Department of Endocrinology, Pudong New Area People's Hospital, Chuan Huan Nan Road No. 490, Shanghai, China.
Ann Endocrinol (Paris). 2012 Jun;73(3):208-12. doi: 10.1016/j.ando.2012.04.009. Epub 2012 Jun 13.
The aim of this study was to evaluate the risk factors of mild cognitive impairment (MCI) in middle-aged patients with type 2 diabetes (T2DM).
Montreal Cognitive Assessment (MoCA) was applied as cognition assessment implement. One hundred and fifty-seven middle-aged type 2 diabetic patients were enrolled in this cross-section study (age 40~69, mean age 55 ± 7). There were 93 patients with MCI (MoCA score<26) in MCI group and 64 with normal cognitive function (MoCA score ≥ 26) in control group. Information of history of disease, family history, data of BMI, WHR, HbA1c, FINS, C-Peptide (C-P), SBP, DBP, blood lipid (TG, TC, LDL-C, HDL-C and carotid ultrasound (carotid IMT, carotid resistance index [RI]) was collected.
There were significant differences in the rate of patients with hypertension ([40.63 vs. 58.06%], P=0.026), duration of diabetes mellitus ([3.09 ± 4.04 y vs. 4.80 ± 4.94 y], P=0.024), C-P ([2.79 ± 1.09 ng/ml vs. 2.26 ± 1.00 ng/ml], P=0.008), Max C-IMT ([0.81 ± 0.15 mm vs. 0.91 ± 0.15 mm], P<0.001), Min C-RI (0.71 ± 0.06 vs. 0.68 ± 0.06, P<0.05), and no significant differences in the duration of hypertension and hyperlipidemia, BMI, WHR, HbA1c, SBP, DBP and blood lipid between control group and MCI group. MoCA scores were positively correlated with C-P (r=0.252, P=0.005), and negatively correlated with the history of hypertension (r=-0.244, P=0.002), duration of DM (r=-0.161, P=0.044), Max C-IMT (r=-0.253, P=0.005) and Min C-RI (r=-0.183, P=0.023). Multiple regression analysis showed that history of hypertension (Beta=-0.267, P=0.002), C-P (Beta=0.281, P=0.001) and Min C-RI (Beta=-0.221, P=0.011) were significantly independent determinants for the MoCA scores.
The longer duration of diabetes, history of hypertension, lower serum C-P levels, thickened C-IMT and higher C-RI could be risk factors of MCI in type 2 diabetic patients. This finding could have an important impact on the management of cognitive decline in diabetic patients.
本研究旨在评估中年 2 型糖尿病（T2DM）患者轻度认知障碍（MCI）的危险因素。
采用蒙特利尔认知评估（MoCA）作为认知评估工具。共纳入 157 例中年 2 型糖尿病患者（年龄 40~69 岁，平均年龄 55±7 岁）。MCI 组 93 例（MoCA 评分<26），对照组 64 例认知功能正常（MoCA 评分≥26）。收集病史、家族史、BMI、WHR、HbA1c、FINS、C-肽（C-P）、SBP、DBP、血脂（TG、TC、LDL-C、HDL-C）和颈动脉超声（颈动脉 IMT、颈动脉阻力指数[RI]）等数据。
MCI 组高血压发生率[40.63%比 58.06%，P=0.026]、糖尿病病程[3.09±4.04 年比 4.80±4.94 年，P=0.024]、C-P[2.79±1.09ng/ml 比 2.26±1.00ng/ml，P=0.008]、最大颈动脉 IMT[0.81±0.15mm 比 0.91±0.15mm，P<0.001]、最小颈动脉 RI[0.71±0.06 比 0.68±0.06，P<0.05]显著高于对照组，而两组高血压、高血脂病程、BMI、WHR、HbA1c、SBP、DBP、血脂比较差异无统计学意义。MoCA 评分与 C-P 呈正相关（r=0.252，P=0.005），与高血压史（r=-0.244，P=0.002）、糖尿病病程（r=-0.161，P=0.044）、最大颈动脉 IMT（r=-0.253，P=0.005）和最小颈动脉 RI（r=-0.183，P=0.023）呈负相关。多因素回归分析显示，高血压史（Beta=-0.267，P=0.002）、C-P（Beta=0.281，P=0.001）和最小颈动脉 RI（Beta=-0.221，P=0.011）是 MoCA 评分的显著独立决定因素。
糖尿病病程较长、有高血压史、血清 C-P 水平较低、颈动脉 IMT 增厚和颈动脉 RI 较高可能是 2 型糖尿病患者发生 MCI 的危险因素。这一发现可能对糖尿病患者认知能力下降的管理具有重要意义。
