| Objective: ⑴To evaluate the characteristics and the involved domains of cognition impairment in patients with type 2 diabetes mellitus and mild cognitive impairment(T2DM+MCI). ⑵ To investigate the related factors of T2 DM combined with MCI. ⑶To evaluate the influence of insulin resistance(IR),serum levels of insulin degrading enzyme(IDE) and adiponectin(ADP) on T2 DM combined with MCI and to illustrate the possible mechanism for influence of IR on cognition function.Methods: ⑴Data collection: In total, 212 patients with T2 DM hospitalized in Diabetic Neurology of our hospital and 30 patients diagnosed with MCI but without T2 DM history visited Tian Jin Huan Hu hospital were recruited randomly from November 2013 to November 2014 as research subjects. General clinical data,biochemistry parameters and fasting venous blood were collected. Enzyme-linked immunosorbent assay(Elisa)were used to test serum levels of IDE, ADP. The homeostasis model assessment of insulin resistance index(HOMA-IR) was calculated based on the following formula: HOMA-IR = fasting plasma glucose(mmol/L)·fasting serum C-peptide(ng/m L)/22.5. ⑵ Montreal Cognitive Assessment,(MOCA), activities of daily living(ADL) were adopted to evaluate the cognition function and activities of daily living. Self-rating anxiety scale(SAS), self-rating depression scale(SDS) were adopted to evaluate the emotional states. 90 T2 DM patients with 12 ≤ MOCA < 26 points were grouped into T2DM+MCI, 122 T2 DM patients with MOCA ≥ 26 points were grouped into T2 DM and 30 without T2 DM patients with 12≤MOCA <26 points were grouped into MCI. ⑶T-test were used to compare the difference of clinical data and Mo CA between T2DM+MCI and MCI as well as T2DM+MCI and T2 DM. Univariate logistic regression analysis were adopted to investigate the related factors of T2 DM combined with MCI. ANOVA were conducted to test the influence of different HOMA-IR, IDE, ADP on prevalence of MCI. Multivariable adjusted Logistic regression analysis were adopted to examine the odds ratios(OR) for MCI. ⑷ T-test and ANOVA were used according to the number of groups for continuous variable. X2 test and Fisher’s exact test were usedfor categorical variables. Spearman’s correlation coefficient r was used to measure the relationship between variables. Logistic regression analysis were conducted to test the related factors of MCI.Results: ⑴The age, total points of MOCA, delayed recall of MOCA, IDE, ADP of the T2DM+MCI group were lower compared with MCI group, whereas BMI,FPG,TG,LDL,HOMA-IR were higher( P < 0.05). ⑵ Compared with T2 DM group,T2DM+MCI group exhibited lower serum levels of IDE, ADP, education background,lower total points of MOCA, visual space and executive function, naming, attention,language, abstraction and delayed recall of MOCA, longer duration, higher age, BMI,TC, LDL, UMA, TP, HOMA-IR and higher rates of fatty liver, hypertention(P<0.05).⑶ Ages, duration, BMI, Ho MA-IR, LDL, UMA were the risk factors of MCI and ADP, IDE, education background were the protect factors of MCI(P < 0.05). ⑷Comparison among patients with a similar DM duration showed a higher level of Ho MA-IR was inversely associated with IDE, ADP, Mo CA and positively associated with prevalence of MCI. ⑸ Ho MA-IR was independent risk factor of MCI and IDE, ADP were independent protect factors of MCI after adjustment for multivariables. ⑹Ho MA-IR was positively associated with BMI and negatively associated with Mo CA,serum levels of IDE, ADP.Conclusion: ⑴Compared with patients without diabetes, patients with T2 DM developed MCI at a younger age and exhibited more serious cognition impairment.⑵ The characteristics of cognition impairment in patients with T2 DM is multidomains involved amnestic MCI. ⑶ Ages, duration, BMI, Ho MA-IR, LDL,UMA were the risk factors of MCI. ⑷ Ho MA-IR was independent risk factor of MCI and IDE, ADP were independent protect factors of MCI. Influencing serum levels of IDE, ADP may be the mechanism of IR on cognition function. |
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