综合干预措施对老年糖尿病患者轻度认知功能障碍的影响

Influence of Comprehensive Intervention on Mild Cognitive Impairment in Elderly Diabetic Patients

目的探讨综合干预措施对老年糖尿病患者轻度认知功能障碍(mild cognitive impairment,MCI)的影响。方法将2008年5月—2011年5月确诊的80例伴MCI的2型糖尿病患者随机分为干预组和对照组各40例。对照组采取常规治疗,疗程结束后给予常规出院指导;干预组在对照组基础上给予综合干预措施。分别于干预前及干预后1、3、6、12及18个月比较两组糖代谢指标及蒙特利尔认知评估量表(MoCA)、日常生活能力量表(ADL)评分。结果干预后不同时间点,干预组糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)及空腹C肽(FC-P)均较干预前显著降低(P<0.05);干预后相同时间点两组比较,除干预后1个月及6个月HbA1c外,其余糖代谢指标差异均有统计学意义(P<0.05)。干预后不同时间点,干预组MoCA评分均较干预前显著提高(P<0.05);同时间点比较,干预组MoCA评分均高于对照组(P<0.05)。干预组ADL评分与干预前比较,自干预后6个月开始有显著提高(P<0.05);与对照组比较,自干预后12个月开始有显著提高(P<0.05)。结论对老年糖尿病伴MCI患者进行积极综合干预,可以延缓患者认知功能障碍的进展,提高日常生活能力。

Objective To explore the influence of comprehensive intervention on mild cognitive impairment （MCI） in elderly diabetic patients. Methods Eighty patients diagnosed as having type 2 diabetes mellitus complicated with MCI during May 2008 and May 2011 were randomly divided into intervention group （ n = 40） and control group （ n = 40）. The control group received routine treatment and discharged guidance after the course of treatment ; the intervention group received comprehensive intervention based on the routine interventions in control group. The indicators of glycome- tabolism, scores of Montreal cognitive assessment （MoCA） and activity of daily living （ADL） scale in the two groups were compared before intervention and 1, 3, 6, 12 and 18 months after intervention. Results Levels of glycosylated he- moglobin （HbAlc） , insulin resistance index （HOMA-IR） and fasting C-peptide （FC-P） at different times after inter- vention in intervention group were significantly decreased, compared with those before intervention （ P 〈 0.05 ） ; the differences of glycometabolism indexes in the two groups were statistically different at the same time after intervention （P 〈 0. 05） excepted for the differences in HbAle at 1＂ and 6＇h month after intervention （P 〉 0.05 ）. In intervention group, MoCA scores were significantly increased at different times after intervention compared with those before interven- tion （P 〈 0.05） ; at the same time, MoCA scores were all significantly higher in intervention group compared with those of control group （P 〈 0. 05）. In intervention group, ADL scores had significantly improved since six months after inter- vention compared with those before intervention （P 〈 0. 05 ） ; compared with those of control group, the scores were sig- nificantly higher 12 months after the intervention （P 〈 0. 05）. Conclusion Comprehensive intervention in treatment of elderly diabetic patients with MCI can delay the MCI progress and improve ADL of the patients.