| Part 1: Analysis of white matter microstructural damage patterns in T2 DM cognitive impairment patients Objective: To identify the structural change pattern of white matter microstructural integrity in T2 DM patients with cognitive impairment and to determine whether the structural change pattern are associated with the cognitive impairment.Methods:68 participants were recruited from outpatients and inpatients of neurology department in the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2017 to December 2018.We collected all people’ general clinical data and neuropsychological test.Then we divided diabetic patients into type 2 diabetes mellitus with cognitive impairment(T2DM-CI)and T2 DM without cognitive impairment(T2DM-non CI)group according to the neuropsychological test.43 participants with no history of diabetes and normal cognition were recruited meanwhile.All went through MRI including 3DTIWI,DTI,SWI and FLAIR.The diffusion parameters on 20 fiber tracts were obtain by the atlas-based segmentation.We compared the differences among three groups,and did further correlation analysis on the significant difference fiber tracts between the group of T2DM-non CI and T2 DMCI.Results:(1)111 participants were recruited,and 68 was diabetic patients.There had no significant difference among three groups on sex,age,education and general clinical data.Lacunar infarction of imaging index and fasting plasma glucose,Hb A1 c of blood test had significant difference.(2)The FA value of white matter fiber tracts in 3 groups showed a declining trend,while the MD value showed an escalating trend.(3)The comparison between NC group and T2DM-non CI group showed that there was significant difference of FA value in right cingulum(cingulate gyrus),left inferior longitudinal fasciculus.And the MD value of left corticospinal tract,right cingulum(cingulate gyrus),right uncinate fasciculus had significant difference.(4)The comparison between T2DM-non CI group and T2DM-CI group showed that there was significant difference of FA value in bilateral corticospinal tract,right cingulum of hippocampus,forceps major,forceps minor,right inferior fronto-occipital fasciculus and right inferior longitudinal fasciculus(all P<0.05/20).Among,forceps minor,right inferior longitudinal fasciculus were significantly correlated with language function.Bilateral corticospinal tract,forceps minor was significantly correlated with processing speed(all P<0.05).There was significant difference of MD value in bilateral corticospinal tract,forceps minor,bilateral inferior fronto-occipital fasciculus and bilateral superior longitudinal fasciculus(all P<0.05/20).Among,right inferior frontooccipital fasciculus,right superior longitudinal fasciculus was significantly correlated with language function(all P<0.05).Conclusions: Microstructural integrity of white matter was damaged in patients with cognitive impairment,and Language function were significantly correlated with microstructural integrity of white matter in T2DM-CI.Forceps minor,inferior longitudinal fasciculus,inferior fronto-occipital fasciculus and superior longitudinal might cause the language function impaired,and corticospinal tract,forceps minor might correlated with processing speed impaired.Part 2:Atrophy patterns of hippocampal subfields in T2 DM patients with cognitive impairmentObjective: To identify the hippocampus subfields volume changes in T2 DM patients with cognitive impairment and to determine whether hippocampal subfields atrophy patterns are associated with the cognitive impairment.Methods: A total of 117 individuals were recruited from outpatients and inpatients of neurology department in the Affiliated Drum Tower Hospital of Nanjing University Medical School from January 2017 to February 2019,including 34 T2 DM patients with cognitive impairment(T2DM-CI),36 T2 DM patients without cognitive impairment(T2DM-non CI)and 47 normal controls(NC).We collected people’ general clinical data,neuropsychological test.All had went through blood test and MRI.12 on each hippocampal side of hippocampal subfield volumes were assessed using 3DT1 images processed by the Free Surfer 6.0.0 image analysis.Then,further correlation analyses were estimated the relationship between the cognitive domain and hippocampal subfield volume.Results:(1)The total hippocampal volume had a degressive trend among NC,T2 DMnon CI and T2DM-CI group,but the significantly difference only was found between NC group and T2DM-CI group.(2)Regarding the hippocampal subfields,the volumes of left subiculum,left presubiculum,left fimbria,right CA1 and right molecular layer HP decreased significantly among three groups(all P <0.05/12).(3)After adjust sex,age,education and e TIV,partial correlation analyses showed the volumes of the left subiculum,left fimbria and left presubiculum were significantly related to executive function.The right hippocampal CA1 volume was significantly correlated with memory in the T2DM-CI group(P <0.05).For T2DM-non CI group,the left fimbria volume was significantly related to memory.For NC group,left presubiculum was significantly related to executive function and left fimbria volume was significantly related to memory.(4)But,the correlation between the left fimbria volume and the memory,the left subiculum volume and global cognitive were different between T2DM-non CI and T2DM-CI /NC group(P <0.05).Conclusions: For T2 DM patients with and without cognitive impairment patients,the atrophy of hippocampal subregions was heterogeneous.To these subregions,the atrophy of left presubiculum was significantly associated with worse executive function,and right CA1 was related to memory impairment.But the relationship between some subregions such as the left fimbria,the left subiculum and the cognitive was variable in T2 DM patients.It seemed that there was a compensation mechanism under the early process of cognitive impairment and morphological changes of hippocampus of T2 DM patients. |
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