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Aging and disease    2015, Vol. 6 Issue (4) : 236-244     DOI: 10.14336/AD.2014.1004
Original Article |
Clinical Characteristics for the Relationship between Type-2 Diabetes Mellitus and Cognitive Impairment: A Cross-Sectional Study
Zhou Yi1, Fang Rong1, Liu Li-Hua2, Chen Sheng-Di1,*, Tang Hui-Dong1,*
1Department of Neurology, Rui Jin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
2Department of Neurology, the People's Hospital of Jurong City, Zhenjiang, 212400, China
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Abstract  

We explored the potential differences in cognitive status, lipid and glucose metabolism, ApoEε4 alleles and imaging between diabetic and non-diabetic subjects. 83 subjects with normal cognitive function and 114 mild cognitive impaired patients were divided into four groups by history of diabetes. General demographics was collected from all participants followed by MRI scan, biochemical examinations and a series of neuropsychological tests. Student’s t test, multiple regressions and one-way ANOVA were applied to investigate the differences between groups. Comparing diabetic patients with non-diabetic subjects in the mild cognitive impaired group, we found several decreased items in recall of three words in MMSE (p=0.020), AVLT and SCWT (p<0.050). The multiple linear regression revealed that two-hour glucose level (B= -0.255,p<0.001) and fasting C-peptide (B= -0.466,p=0.001) had negative effects on the score of MMSE. In addition, diabetic patients treated with insulin and other diabetes medication performed better in part of the AVLT (p<0.050) compared to patients with insulin treatment or oral antidiabetic medication only. Patients with metformin medication had a better memory outcome compared to patients with sulphonylurea medication in the AVLT long delay free recall (p =0.010). These findings show that patients of mild cognitive impairment with diabetes mellitus have a worse outcome in attention, information processing speed and memory compared to non-diabetic patients. Higher two-hour glucose level and C-peptide level may be risk factors for severe cognitive impairment in type-2 diabetes mellitus patients. The results of this study also suggest that medication may have effects on cognitive function.

Keywords Type-2 diabetes mellitus      mild cognitive impairment      C-peptide      blood glucose     
Corresponding Authors: Chen Sheng-Di,Tang Hui-Dong   
About author:

