| OBJECTIVES To investigate the relationship between the diabetic nephropathy(DN) and cognitive impairment by testing the performance on cognitive function and the structure and metabolism of the cerebrum in type2diabetes mellitus patients with different stages of renal function.METHODS Eighty six patients with type2diabetes mellitus (T2DM) were enrolled into this study. The patients with T2DM were divided into three groups:T2DM without DN groups(DM group,n=33), early DN group(DN III group, n=26) and clinical stage group (DNⅣ group,n=27) according to the urinary albumin excretion rate(UAER). Thirty health adults were taken as the control group(NC group). The four groups were matched with age, sex and education background. Their height (Ht), weight(Wt), waist circumference (Wc) and tested triglycerides (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C),24h urinary albumin were measured by immunonephelometric method.Glycosylated hemoglobin (HbA1c) were examined by the biochemical analyzers. The fasting plasma glucose (FPG) was detected by glucose oxidase. The glomerular filtration rate was tested by single photonemission-computed tomography (SPECT). The performance on cognitive function was measured by Montreal Cognitive Assessment (MoCA,Beijing version) and mini-mental state examination (MMSE) The metabolic peaks and the peak area of N-acetylasparte(NAA), creatine(Cr), choline-containing compounds (Cho) were detected and the ratio of NAA to Cr and Cho to Cr were calculated by magnetic resonance imaging (MRI) and magnetic resonance spectroscopy(MRS). RESULTS①The levels of FPG and HbA1c in all groups were all higher than that of the control group(p<0.05), while the level of age, sex, education background, body mass index(BMI),systolic pressure, diastolic pressure, TC, TG, HDL-C, LDL-C were found no significant difference (P>0.05).②UAER decreased significantly in the DN Ⅲ and DN Ⅳ groups compared with NC group(p<0.05), but there was no difference between in NC group and in DM group (p>0.05). GFR in DN Ⅳ group decreased significantly compared with in NC group(P<0.05), but there was no difference in DM group and in DN Ⅲ group.(P>0.05)③The MMSE scores of the T2DM patietnts and control showed no statistical difference between them. The scores of MoCA were significant lower in DN Ⅲ and in DN IVgroup than that in NC group(P<0.05), while there was no difference between DM group and NC group(P>0.05). The results also indicated that the patients with DN Ⅲ or DNⅣ got significant lower scores in several cognitive domains including abstraction and delayed recall than with in DM group.(P<0.05).④There was significant difference in left N-acetylaspartate (LNAA), left choline(LCho) between the case groups. The results revealed that the level of LNAA decreases significantly and LCho increased significantly in the DN group than in the DM group.(P<0.05). We used creatine(Cr) as standard to reevaluate, then the consequence suggested that there was statistic difference only in the left Cho/Cr between the two groups(P<0.05).⑤Pearson correlation analysis showed that the MoCA scores of T2DM patients were negatively correlated to uAER (r=-0.285, P=0.03),but positively correlated to GFR (r=0.379, P=0.02).the Logistic regression analysis indicated that the increasing uAER (OR=6.532, P=0.001) and decreasing GFR (OR=3.622, P=0.01) are risk factors for the type2diabetes mellitus with cognitive impairment.CONCLUSION1.The patients with DN have cognitive disorders, mostly showing lower scores in abstraction, delayed recall and general.2.Diabetic nephropathy is closely correlated with the cognitive impairment in patients with type2diabetes.With the decline of glomerular filtration function, the cognitive disorder tended to be aggravated. UAER and GFR are the independent factors of cognitive dysfunction.3.The Hippocampal brain metabolism may be have some changes in patients with diabetic nephropathy, which mainly manifested as higher left Cho/Cr. |
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