| Objective: Diabetes is one of the most common chronic diseases in theworld, including90%~95%for type2diabetes mellitus. Type2diabetesmellitus(T2DM)can cause multiple system damage, central nervous systemdamage may lead to damage of the brain structure and function, and the mainclinical manifestation is mild cognitive impairment (MCI). A number ofstudies have shown that cognitive dysfunction in type2diabetes mellitusrelated to a variety of factors, including gender, age, level of education,lifestyle, metabolic disorders, blood glucose levels, insulin resistance, thehypothalamic-pituitary-adrenal(HPA) axis regulation, inflammatory mediators,and so on. Most Magnetic Resonance Imaging studies also found that mildcognitive impairment in T2DM related to cerebral infarction,White matterhyperintensities (WMHs)and the severity of brain atrophy.Hippocampus plays an important role in learning, memory, and emotionsof the human being, and is closely related to cognitive function. Study ofhippocampal volume is fundamental for evaluation of normal physiologicaland pathological changes in the hippocampus.This study was to discuss the characteristics and relevant factors ofcognitive dysfunction in T2DM, evaluate the effect of MRI measurement ofhippocampal volume in MCI diagnosis by comparison among control group,T2DM non-MCI group and T2DM-MCI group, with the help of MRI.Method：Select28cases of patients with T2DM treated in the SecondHospital of HeiBei Medical University between January2011and January2012(14cases were male and14females,53.68±13.36years of age). All ofthem were in line with the2003United States Diabetes Association (ADA)diagnostic criteria for type2diabetes mellitus. The exclusion criteria was as follows:(1) Had ketoacidosis or coma caused by diabetes or treatment.(2)Have repeated serious cerebrovascular disease history or abnormal nervoussystem examination signs.(3) Have mental retardation, dementia, braintrauma,epilepsy or other nervous system diseases.(4) Have hypothyroidism or otherserious physical diseases which may affect cognitive function in thedetermination.(5) Have psychosis which may affect cognitive function.(6)People who are addicted to alcohol and are dependent on other psychoactivesubstances. MCI diagnosis followed the criteria of Petersen：(1) complaint ofdefective memory,(2) abnormal memory function for age,(3) normal generalcognitive function,(4)normal activities of daily living, and (5) absence ofdementia. Neuropsychological tests applied to the following criteria:(1)Montreal cognitive assessment (MoCA) scale total score <26,(2) Daily livingskills keep normal:activities of daily living scale score20,(3)Clinical dementiarating (CDR)score0.5.Accordingly, the selected patients were divided intoT2DM cognitive impairment group and T2DM non-cognitive impairmentgroup. Normal control group:11volunteers from Medical examination centerof the same hospital on the same period,6cases were male and5females,53.68±13.36years of age. All of the volunteers completed MRI examinationwith no visible lesions of the nervous system. There were no related diseasescan cause cognitive impairment, no history of alcohol or drug abuse.And theirCDR score0, MoCA score≥26.All the participants completed investigation table with gender, age, height,weight, length of education and past medical history, excluding Melancholiaby which was tested the Hamilton (HAMD) depression scale.In addition,allsubjects underwent a head MRI scan (GE Signa the EXCITE3.0T),afterimage processing, outlined the hippocampus boundary, then got bilateralhippocampal volumes through the Volume analysis package.Cranial volume isobtained through multiplying the height to diameter, anteroposterior diameterand transverse diameter of head. Applying division algorithm standardizedhippocampal volumes respectively.Using SPSS19.0software package for data processing. P<0.05was considered statistical difference.Results：1The demographic characteristics of normal control group and T2DMpatientsThere was no significant difference between normal control group andT2DM group on gender(χ~2=0.022, P=0.883), age(F=1.334, P=0.609), level ofeducation(F=0.125, P=0.737).2Comparison of MoCA sub-score in three different groupsVisuospatial and Executive Function: The alternate connection test,visuospatial cube the visuospatial watch of MoCA are all the detection ofvisuospatial and executive function. The Kruskal-Wallis H test results of dataobtained by adding up the three results showed that the score of type2diabetes MCI group decreased significantly compared with the other twogroups (P<0.01).The comparison of control group and non-MCI group was nostatistical significance(P>0.05).Attention: Detection of attention include the digit span, alertness andcalculation. The Kruskal-Wallis H test results of data obtained by adding upthe three results showed that the score of type2diabetes MCI group wassignificantly lower than that of the other two groups (P<0.05).The comparisonof control group and non-MCI group was no statistical significance(P>0.05).Language: We found that, in the same way, the language score of MCIgroup was significantly lower than non-MCI group(P<0.01).Delayed Recall: There was significant difference on delayed recall amongthe three groups. The score of the MCI group was significantly lower than thatof the other two groups(P<0.01), while performance of control group andnon-MCI group was no significant difference (P>0.05).Naming, Abstract Thinking, Disorientation: There was no significantdifference on naming, abstract thinking, disorientation among the three groups(P>0.05).3The demographic characteristics of three different groupsThree groups of subjects had no significant difference (P>0.05)on age and body mass index (BMI). The years of education of the MCI groupsignificantly lower than that of the non-MCI group(P<0.05). Thenon-MCI group had no significant difference compared with normal controlgroup(P>0.05). The MCI group were mostly women, longer course(P<0.05).4Comparison of the hippocampal volume in three different groupsThe normality test results of the left, right and bilateral hippocampalvolume in the three groups were all in line with normal distribution. One-wayANOVA analysis showed that left hippocampal volume in MCI group(1.007±0.129)was significantly smaller than that in control group(1.127±0.101)(P<0.05), while comparison of control group and non-MCIgroup (1.086±0.101)was not significantly different(P>0.05). There was nostatistically significant difference on right and bilateral hippocampal volumeamong the three groups(P>0.05).5Relevant factors of MoCAMoCA total score had positively correlation with the level ofeducation(r=0.773, P<0.01) and left hippocampal volume (r=0.325,P <0.05),but no significant correlation with age, right hippocampal volume and bilateralhippocampal volume(P>0.05). Therefore，MCI had negtively correlation withthe level of education and left hippocampal volume.Conclusion:1Cognitive impairment in T2DM patients was manifested mainly invisuospatial and executive function, attention, language, and delayed recallaspects.2MCI of T2DM was correlate with gender, course of disease and yearsof education, the longer course of disease, the lower educational level, thehigher incidence of MCI, and women had higher incidence than men.3The left hippocampal volume of T2DM patients with MCI wasobvious atrophy compared with the control group and non-cognitive disorders.The more severe cognitive impairment, the smaller of hippocampalvolume.There was no significant difference in right hippocampal volumeamong the three groups. |
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