中老年2型糖尿病早期认知功能改变的临床研究

Clinical research of cognitive function in middle aged and older people with type 2 diabetes mellitus

目的:了解中老年糖尿病早期认知功能损害特点及其相关危险因素。方法:选择本地区中、老年糖尿病患者120例,应用简易智能精神状态检查量表筛查,>25分者入选。其中2型糖尿病60例,与之相匹配的非糖尿病对照组60例。两组分别测定快速词汇测验、词汇测验、相似性测验、数字广度测验和木块图测验。异常结果与血压、空腹血糖、糖化血红蛋白和血脂进行相关回归分析。结果:糖尿病组与对照组相比,快速词汇和木块图两项检查差异显著,糖尿病组得分低于对照组(P均<0.05)。经逐步回归分析,快速词汇与年龄、收缩期高血压呈显著的负相关(P<0.01)。木块图与年龄、糖化血红蛋白呈显著的负相关(P<0.01)。而其它方面的差异均无统计学意义。经协方差分析,去除年龄因素后,木块图测验仍与糖化血红蛋白呈显著的负相关(P<0.05)。结论:本地区中老年糖尿病早期认知功能损害以视觉空间认知为突出。糖尿病血糖控制情况及其所伴发的血管病变和年龄老化因素均参与了认知功能减退的进程。慢性高血糖是损害认知功能的独立危险因素。

Objective To investigate the characteristics of diabetes correlated cognitive impairment and its relative risk factors in this district＇s well-educated crowd. Methods One hundred and twenty middle aged and older diabetic patients received mental state test. A total of 60 type 2 diabetes 〉25 score and 60 non-diabetes control objects were recruited. Rapid verbal retrieve and vocabulary test, similarly, digit span （forward, back） and block design were examined. Correlativity and step regression analysis was used to identify demographic and biomedical variables associated with cognitive dysfunction. Results The rapid verbal retrieve and block design were significantly lower in diabetic group than in control group （P〈0. 05）. The rapid verbal retrieve scale was under the influence of age and systolic blood pressure （P〈0.01）. The block design scale was relative to age and glycosylated hemoglobin （P〈0.01）. There was no difference between two groups in the other tests. Omitting the factor of aging from covariance analysis, the block design scale is still relative to glycosylated hemoglobin （P〈0.05）. Conclusion The course of cognitive function decrease in diabetes may be concerned with hyperglycemia and vascular changes and aging in the brain. Chronic hyperglycemia is an independent risk factor in cognitive impairment.