| Background:At present, the prevalence rate of diabetes mellitus in China is 9.7%, and the prevalence of prediabetes reaches as high as 15.5%. The disease of diabetes mellitus itself does harm to people’s health. Meanwhile, its complications also bring heavy economic burdens to the family as well as to the society, and severely reduce the patient’s living quality. Mild cognitive impairment(MCI) is AD￠s early stage, there was 10-15% patients of MCI developing into AD every year. Type 2 diabetes itus(T2DM) accounts for more than 90% of the patients with diabetes, and is an independent risk factor for MCI’s developing into AD. Patients with T2 DM demonstrate the risk of developing into AD three times higher than healthy subjects. More and more evidence shows that T2 DM can cause brain structure and function abnormal, and can accelerate brain aging, thus being considered as an important risk factor fmellor cognitive impairment in the aging group. Consequently, T2 DM patients with early cognitive impairment, as high risk population for AD, are receiving more and more concerns. The recognition of cognitive impairment is of much help to the early diagnosis and treatment of AD, and can delay its onset and development.Objectives:The objectives of this thesis are to make, through Montreal cognitive assessment(Mo CA) scores, cognitive evaluation on patients with T2 DM and people with normal glucose tolerance, to determine their hippocampal volume, magnetic resonance spectroscopy(MRS) and cytokines, to explore the relationship of hippocampalvolume, biochemical parameters changes as well as cell factor with T2 DM mild cognitive function, and to reveal their values in the predict and diagnosis of T2DM-MCI.Methods:1. We chose as research objects the hospitalized patients with T2 DM, ranging from 50 to 75 years old, during the period from September 2011 to September 2012, in the Department of Endocrinology, the People’s Hospital of Henan Province. They all fit in well with the diagnosis standard of diabetes formulated by the WHO in 1999. Exclusion was made as to the cognitive impairment caused by other diseases, as well as the diseases and drug use history which might affect the target level to be detected. The normal control group consist of non-diabetic patients who were receiving health examination in the People’s Hospital of Henan Province during the corresponding period, matching with the case group with respect to their ages, sex, and degree of education.2. Mo CA scores were used to make cognitive function evaluation. With Mo CA score of 26 as the demarcation line, the patients with T2 DM were divided into T2 DM mild cognitive impairment(T2DM-MCI) group of 25 cases and T2 DM without cognitive impairment(T2DM-NC) group of 35 cases. For sake of comparison, a normal control group of 25 cases of patients with normal glucose tolerance and cognitive function(NGT-NC) was also set up.3. All the information concerning the research objects were collected, such as their general information and biochemical data. Automatic biochemical analyzer was used to measure the glycosylated hemoglobin, lipid and uric acid. The hippocampus area of the research objects were scanned by Siemens 3.0T magnetic resonance. The images thus obtained were three-dimensionally reconstructed in the station. Each layer of the hippocampus was then sketched in the three-dimensional image, in this way getting the absolute volume of the hippocampus, and after standard treatment, obtaining the relative volume of the hippocampus. 1H-MRS data were repeatedly acquisited by using a voxel, obtaining the spectral peak, peak curve area and the ratio of NAA/Cr, MI/Cr, Cho/Cr of N-acetyl aspartic acid(NAA), choline(Cho), creatine(Cr) and Myo-inositol(MI). Adiponectin, leptin, and resistin were measured by means of enzyme-linked immunosorbent assay(ELISA).4. All data were processed with SPSSl6.0 statistical software package. P<0.05 had statistical difference.Results:1. General contrast among the three groups(1) Compared with normal controls, patients with T2 DM were matched in age, gender, degree of education and body mass index(BMI), thus having no statistical significance( P>0.05).(2) The duration of the disease in T2DM-MCI group is obviously longer than that in T2DM-NC group,the difference being of statistical significance(P<0.05).2. Mo CA score: The Mo CA score in T2DM-MCI group decreased, compared with those in T2DM-NC group and NGT-NC group, the difference being statistically significant(P<0.05). Delayed recall: The delayed recall in T2DM-MCI group decreased as compared with those in T2DM-NC group and NGT-NC group, the difference being of statistical significance(P<0.05). Visual space and executive function, language: The difference with respect to visual space and excutive function, attention and language between T2DM-MCI group and T2DM-NC group and NGT-NC group has statistical significance(P<0.05). Attention, naming, abstraction, orientation: The difference with respect to attention, naming, abstraction and orientation between T2DM-MCI group and T2DM-NC group and NGT-NC group has no