Characteristics Of Cognitive Impairment In Patients With Metabolic Syndrome

Background and purpose:Metabolic syndrome is characterized by a range of cardiovascular and cerebral vascular risk factors,including abdominal obesity,glucose metabolism disorder,hypertension and dyslipidemia^[1].With the improvement of quality of life and the change of diet structure,the prevalence of metabolic syndrome has been increasing in recent years,which has gradually become a serious public health and clinical problems.The epidemiological study found that the prevalence of metabolic syndrome in the global range is 2.4% to 35.3%^[8],while in China the prevalence of metabolic syndrome is between 10% and 26.4%^[5-7].A growing number of studies have shown that components of metabolic syndrome are at increased risk of cognitive dysfunction,but this risk increases in the case of metabolic syndrome.The mechanism of how metabolic syndrome affects cognitive function has not been fully understood,and there is still some controversy about the characteristics of cognitive impairment.It is not clear whether the cognitive impairment is the superposition of components,or there is a certain difference.Dementia is a clinical syndrome characterized by chronic acquired progressive decline of intelligence.Memory impairment is the main core symptom,accompanied by varying degrees of personality,mood,language,executive power,attention^[12].Is one of the main causes of death and disability.With the formation of the aging society of the population,the prevalence of dementia will rise sharply,which has become a major public health problem.About 48 million people worldwide suffer from dementia,which is expected to increase to131 million by 2050^[14].At the same time,mild cognitive impairment（MCI）develops to Alzheimer disease at an annual rate of about 10% to 20%^[15].Because of the complexity and variety of factors,the clinical symptoms of dementia vary greatly from individual to individual.Due to the complexity and variety of formation factors,the clinical symptoms of dementia vary greatly among individuals,and lack of definite biomarkers,the clinical diagnosis is facing great challenges.At the same time,due to the current limited intervention and treatment measures,leading to a high rate of disability and mortality,causing a heavy burden on the family and society.The purpose of this study was to compare and analyze the characteristics of cognitive function among the three groups by measuring the cognitive function of the patients with type 2 diabetes mellitus,primary hypertension and metabolic syndrome,and to explore the difference of cognitive function between them,and clarify the characteristics of cognitive function in metabolic syndrome.The change characteristics of latency and amplitude of P300 wave in three groups were compared and analyzed to determine the change characteristics of event-related potentials of metabolic syndrome（MS）.The purpose of this study was to investigate the characteristics of cognitive impairment and EEG changes in patients with metabolic syndrome,and to provide evidence for clinical intervention strategies.Subjects:A total of 96 patients with type 2 diabetes mellitus,primary hypertension and metabolic syndrome were selected from May 2017 to May 2018 in the Department of Hypertension and Endocrinology,third affiliated Hospital of military Medical University of the Army.There were 34 cases of type 2 diabetes mellitus,20 cases of primary hypertension and 42 cases of metabolic syndrome,with an average age of 60.9±8.8 years.Research methods:Selection criteria:Patients are 18 to 75 years old,both male and female.Type 2Diabetes conforms to the definition of “Chinese guidelines for the Prevention and treatment of Type 2 Diabetes”.Primary hypertension conforms to the definition of “Chinese guidelines for the Prevention and treatment of Hypertension 2010”.Metabolic syndrome meets the definition of “Chinese guidelines for the prevention and treatment of adult dyslipidemia 2007”.Exclusion criteria:Under 18 or older than 75;Suffering from neurological diseases such as dementia,cerebral hemorrhage,cerebral infarction,epilepsy,etc;History of brain injury;Mentally ill:such as anxiety,depression,schizophrenia,etc;Patients with a history of alcohol or drug addiction;Persons with learning disabilities;Persons with developmental disabilities or dyskinesia;Persons with sensory dysfunction;Type 1 diabetes,gestational diabetes,special