| Objectives To investigate the best cut-off value of the Changsha version of the montreal cognitive assessment for screening mild cognitive impairment in type 2 diabetes mellitus population and evaluate its diagnostic value. Based on the best cut-off value, we further explored the main impaired functions, cognitive impairment characteristics and the influencing factors of the main impaired functions.Methods The first study:using the convenience sampling method to extract 158 patients with type 2 diabetes from the department of endocrinology at one first-class hospitals at Grade 3 in Anhui Province between January 2015 and May 2015. All of the patients were assessed using Questionnaires of general information, the Changsha version of the montreal cognitive assessment, Activity of daily living scale, Global deterioration scale, Clinical dementia rating scale and Hamilton depression scale for mild cognitive impairment. Suspicious positive was left to the doctors for correctly diagnosed after objective testing. The second study:We enrolled 366 patients with type 2 diabetes from the department of endocrinology of two first-class hospitals at Grade 3 in Anhui Province from June 2015 to November 2015. Questionnaires of general information, Activity of daily living scale, Global deterioration scale and the Changsha version of the montreal cognitive assessment were used to carry out the cross-sectional study to explore the occurrence status and influencing factors of the main impaired functions.Results The first study:(1) The best cut-off value of the Changsha version of the montreal cognitive assessment scale for screening mild cognitive impairment in type 2 diabetes patients was 26 points. The sensitivity and specificity were 87.0% and 90.1%, the false negative rate and false positive rate were 13.0% and 9.9%, the positive and negative predictive values were 89.3% and 88.0%. Kappa statistics showed better agreement between the montreal cognitive assessment scale and consortium criteria (kappa=0.770). The area under the ROC curve was 0.952 (P<0.01), the area of standard error of 0.015. The second study:(1) About 50.55% type 2 diabetes mellitus were mild cognitive impairment. (2) The majority of impaired cognitive functions in type 2 diabetes with mild cognitive impairment from high to low were:delay memory (96.2%), visual space/executive function (93.5%), abstract (87.6%), attention (47.6%), language (45.4%) and orientation (17.8%). (3) The majority of cognitive impairment was involved with 3 to 5 cognitive functions, and the percentages in order were 33.51%,30.81% and 22.70%. (4) The multivariable logistic regression analysis showed that age, gender, educational level, glycated hemoglobin and self-monitoring were influencing factors of mild cognitive impairment. (5) Multiple factors analysis shows that the influencing factors of delay memory were age, gender, educational level, drinking, history of cerebral infarction and diastolic blood pressure; The influencing factors of visual space/executive function were age, gender, educational level, glycosylated hemoglobin and treatment method; The influencing factors of abstract function were gender, educational level, smoking, history of cerebral infarction and high-density lipoprotein level.Conclusions When the Changsha version of the montreal cognitive assessment scale were used to screen the mild cognitive impairment, the best cut-off value was 26 points, with high sensitivity and specificity, which can be proved as an effective tools for screening of mild cognitive impairment. The cognitive impairment in type 2 diabetes with mild cognitive impairment were mainly performance for cognitive domains joint damage. High educational level were protective factor and the elderly, women, poor educaiton, high glycated hemoglobin and poor compliance of self-monitoring were the risk factors for delaying the onset of mild cognitive impairment. High educational level is protective factor of the main impaired cognitive functions. |
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