| Background:The prevalence rate of Diabetes mellitus(DM) is rising in the world,and DM has become one of the global public health problems affecting to human health seriously. Diabetes mellitus is a major cause of the death,disability and medical expenses increased in most country in the world.The prevalence rate of Cognitive dysfunction and dementia is increasing year by year.It is expected that the number of dementia will double every 20 years.Diabetes is considered to be an important independent risk factor of cognitive dysfunction and dementia.Diabetes itself can cause damage to the function and integrity of central nervous system,known as "diabetic encephalopathy." Diabetic patients combined with cognitive dysfunction and cognitive impairment can influence the control of blood glucose directly,thus deteriorating the complications of diabetes,worsening the condition of cognitive impairment,which is a vicious circle.Homocysteine(Hcy) is a sulfurate amino acid generated from the metabolism of methionine(Met) in vivo.Recently,the correlation between homocysteine(Hcy) and cognitive impairment or dementia is a hot spot in the medical research field domestically and internationally.Most researchers believe that hyperhomocysteinemia is a risk factor or the prediction of dementia and Alzheimer's disease(AD).Due to lack of effective treatment for severe cognitive impairment,it is extremely significant to pay attention to early diagnosis and explore valid serum indicators.Objective:To investigate the relationship between total serum homocysteine(tHcy) level and cognitive impairment in type 2 diabetic patients,to explore the prediction and diagnostic value of cognitive impairment in type 2 diabetes,and to analyze other risk factors influencing cognitive function.Method:We study patients with type 2 diabetes in the Department of Endocrinology of Shandong Provincial Hospital.All of them were aged beween 50 years old and 75 years old.The patients were diagnosed according to the diagnostic criteria for diabetes developed by WHO in 1999.The patients with other diseases causing cognitive impairment or with disease history and medication history affecting the level of the measured indicators were removed.According to the Mini-Mental State Examination(MMSE) score,type 2 diabetic patients were divided into two groups, one group with 30 cases with cognitive impairment,the other one with 32 patients with non-cognitive impairment;and 30 normal participants as controls.The general information,medical history information,information checkup and biochemical indicators were collected in all subjects.Serum total homocysteine(tHcy) was measured by Protein-specific immune analyzer nephelometry in all subjects.HbAlc, blood lipids,uric acid,fibrinogen,and other biochemical indicators were measured by automatic biochemical analyzer in all subjects.Immunoturbidimetric assay used measured 24h urinary microalbumin.All data were processed by statistic package deal SPSS16.0.Analysis of variance was used to the numerical variables of three groups. x~2 test was used to classification variables.The analysis of Spearman correlation was used influencing factors of MMSE score.A P value less than 0.05 was considered indicative of statistical significance.Result:1.The serum tHcy level of the group with cognitive impairment was significantly higher than that both of the group with non-cognitive impairment(P＜0.05) and of the normal control group(P＜0.01).2.MMSE score of patients with type 2 diabetes negativly correlated with age,the duration of diabetes,HbAlc,body mass index,and serum levels of tHcy(r=-0.315,-0.384,-0.276,-0.282,-0.309,all P＜0.05);positively correlated with number of years of education(r=0.296,P＜0.05);was unrelated with TC,TG,LDL-C,HDL-C,Fib,and 24h urinary microalbumin(all P＞0.05).In addition,tHcy was positively correlated with body mass index(r=0.375,P=0.003).Conclusion:1.Increased serum tHcy level may be an important risk factor for cognitive impairment in type 2 diabetic patients.It was suggested that tHcy may be involved in the pathogenesis of diabetic encephalopathy.2.Diabetes duration,glycosylated hemoglobin and body mass index are important risk factors affecting cognitive function in patients with type 2 diabetes.It is of great importance to control blood glucose levels and maintain body weight normally for the prevention and improvement of cognitive impairment in patients with type 2 diabetes.
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