type diabetes,acute diabetic complications;Secondary hypertension,pregnancy hypertension,hypertension with pregnancy;The patient has severe liver disease,kidney disease,heart disease;Suffering from macrovascular diseases such as renal artery stenosis,lower extremity arteriosclerosis,carotid artery stenosis,etc;A person who is using poison or psychotropic substances.Examination items:Age,sex,education,past medical history,family history,drug use,tobacco and alcohol history were collected from all patients.Measure blood pressure,waist circumference,height,body mass index;Detection of ALT,AST,TG,TC,TG,HDL-C,LDL-C,Scr,FPG,HbA1c.Cognitive function scale test:The patients completed the mini-mental state scale（MMSE）,word memory test（RAVL）,memory and executive function scale（MES）,attention and orientation test（line test,TMT）,)Language fluency Test（Animal and Vocabulary fluency,ANT）,Visual Space ability Test（clock drawing Test,CDT）,digit Span memory Test（DST）.etc.The P300 test:The P300 can be detected by using the BrainAmp MR32 EEG analyzer in Germany.Using the classic Oddball experimental paradigm.The placement of recording electrodes refers to the international 10-20 system electrode coordination method.The electrode is placed at the Fz,Cz,Pz point,the central electrode in the prefrontal lobe is grounded,and the mastoid process behind the ears is placed with the reference electrod e.Sound stimulation using a pure tone with a composition ratio of 0.2 to 0.8.20% of them were target stimuli（T）,80% were non-target stimuli（NT）,100 Hz were sound frequencies,and 110 dB were tones.The rise and fall time is 2 Ms,the maintenance time is 100 Ms,the filter is set to 0.5Hz and 100Hz,T randomly distributed in NT.The subjects were asked to react by pressing the numeric key"1"when they heard T,and counted in silence.After the experiment,if the error rate of the subjects exceeded 20%,it would be regarded as invalid in this round of tests.After data acquisition,the latency and amplitude of P300 wave at Fz,Cz,Pz point were analyzed by software.All the measurement data were tested for normality and variance homogeneity.The measurement data in accordance with normal distribution were expressed as mean±standard deviation.The mean values of samples between the two groups were compared by independent sample t test,and the three groups of samples were compared by single factor variance analysis（ANOVA）.the comparison between the two groups was performed by LSD test.The Chi-square test is used to compare the composition ratio and grade data.A bilateral P<0.05 was considered statistically significant.The statistical results were analyzed by SPSS 19.0 and GraPhPad Prism 5.0.Result:1.There was no significant difference in age,sex,education level,diastolic blood pressure,TC,HDL-C,LDL-C,glutamic pyruvic ALT,AST and SCr among the three groups（P>0.05）.The systolic blood pressure,WC,BMI and TG in metabolic syndrome group were significantly higher than those in type 2 diabetes mellitus group（P<0.05）.The FPG,WC,BMI and TG in metabolic syndrome group were significantly higher than those in primary hypertension group（P<0.05）.2.Compared with the patients with in type 2 diabetes mellitus and primary hypertension,patients with metabolic syndrome have lower scores in digital memory tests,visual spatial ability,memory and total score in the memory and executive tests（P<0.05）;3.The patients with metabolic syndrome had significant delayed P300 latencies than those of type 2 diabetes mellitus and primary hypertension（P<0.05）,decreased P300amplitudes than type 2 diabetes mellitus（P<0.05）,but there was no significant difference compared with the primary hypertension（P>0.05）.Conclusion:1.Cognitive impairment of metabolic syndrome is manifested in cognitive decline in many fields,such as cognitive population,memory span,memory,visual space and so on.Compared with type 2 diabetes mellitus and primary hypertension,there is partial overlap,but it is not a simple superposition of cognitive impairment in each group,suggesting that metabolic syndrome as a whole has different cognitive impairment from that of each component.2.The electrophysiologic manifestation of metabolic syndrome was that the processing time was prolonged and the processing ability was decreased,which was mainly located in the prefrontal lobe,suggesting that the cognitive function of the patients with metabolic syndrome was significantly decreased and has its own characteristic changes.