Study On The Influencing Factors Of Early Cognitive Impairment In Acute Cerebral Infarction Among The Patients With Type 2 Diabetes

ObjectivesTo explore the influencing factors of cognitive impairment in acute cerebral infarction among the patients with type 2 diabetes mellitus（T2DM）,so as to provide evidence for the prevention and treatment of cognitive impairment in T2DM patients after acute cerebral infarction.Methods1.128 patients with T2DM complicated with acute cerebral infarction were selected as the experimental group,and then divided into 75 cases of cognitive impairment group and 53 cases of normal cognition group according to the score of Mini-Mental State Examination（MMSE）.70 patients with acute cerebral infarction without diabetes at the same time were selected as cerebral infarction group.70 patients with type 2 diabetes in the same period were chosen as T2DM group.70healthy people who matched the age,sex and education level of the experimental group in the same period were chosen as the control group.2.Collect information about the ages,genders and education levels of all subjects.Collect laboratory examination data（Hemoglobin Ale,blood biochemistry,blood lipid,etc.）,imaging data（cranial MRI,Neck vascular ultrasound）and general data（blood pressure,past medical history,etc.）of the patients in the experimental group.3.All of the participants in the study completed the cognitive scale evaluation such as MMSE,Trail-making Test（TMT）,Boston Naming Test（BNT）,Hopkins Verbal Learning Test（HVLT）and Clock Drawing Test（CDT）within two weeks of onset.4.T test,one-way ANOVA,X~2 test and non-parametric test were used to compare the differences among groups.Multivariate Logistic regression analysis was used to explore the independent risk factors for cognitive impairment in the experimental group,and ROC curve is used to analyze the predictive value of each factor.Results1.There were 75 cases of the experimental group had cognitive impairment,and the incidence of cognitive impairment was 58.59%.There were 30 cases of cerebral infarction group had cognitive impairment,and the incidence of cognitive impairment was 42.86%.There were 12 cases of T2DM group had cognitive impairment,and the incidence of cognitive impairment was 17.14%.There were 8 cases of the control group had cognitive impairment,and the incidence of cognitive impairment was 11.43%.2.Compared with the experimental group,the cerebral infarction group,the T2DM group and the control group,there was no significant differences in age,gender and education level.BNT score and CDT evaluation time in the experimental group were significantly lower than those in cerebral infarction group,T2DM group and control group（P<0.05）.TMT evaluation time,HVLT and CDT score in the experimental group were significantly lower than those in T2DM group and control group（P<0.05）.3.The levels of neutrophil-to-lymphocyte ratio（NLR）,D-dimer,homocysteine（Hcy）,hemoglobin A1c（Hb A1c）and fibrin degradation in cognitive impairment group were significantly higher than those in cognitive normal group（P<0.05）;The cognitive impairment group had higher average age,lower education level,higher morbidity of stroke and hypertension,more cerebral infarction times,longer duration of hypertension and diabetes（P<0.05）than those of cognitively normal group.4.Multivariate binary logistic regression analysis showed that the course of hypertension（OR=1.091,P<0.05,95%CI 1.061～1.171）,Hcy（OR=1.104,P<0.05,95%CI 1.026～1.187）and Hb A1c（OR=1.299,P<0.05,95%CI 1.009～1.671）were independent risk factors for cognitive impairment after acute cerebral infarction in T2DM patients.5.ROC curve analysis showed that the duration of hypertension,Hcy and Hb A1c predicted the cognitive impairment of patients with type 2 diabetes after acute cerebral infarction with the area under ROC curve of 0.657,0.627 and 0.615 respectively（all P<0.05）,and the area under the curve predicted by the course of hypertension,Hcy and Hb A1c is 0.725（P<0.05）.Conclusions1.Patients with acute cerebral infarction complicated with T2DM have a higher incidence of cognitive impairment,which is significantly higher than those without T2DM.2.Patients with T2DM complicated with acute cerebral infarction have decreased in cognitive fields such as language ability,memory,visual space and executive power.3.The age,education,history of cerebral infarction,history of cerebral infarction,Previous cerebral infarction times,duration of diabetes,hypertension,duration of hypertension,NLR,D-2 aggregation,Hcy,Hb A1c and fibrinogen degradation of T2DM patients with acute cerebral infarction are risk factors related to cognitive impairment,among which hypertension,Hcy and Hb A1c are independent risk factors for early cognitive impairment in T2DM patients with acute cerebral infarction.4.The course of hypertension,Hcy and Hb A1c have certain predictive value for cognitive impairment of T2DM patients with acute cerebral infarction,and the combined predictive value of the three factors is higher.