The Study Of Cognitive Function Impairment And Relative Factors In Elderly Patients With Type 2 Diabetes

Objective:To investigate the profiles of different degrees of cognitive function impairment, evaluate the associations between cognitive function deterioration and relative factors in elderly patients with type 2 diabetes aged 60 and over.To follow-up the development of cognitive function impairment and assess possible risk factors in these cases without stroke at the end of 12 weeks.Methods:All 214 cases with type 2 diabetes aged 60 and over were selected in the study. The basic medical history,test of glucose level,and cognitive function status assessed by the Mini-Mental State Examination(MMSE),Loeweistein Occupational Therapy Cognitive Assessment(LOTCA),Clinical Dementia Rating(CDR) and Global Deterioration Scale(GDS) were collected successfully.Cognitive function status was divided into three subgroups depending on the total scores of tests of MMSE,LOTCA and CDR.Three subgroups of cognitive function status were defined as normal cognitive function(NCF) with MMSE≥24,CDR=0 or GDS=1, mild cognitive impairment(MCI) with MMSE≥24,CDR=0.5 or GDS=2-3,and severe cognitive impairment(SCI) with MMSE＜24,CDR≥1 or GDS≥4.The scores of six domains from MMSE,LOTCA and CDR were recognized as the six cognitive function status of orientation,memory,language,visuospatial ablities, attention,executive function separately.The 178 cases of 182 patients without stroke were successfully followed-up to the end of 12 weeks,and the profiles of cognitive function and glycosylated hemoglobin Alc(HbAlc) were tested.Rusult:PartⅠ:Of the all 214 cases,76 cases(35.5%) with NCF,92 patients(43.0%) with MCI and 46 patients(21.5%) with SCI were found.Compare of total and domain scores of cognitive function within three subgroups were showed significantly differences(P＜0.01).And compare of total and domain scores of cognitive function between MCI and SCI were also showed significantly differences(P＜0.01).Compare of the scores of cognitive function but scores of MMSE,CDR and orientation,language between NCF and MCI were showed significantly differences(P＜0.01).The univariate analysis of age,education level,history of hypoglycemia and stroke,benzodiazepine use,duration of 2-diabetes and the diabetic microangiopathy within three subgroups were showed significantly differences(P＜0.05).Compare of education level,history of stroke,and the diabetic microangiopathy between MCI and SCI were showed significantly differences(P＜0.0167).And compare of age, history of stroke,benzodiazepine use,duration of 2-diabetes and history of hypoglycemia between NCF and MCI were showed significantly differences(P＜0.0167).The assosiations of the above significant factors within three subgroups were analyzed with Polytomous Ordinal Logistic Regression models. Age(OR=1.166,95%CI:1.101～1.234) and history of stroke(OR=17.668,95%CI: 2.097～148.829) were showed significantly differences after adjusting BMI and occupation.PartⅡ:The 178 patients without stroke were successfully followed-up at the baseline and the end of 12 weeks,and the profiles of cognitive function and HbAlc were tested.The scores of LOTCA,memory performance and visuospatial abilities but the HbAlc were showed significantly decline(P＜0.01) with paired t test.The univariate analysis of above relative factors was assessed.The decrease score of LOTCA was associated with age,education level,gender,diabetic retinopathy,duration of diabetes,and benzodiazepine use.The memory decline was associated with age,education level,occupation,and history of hypoglycemia.The decrease score of visualspatial function was associated with age,education level, gender,occupation,diabetic retinopathy,duration of diabetes,and history of hypoglycemia.The Stepwise Logistic Regression analysis was used to assess the risk factors of cognitive function impairement.The decrease score of LOTCA was associated with age(OR=1.066,95%CI:1.016～1.119),education level(OR=0.236,95%CI: 0.103～0.538) and diabetic retinopathy(OR=2.859,95%CI:1.141～7.167).The memory decline was associated with age(OR=1.076,95%CI:1.023～1.132),history of hypoglycemia(OR=10.570,95%CI:3.199～34.925) and occupation(OR=0.793, 95%CI:0.678～0.927).The decrease score of visualspatial function was associated with education level(OR=0.120,95%CI:0.097～0.414) and HbAlc level at the end of 12 weeks(OR=1.552,95%CI:1.130～2.132).Of the factors in diabetes,the decrease score of LOTCA was associated with diabetic retinopathy(OR=2.919,95%CI:1.096～7.773),the memory decline was associated with history of hypoglycemia(OR=8.679,95%CI:2.642～28.504),and the decrease score of visualspatial function was associated with diabetic retinopathy(OR=2.626,95%CI:1.013～6.808) and HbAlc level at the the end of 12 weeks(OR=1.485,95%CI:1.021～2.159) after adjusting age.The factors of average blood glycemic level and subtype of diabetic microangiopathy was also statistically analysed.The decrease score of visualspatial function was associated with diabetic microangiopathy in the subgroup of well-controlled blood glycemic level.The decrease score of visualspatial function was not associated with the all factors of diabetic in the subgroup of controlled blood glycemic level.The decrease score of visualspatial function was associated with insulin treatment in the subgroup of uncontrolled blood glycemic level.The decrease score of visualspatial function was only associated with diabetic retinopathy in the all subtype of diabetic microangiopathy.Conclusion:The cognitive function impairment in the elderly patients with type 2 diabetes was prevalence and associated with multiple risk factors in which the age and stroke were important.The impairment of total cognitive function,memory and visualspatial function were showed at the end of 12 weeks in elderly patients without storke of type 2 diabetes aged 60 and over.The cognitive function decline was obviously associated with the factors of diabetes in above cases.The results were helpful to prevent and treat the cognitive function impairment in the elderly patients with type 2 diabetes.The methods of the study would be benefit in the field of cognitive function in the future.