The Characteristics And Influencing Factors Of Cognitive Impairment In Middle-aged Patients With Type 2 Diabetes

Backgrounds and objective:Type 2 diabetes mellitus(T2DM)has adverse impact on the cognitive function by risk factors including hyperglycemia,insulin resistance,and advanced glycation endproducts.T2 DM can accelerate the development of cognitive impairment to dementia.Given the growing prevalence of diabetes,the phenomenon of cognitive impairment in patients with T2 DM was outstanding.Epidemiological data showed that middle-aged people with T2 DM accounts for much of the diabetic population,and impaired cognitive in middle-aged people was also outstanding.But previous studies were lack of the further analysis about its characteristics and influence factors of the cognitive damage combined with brain magnetic resonance imaging(MRI)data.So in this study,we collect the blood biochemical data and neuropsychological scale combing with the craniocerebral MRI data to analyze the characteristics and influencing factors of cognitive impairment of middle-aged T2 DM patients for the purpose to provide theory for delay cognitive decline,thus reduce the occurrence of dementia in T2 DM patients.Material and methods:Fifty-two T2 DM patients(DM group)and fifty-two cases of age-,sex-and educationmatched subjects without T2DM(NDM group)were involved in this study.DM group was further divided into four groups according to the glycosylated hemoglobin(Hb A1c)level(group1:HbA1c?7%,group2:7%(27)HbA1c?8%,group3:8%(27)HbA1c?9%,group4:HbA1c>9%).All of the T2 DM patients were from Southwest Hospital Endocrinology department in Chongqing.All participants were told in detail of the purpose,significance,the experimental processes and matters need attention of this study.Then sign the informed consent book into the group.All participants were collected their age,gender,education,height,body mass,body mass index(BMI),and the history of drinking,smoking.At 7:00 the blood pressure was measured,the blood biochemical data such as fasting plasma glucose(FPG),HbA1 c,fasting insulin(FINS),etc.were also collected.The tests of diabetes complications such as diabetes electromyography examination,24 hours urine protein,etc.were also collected in T2 DM patients.Mini-Mental State Examination(MMSE),Montreal cognitive assessment scale(MoCA),Activity of Daily Living scale(ADL),Trail-Making Test(TMT),digit span test(DST),Auditory Verbal Learning Test(AVLT),verbal fluency test(VFT)test were applied to the two groups to examine the cognitive function in quiet condition.3.0 T MR scanner was used to collect participators' structural MRI data,all participants were told to stay awake,close their eyes,try to overcome the movement of head.3D-T1 WI was collected with MPRAGE.Data was analyzed by FreeSurfer and VBM software.Inter group comparison of demographic and clinical data was conducted with SPSS 18.0 software.MRI date were conducted with SPM8 software.P<0.05 was considered statistically significant.Results:The Mo CA,DST(back)and TMT-B rating scores of T2 DM group were poorer than NDM group(P<0.05).Cognitive impairment is worse when patients with diabetic retinopathy.There was no difference between the patients with HbA1c?7% and NDM group about neuropsychological scale,Compared with the patients with Hb A1c?7% and NDM group,TMT-B rating scores were poorer when HbA1c>7%.DM group gray matter volume reduced area is located in the medial frontal gyrus when compared with the NDM group.Conclusion:Middle-aged patients with T2 DM have existed cognitive impairment,mainly manifested in the ability decline of memory,execute and attention.Cognitive impairment was worse in patients with diabetic retinopathy.Compared with people without T2 DM,middle-aged patients with T2 DM has the trend of the gray matter volume reduction.Early detection of impaired cognitive function,blood sugar control have positive sense to delay cognitive decline.