老年糖尿病对轻度认知障碍患者记忆功能的影响

The effect of diabetes meliitus in the elderly on memory function in patients with mild cognitive impairment

目的探讨老年糖尿病(DM)对轻度认知障碍(MCI)患者记忆功能影响.方法对449例社区居民进行2年随访调查,选择蒙特利尔认知评估量表(MOCA)和简易精神状态量表(MMSE)进行总体认知功能评估,采用FULD物体记忆测验(FOM)和数字广度测试(DST)评估延时性回忆和瞬时记忆,收集人口学数据(性别、年龄、文化程度、婚姻史、年收入、血压、既往病史等),定期检查受试者糖化血红蛋白、空腹胰岛素、颈动脉内中膜厚度(CIMT).按照DM和MCI分为非DM认知正常组(NDM-NC组)、非DM患者MCI组(NDM-MCI组)、DM认知正常组(DM-NC组)和DM患者MCI组(DM-MCI组).结果横断面观察DM-MCI组在FOM测验中首次、再次、末次回忆评分呈下滑趋势,DM-NC组和NDM-MCI组的3次回忆评分趋势类似"U"字形变化,NDM-NC组的三次回忆评分无明显变化;DM-MCI组和NDM-MCI组DST顺背和倒背测验评分比较,差异均无统计学意义(均P>0.05).纵向随访与其他三组两两比较,DM-MCI组糖化血红蛋白(6.78±0.60)%最高(P<0.05);DM-MCI组随访CIMT平均值(1.03±0.20)mm高于NDM-NC组(0.89±0.20)mm(P<0.05);与其他三组纵向随访CIMT结果比较,DM-MCI组CIMT增厚速度最快.结论老年DM患者群具有较高的MCI患病率,记忆功能出现明显波动或减退,定期检测记忆功能有利于改善DM和MCI病情进展.

Objective To investigate the effect of diabetes mellitus in the elderly on memory function in patients with mild cognitive impairment(MCI).Methods Totally 449 community residents were selected for a 2-year follow-up survey.Montreal Cognitive Assessment(MoCA)and Mini-Mental State Examination(MMSE)were selected for overall cognitive function assessment.Fuld Object Memory(FOM)and Digital Span Test(DST)were used to evaluate delayed recall and instantaneous memory.Demographic data such as gender,age,education level,marital history,annual income,blood pressure,medical history ete.were collected.The glycosylated hemoglobin,fasting insulin,and carotid artery intima-media thickness were checked regularly.All subjeets were grouped into non-diabetes mellitus normal cognitive group(NDM-NC group),non-diabetes mellitus mild cognitive impairment group(NDM-MCI group).diabetes mellitus normal cognitive group(DM-NC)group and diabetes mellitus mild cognitive impairment group(DM-MCI group).Results In cross-sectional observation,the first,second,and last recall scores in the FOM showed a decreasing trend in the DM-MCI group,showed a word"U"-shaped fluctuation trend in the DM-NC group and the NDM-MCI group.and showed no significant change in the NDM-NC group.There were no significant differences in DST anterior-backward test scores between the DM-MCI group and NDM-MCI group(all P>0.05).Through longitudinal follow-up and two-by-two comparison with the other three groups.the average value of glycosylated hemoglobin in the DM-MCI group(6.78±0.60)%was the highest,and the differences were statistically significant(P<0.05).During follow-up,the average carotid intima-media thickness(CIMT)was higher in the DM-MCI group(1.03±0.20)mm than in NDM-NC group(0.89±0.20)mm(P<0.05),and the difference was statistically significant.Comparing with the other three longitudinal follow-up groups,the CIMT thickening speed in DM-MCI group was fastest.Conclusions Elderly DM patient population have a higher prevalence of MCI,and their memory function fluctuates or declines significantly.Therefore,regular detection of memory function is conducive to delaying the progression of DM and MCI.