Abstract：Objective To study the relationship between cognitive decline with diabetes in patients with white matter lesions(WML) and mild cognitive impairment(MCI).Methods From January to December 2012, 257 patients with WML and MCI were selected from the inpatients in the Department of Neurology of Daping Hospital in the city of Chongqing. This is a prospective study, the patients enrolled into the present study accepted follow-up for 1 year. The demographic data, vascular risk factors, MRI and neuropsychological tests were collected . All patients were divided into cognitive decline group and non-cognitive decline group according to the reduction value of mini-mental state examination(MMSE) within 1 year. The differences between 2 groups were compared.Results A total of 246 patients completed the follow-up, 8 patients died and 3 patients quitted. There were 154 patients in cognitive decline group, and 92 patients in non-cognitive decline group. Among of them, 210 patients were regression analyzed, but 36 patients were rejected duo to stroke attacked during the watch. In addition to the education level and hyperlipidemia, the other risk factors such as age, gender gap, hypertension, diabetes and transient ischemic attack were statistically different between two groups(all P values<0.05). According to regression analysis, the decrease of MMSE scores over the 1-year study period was mainly attributed to diabetes, WML severity and deterioration of WML severity. In addition, the impact on cognitive decline from big to small in turn was baseline WML degree(βj′ =0.570), deterioration of WML severity(βj′ =0.244) and diabetes(βj ′=0.171).Conclusions The occurrence of diabetes can lead to significant cognitive decline in patients with WML and MCI. Thus we should take the MCI patients with diabetes and severe WML as a high risk group of dementia, and give intervention timely.
霍颖超,甘小娅,李梦颖,彭泽艳,王延江,周华东,符晓艳. 糖尿病对脑白质病变伴轻度认知功能障碍患者认知功能的影响[J]. 中华解剖与临床杂志, 2016, 21(5): 385-390.
Huo Yingchao, Gan Xiaoya, Li Mengying, Peng Zeyan, Wang Yanjiang, Zhou Huadong, Fu Xiaoyan.. Effect of diabetes on cognitive function in patients with white matter lesions and mild cognitive impairment. Chinese Journal of Anatomy and Clinics, 2016, 21(5): 385-390.
Giuli C, Fabbietti P, Paoloni C, et al. Subjective memory complaints in Italian elderly with mild cognitive impairment: implication of psychological status[J]. Neurol Sci, 2016, 37(7): 1153-1157. DOI:10.1007/s10072-016-2553-6
[2]
Gordon MF, Lenderking WR, Duhig A, et al. Development of a patient-reported outcome instrument to assess complex activities of daily living and interpersonal functioning in persons with mild cognitive impairment: the qualitative research phase[J]. Alzheimers Dementia, 2016, 12(1): 75-84. DOI:10.1016/j.jalz.2015.04.008
[3]
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment—beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment[J]. J Intern Med, 2004, 256(3): 240-246. DOI:10.1111/j.1365-2796.2004.01380.x
[4]
Raz N, Yang YQ, Rodrigue KM, et al. White matter deterioration in 15 months: latent growth curve models in healthy adults[J]. Neurobiol Aging, 2012, 33(2): 429-421. DOI:10.1016/j.neurobiolaging.2010.11.018
[5]
Chabriat H. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy[J]. Geriatr Psychol Neuropsychiatr Vieil, 2014, 12(2): 183-192. DOI:10.1684/pnv.2014.0467
[6]
Debette S, Seshadri S, Beiser A, et al. Midlife vascular risk factor exposure accelerates structural brain aging and cognitive decline[J]. Neurology, 2011, 77(5): 461-468. DOI:10.1212/WNL.0b013e318227b227
[7]
Horsburgh K, Reimer MM, Holland P, et al. Axon-glial disruption: the link between vascular disease and Alzheimer′s disease[J]. Biochem Soc Trans, 2011, 39(4): 881-885. DOI:10.1042/BST0390881
[8]
Verdelho A, Madureira S, Moleiro C, et al. White matter changes and diabetes predict cognitive decline in the elderly: the LADIS study[J]. Neurology, 2010, 75(2): 160-167. DOI:10.1212/WNL.0b013e3181e7ca05
[9]
Umemura T, Kawamura T, Umegaki H, et al. Endothelial and inflammatory markers in relation to progression of ischaemic cerebral small-vessel disease and cognitive impairment: a 6-year longitudinal study in patients with type 2 diabetes mellitus[J]. J Neurol Neurosurg Psychiatr, 2011, 82(11): 1186-1194. DOI:10.1136/jnnp.2010.217380
[10]