statistical significance(P>0.05).3. Hippocampal volume(1) The bilateral hippocampal volume in T2DM-MCI group was significantly reduced, compared with those in T2DM-NC group and NGT-NC group(P<0.05);(2) The difference in bilateral hippocampal volume between T2DM-NC group and NGT-NC group has no statistical significance(P>0.05).4. Analysis of the hippocampal biochemical indexes(1) The bilateral NAA/Cr in T2DM-MCI group was lower than those in T2DM-NC group and NGT-NC group, the difference being of statistical significance(P<0.05).The difference in bilateral Cho/Cr between T2DM-MCI group and T2DM-NC group and NGT-NC group had no statistical significance(P>0.05). The bilateral MI/Cr in T2DM-MCI group was higher than those in T2DM-NC group and NGT-NC group, the difference having statistical significance(P<0.05);(2) The bilateral NAA/Cr in T2DM-NC group was lower than that in NGT-NC group, the difference being statistically significant(P<0.05). The difference in bilateral Cho/Cr had no statistical significance(P>0.05). The bilateral MI/Cr in T2DM-NC group was higher than that in NGT-NC group, the difference being statistically significant(P<0.05).5. Comparison of three groups of adiponectin, leptin and resistin(1) Comparison of three groups of adiponectin: The adiponectin in T2DM-MCI group was lower than those in T2DM-NC group and NGT-NC group, the difference being statistically significant(P<0.05). The adiponectin in T2DM-NC group was lower than that in NGT-NC group, the difference being statistically significant(P<0.05).(2) Comparison of three groups of leptin: The leptin in T2DM-MCI group was higher than those in T2DM-NC group and NGT-NC group, the difference being statistically significant(P<0.05). The leptin in T2DM-NC group was higher than that in NGT-NC group, the difference being statistically significant(P<0.05).(3) Comparison of three groups of resistin: The resistin in T2DM-MCI group was higher than those in T2DM-NC group and NGT-NC group, the difference being statistically significant(P<0.05). The resistin in T2DM-NC group was higher than that in NGT-NC group, the difference being statistically significant(P<0.05).6. Correlation of Mo CA in T2DM-MCI Group with hippocampal volume and other risk factorsAnalysis of Pearson correlation indicates that MoCA score had positive correlation with the left side(r=0.858, P<0.01)as well as the right side(r=0.537, P=0.006)of the hoppocampal volumes;that Mo CA score had negative correlation with Hb Alc(r=-0.596, P=0.002), diabetic duration(r=-0.533, P=0.006), leptin(r=-0.674, P<0.01), and resistin(r=-0.611, P<0.01), and had positive correlation with adiponectin(r=0.693, P<0.01).7. Correlation of adiponectin, leptin and resistin with hippocampal volume in T2DM-MCI GroupT2DM-MCI Group: Adiponectin was positively correlated with the left and right sides of the hippocampal volume(r=0.648, 0.656, P respectively<0.01). Leptin was negatively correlated with the left and right sides of the hippocampal volume(r=-0.535,-0.552, P=0.006, 0.004). Resistin was negatively correlated with the left and right sides of the hippocampal volume(r=-0.550,-0.519, P=0.004, 0.008).8. Contrast among the three groups regarding blood pressure, hemoglobin, lipids(1) Systolic blood pressure, diastolic blood pressure: The difference in systolic and diastolic blood pressure between T2DM-MCI group and T2DM-NC group, NGT-NC group was not statistically significant(P>0.05); and the difference in systolic and diastolic blood pressure between T2DM-NC group and NGT-NC group was also not statistically significant(P>0.05).(2) Glycosylated hemoglobin(Hb Alc): The Hb Alc in T2DM-MCI group was higher than those in T2DM-NC group and NGT-NC group, the difference being statistically significant(P<0.05); and the difference in Hb Alc between T2DM-NC group and NGT-NC group had statistical significance(P<0.05).(3) Blood lipids: The difference in TC, TG, LDL-C and HDL-C between T2DM-MCI group and T2DM-NC group was statistically significant(P<0.05). The difference in TC, TG, LDL-C and HDL-C between T2DM-NC group and NGT-NC group had statistical significance(P<0.05).Conclusions:1. The bilateral hippocampal volume in T2DM-MCI patients was significantly reduced. The more obvious the MCI is, the smaller the hippocampal volume becomes.2. There existed apparent metabolic abnormalities of hippocampus in T2DM-MCI patients, reduction of bilateral NAA/Cr and elevation of bilateral MI/Cr.The reduction of NAA/Cr indicates the neuronal loss, while the elevation of MI/Cr reflects gliosis. All these might cause the reduction of the hippocampal volume, thus affecting the cognitive function of T2 DM patients.3. The reduction of adiponectin and the increase of leptin and resistin might affect the cognitive function of the T2 DM patients.4. The course of disease, glycosylated hemoglobin, and metabolic disorder of serum lipids all contributed to the formation of T2DM-MCI. The T2 DM patients suffered from mild cognitive impairments with respect to delayed recall, visual space and executive function and language. |
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