

Many studies reported that cut off point ≥ 6 NDS for development DFU (Calle-Pascual et al., 2002) (Tan, 2010)(Tentolouris et al., 2010)(Tentolouris et al., 2009) (Abbott et al., 2002)(N Papanas, Gries, Maltezos, & Zick, 2006) (Nikolaos Papanas et al., 2007) (Boulton, Malik, Arezzo, & Sosenro, 2004)

REFERENCES

Abbott, C. a, Carrington, a L., Ashe, H., Bath, S., Every, L. C., Griffiths, J., … Boulton, a J. M. (2002). The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort. Diabetic medicine : a journal of the British Diabetic Association, 19(5), 377–84. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12027925

Boulton, A. J. M., Malik, R. A., Arezzo, J. C., & Sosenro, J. M. (2004). Diabetic Somatic Neuropathies. Diabetes care, 27, 1458–1486.

Calle-Pascual, A. L., Durán, A., Benedí, A., Calvo, M. I., Charro, A., Diaz, J. a, … Cabezas-Cerrato, J. (2002). A preventative foot care programme for people with diabetes with different stages of neuropathy. Diabetes research and clinical practice, 57(2), 111–7. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12062856

Caselli, A., Pham, H., Giurini, J. M., Armstrong, D. G., & Veves, A. (2002). The forefoot-to-rearfoot plantar pressure ratio is increased in severe diabetic neuropathy and can predict foot ulceration. Diabetes care, 25(6), 1066–71. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12032116

Compostela, S. De. (1998). The prevalence of clinical diabetic polyneuropathy in Spain : a study in primary care and hospital clinic groups.

Ghosal, S., Stephens, J., & Mukherjee, A. (2012). Quantitative vibration perception threshold in assessing diabetic neuropathy: is the cut-off value lower for Indian subjects? [Q-VADIS Study]. Diabetes & metabolic syndrome, 6(2), 85–9. doi:10.1016/j.dsx.2012.08.002

Nyamu, P. N., Otieno, C. F., Amayo, E. O., & Mcligeyo, S. O. (2003). RISK FACTORS AND PREVALENCE OF DIABETIC FOOT ULCERS AT KENYATTA NATIONAL HOSPITAL , NAIROBI Background : Diabetic foot ulcers contribute significantly to the morbidity and mortality of patients with diabetes mellitus . The diabetic patients with foot ulce, 80(1), 36–43.

Papanas, N, Gries, a, Maltezos, E., & Zick, R. (2006). The steel ball-bearing test: a new test for evaluating protective sensation in the diabetic foot. Diabetologia, 49(4), 739–43. doi:10.1007/s00125-005-0111-5

Papanas, Nikolaos, Giassakis, G., Papatheodorou, K., Papazoglou, D., Monastiriotis, C., Christakidis, D., … Maltezos, E. (2007). Sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of peripheral neuropathy in type 2 diabetes patients: a comparison with clinical examination and nerve conduction study. Journal of diabetes and its complications, 21(6), 353–8. doi:10.1016/j.jdiacomp.2006.08.003

Pham, H., Armstrong, D. G., Harvey, C., Harkless, L. B., Giurini, J. M., & Veves, a. (2000). Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial. Diabetes care, 23(5), 606–11. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/10834417

Tan, L. S. (2010). The clinical use of the 10g monofilament and its limitations: a review. Diabetes research and clinical practice, 90(1), 1–7. doi:10.1016/j.diabres.2010.06.021

Tentolouris, N., Marinou, K., Kokotis, P., Karanti, a, Diakoumopoulou, E., & Katsilambros, N. (2009). Sudomotor dysfunction is associated with foot ulceration in diabetes. Diabetic medicine : a journal of the British Diabetic Association, 26(3), 302–5. doi:10.1111/j.1464-5491.2009.02677.x

Tentolouris, N., Voulgari, C., Liatis, S., Kokkinos, A., Eleftheriadou, I., Makrilakis, K., … Katsilambros, N. (2010). Moisture Status of the Skin of the Feet Assessed by the Visual Test Neuropad Correlates With Foot Ulceration in. Diabetes care, 33(5), 1112–1114. doi:10.2337/dc09-2027.