Yin ZG, Cui M, Zhou SM, et al. Association between metabolic syndrome and white matter lesions in middle-aged and elderly patients[J]. Eur J Neurol, 2014, 21(7): 1032-1039. DOI:10.1111/ene.12433
[11]
Petersen RC, Roberts RO, Knopman DS, et al. Prevalence of mild cognitive impairment is higher in man: the Mayo clinic study of aging[J]. Neurology, 2010, 75(10): 889-897. DOI:10.1212/WNL.0b013e3181f11d85
[12]
Jokinen H, Gonalves N, Vigário R, et al. Early-stage white matter lesions detected by multispectral MRI segmentation predict progressive cognitive decline[J]. Front Neurosci, 2015, 9: 455. DOI:10.3389/fnins.2015.00455
[13]
Kitching D. Depression in dementia[J]. Australian Prescriber, 2015, 38(6): 209-2011. DOI:10.18773/austprescr.2015.071
[14]
Yu KH, Cho SJ, Oh MS, et al. Cognitive impairment evaluated with vascular cognitive impairment Harmonization standards in a multicenter prospective stroke cohort in Korea[J]. Stroke, 2013, 44(3): 786-788. DOI:10.1161/STROKEAHA.112.668343
[15]
Lees R, Selvarajah J, Fenton C, et al. Test accuracy of cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke[J]. Stroke, 2014, 45(10): 3008-3018. DOI:10.1161/STROKEAHA.114.005842
[16]
Wales K, Clemson L, Lannin N, et al. Functional assessments used by occupational therapists with older adults at risk of activity and participation limitations: a systematic review[J]. PLoS ONE, 2016, 11(2): e0147980. DOI:10.1371/journal.pone.0147980
Stein J, Luppa M, Maier W, et al. Assessing cognitive changes in the elderly: reliable change indices for the Mini-Mental State Examination[J]. Acta Psychiatr Scand, 2012, 126(3): 208-218. DOI:10.1111/j.1600-0447.2012.01850.x
Launer LJ, Berger K, Breteler MM, et al. Regional variability in the prevalence of cerebral white matter lesions: an MRI study in 9 European countries (CASCADE)[J]. Neuroepidemiology, 2006, 26(1): 23-29. DOI:10.1159/000089233
[22]
He S, Li L, Hu Q, et al. Effectiveness of Traditional Chinese Medicine (TCM) treatments on the cognitive functioning of elderly persons with mild cognitive impairment associated with white matter lesions[J]. Shanghai Arch Psychiatry, 2015, 27(5):289-295. DOI:10.11919/j.issn.1002-0829.215109
Bai J, Wei P, Zhao N, et al. A study of mild cognitive impairment in veterans: role of hypertension and other confounding factors[J]. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn, 2016,23(6): 703-15. DOI:10.1080/13825585.2016.1161000
[25]
Niu MJ, Yin FZ, Liu LX, et al. Non-high-density lipoprotein cholesterol and other risk factors of mild cognitive impairment among Chinese type 2 diabetic patients[J]. J Diabetes Complicat, 2013, 27(5): 443-446. DOI:10.1016/j.jdiacomp.2013.06.001
[26]
Li J, Wang YJ, Zhang M, et al. Vascular risk factors promote conversion from mild cognitive impairment to Alzheimer disease[J]. Neurology, 2011, 76(17): 1485-1491. DOI:10.1212/WNL.0b013e318217e7a4
[27]
Rodríguez-Sánchez E, Mora-Simón S, Patino-Alonso MC, et al. Cognitive impairment and dependence of patients with diabetes older than 65 years old in an urban area (DERIVA study)[J]. BMC Geriatr, 2016, 16: 33. DOI:10.1186/s12877-016-0208-3
[28]
Espeland MA, Bryan RN, Goveas JS, et al. Influence of type 2 diabetes on brain volumes and changes in brain volumes: results from the Women′s Health Initiative Magnetic Resonance Imaging studies[J]. Diabetes Care, 2013, 36(1): 90-97. DOI:10.2337/dc12-0555
[29]
Jing Z, Shi C, Zhu L, et al. Chronic cerebral hypoperfusion induces vascular plasticity and hemodynamics but also neuronal degeneration and cognitive impairment[J]. J Cereb Blood Flow Metab, 2015, 35(8): 1249-1259. DOI:10.1038/jcbfm.2015.55
[30]
Ma J, Zhang J, Hou WW, et al. Early treatment of minocycline alleviates white matter and cognitive impairments after chronic cerebral hypoperfusion[J]. Sci Rep, 2015, 5: 12079. DOI:10.1038/srep12079
[31]
Kim HA, Miller AA, Drummond GR, et al. Vascular cognitive impairment and Alzheimer′s disease: role of cerebral hypoperfusion and oxidative stress[J]. Naunyn Schmiedebergs Arch Pharmacol, 2012, 385(10): 953-959. DOI:10.1007/s00210-012-0790-7
[32]
Choi DH, Lee KH, Kim JH, et al. NADPH oxidase 1, a novel molecular source of ROS in hippocampal neuronal death in vascular dementia[J]. Antioxid Redox Signal, 2014, 21(4): 533-550. DOI:10.1089/ars.2012.5129
[33]
Lacruz ME, Tiller D, Kluttig A, et al. Association of late-life changes in blood pressure and cognitive status[J]. J Geriatr Cardiol, 2016, 13(1): 37-43. DOI:10.11909/j.issn.1671-5411.2016.01.018
2016, Vol. 21 
