高龄糖尿病患者认知功能损害的危险因素

The risk factors of cognitive dysfunction in older diabetic patients

目的探讨高龄糖尿病患者认知功能损害情况及其可能的危险因素。方法糖尿病组133例和对照组175例患者均应用神经心理学量表进行认知功能的评价,包括简易智能状态量表检查(MMSE),蒙特利尔认知评估(北京版)量表(MOCA),临床痴呆量表(CDR)和总体衰退量表(GDS),并测定其空腹血糖(FBG),餐后2 h血糖(2 h-BG)和糖化血红蛋白(Hb A1c)。结果糖尿病组除FBG、2 h-BG和Hb A1c明显高于对照组外,年龄、性别、受教育年限、高血压、高血脂、冠心病及吸烟等病史与对照组均无统计学差异。与对照组比较,糖尿病组MMSE(P<0.001),MOCA(P=0.006)评分明显降低。CDR评价糖尿病组认知功能损害和严重损害者较对照组增多(P=0.001),两组之间GDS评价差异无统计学意义(P=0.174)。糖尿病组逐步回归分析,最终年龄(β=-0.403,P<0.001)、糖尿病病程(β=-0.131,P=0.014)和FBG(β=-0.150,P=0.005)进入方程。结论2型糖尿病对老年患者认知功能有明显的损害,糖尿病病程及FBG水平是重要危险因素。

Objective To study the impairment of cognitive function in older diabetic patients and their possible risk factors. Methods 133 cases in diabetic group and 175 in control group,were evaluated by a battery of cognitive rating scales,including Mini-mental State Examination( MMSE),Montreal Cognitive Assessment( MOCA),Clinical Dementia Rating( CDR) and Global Deteriorate Scale( GDS).The levels of fast blood glucose( FBG),two-hour postprandial blood glucose( 2 h-BG) and Hb A1 c were analyzed. Results No differences were found between the two groups in the general characteristics,such as age,sex,education and the presence of hypertension,hyperlipidemia,coronary heart disease and smoking history,apart from FBG,2 h-BG and Hb A1 c,which were higher in diabetic group than those of control group. The elders in the diabetic group had the worse cognitive function than those in control group,evaluated by MMSE( P<0. 001),MOCA( P = 0. 006) and CDR( P = 0. 001). The difference of GDS assessment between the two groups was found( P = 0. 174). The obvious correlations of the MMSE scores with the age( β =-0. 422,P<0. 001),diabetic duration( β =-0. 084,P = 0. 014),and FBG( β =-0. 384,P= 0. 005) were found. Conclusions The cognitive function in the older patients is impaired,diabetes duration and FBG are important risk factors for cognitive decline of the diabetic olders.