present address: Kunming Biomed International, Kunming, Yunnan, 650500, China

Issue Date: 01 August 2015
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Zhou Yi
Fang Rong
Liu Li-Hua
Chen Sheng-Di
Tang Hui-Dong
Cite this article:   
Zhou Yi,Fang Rong,Liu Li-Hua, et al. Clinical Characteristics for the Relationship between Type-2 Diabetes Mellitus and Cognitive Impairment: A Cross-Sectional Study[J]. Aging and disease, 2015, 6(4): 236-244.
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http://www.aginganddisease.org/EN/10.14336/AD.2014.1004     OR     http://www.aginganddisease.org/EN/Y2015/V6/I4/236
Figure 1.  Brain MRI: measurement of the interuncal distance (IUD) and the intracranial width (ICW). IUD and ICW were acquired at the suprasellar stern level from the axial T1 images. The measurement of IUD is indicated by the black arrows and the ICW by the white arrows.
Total numberMale(female)Age (yrs)Education
(yrs)
APOE ε4 (+) carriers (%)
NC
Non-DM4023(17)64.45±8.9812.69±3.3925.0
DM4322(21)68.42±9.1012.77±3.1018.6
p0.5630.0630.9250.434
MCI
Non-DM6533(32)66.12±9.3612.81±12.8831.4
DM4924(25)68.68±8.2311.78±3.7624.5
p0.8500.0910.9630.537
Table 1A  Comparison of demographic information between control and mild cognitive impairment groups
FPG2h-PGFINS2h-INSHbA1cFCP
mmol/Lmmol/Lμl U/mlμl U/ml%ng/ml
NC
Non-DM5.16±0.897.68±3.737.02±2.9455.03±24.245.97±0.331.87±0.23
DM6.63±1.2310.55±3.2711.85±19.4251.41±35.397.02±1.712.24±1.35
p<0.0010.0060.5090.4850.0020.175
MCI
Non-DM5.07±0.607.22±1.269.27±5.9780.43±69.195.6±0.823.07±1.13
DM7.10±2.1012.25±5.8311.50±8.1579.43±95.287.44±1.552.53±1.78
p<0.001<0.0010.5550.817<0.0010.491
Table 1B  Comparison of glucose metabolism between control and mild cognitive impairment groups
TCTGHDLLDL
mmol/Lmmol/Lmmol/Lmmol/L
NC
Non-DM4.49±0.971.31±0.691.32±0.272.80±0.83
DM4.89±0.961.84±1.421.39±0.552.97±0.74
p0.1420.0700.7580.498
MCI
Non-DM5.00±0.971.87±1.171.25±0.332.98±0.82
DM4.96±0.981.43±0.771.31±0.343.19±0.73
p0.7410.0420.6490.186
Table 1C  Comparison of lipid metabolism between control and mild cognitive impairment groups
IUDICWIUD/ICW
cmcm
NC
Non-DM2.43±0.2712.80±0.630.19±0.02
DM2.57±0.3612.71±0.580.20±0.03
p0.1310.5670.068
MCI
Non-DM2.51±0.4112.71±0.720.20±0.31
DM2.50±0.3312.65±0.600.20±0.03
p0.8800.6670.895
Table 1D  Comparison of lipid metabolism between control and mild cognitive impairment groups
MCI
(non-diabetic)
MCI
(diabetic)
p
n=65n=49
Recall in MMSE (3 words)2.04 ± 0.841.57 ± 1.080.020*
MMSE total score27.12 ± 2.3525.84 ± 3.580.099
AVLT immediate recall
(36 words)
13.05 ± 5.0810.89 ± 3.870.066
AVLT 5-minute recall
(5 min/12 words)
3.55 ± 2.832.41 ± 2.010.031*
AVLT long delay free recall
(20 min/12 words)
3.03 ± 2.791.93 ± 1.890.049*
AVLT long delay cued recall0.55 ± 1.310.74 ± 1.220.379
SCWT-A performance time (s)30.86 ± 10.7736.26 ± 13.860.035*
SCWT-A correct number (50)49.13 ± 3.0748.17 ± 7.770.750
SCWT-B performance time (s)45.56 ± 13.3851.50 ±21.160.253
SCWT-B correct number (50)48.54 ± 2.9344.73 ± 10.980.046*
SCWT-C performance time (s)91.47 ± 36.3100.88 ±58.820.688
SCWT-C correct number (50)44.72 ± 8.0243.18 ± 9.560.457
Table 2  Comparison of cognitive function between MCI patients without diabetes and MCI patients with diabetes
Coefficientp
Duration0.2160.966
FPG-0.0290.449
2h-PG-0.255<0.001*
FINS-0.0900.993
2h-INS-0.1270.939
HbA1c-0.2640.257
FCP-0.4660.001*
TC-0.1110.780
TG-0.0060.971
HDL-0.0680.854
LDL-0.1030.469
Table 3  Correlation between MMSE scores and clinical characteristics
Insulin treatment onlyOral antidiabetic medication onlyCombined treatmentANOVA
Number12599
AVLT immediate recall (36 words)14.70 ± 5.1712.83 ± 5.0316.75 ± 5.63F = 2.406
p = 0.097
AVLT 5-minute recall
(5 min/12 words)
3.90 ± 3.283.78 ± 2.655.25 ± 2.86F = 1.000
p = 0.373
AVLT long delay free recall (20 min/12 words)3.50 ± 3.033.33 ± 2.704.75 ± 3.28F = 0.905
p = 0.409
AVLT long delay cued recall0.40 ± 0.701.17 ± 1.813.38 ± 2.26F = 6.971
*p = 0.002
SCWT-A
performance time (s)
31.80 ± 12.5632.20 ± 12.1126.75 ± 7.07F = 0.729
p = 0.486
SCWT-A
correct number (50)
50.00 ± 0.0048.72 ± 6.8049.75 ± 0.71F = 0.260
p = 0.772
SCWT-B
performance time (s)
41.90 ± 11.1347.96 ± 18.9534.86 ± 6.75F = 2.286
p =0.110
SCWT-B
correct number (50)
49.70 ± 0.9546.52 ± 7.7349.88 ± 0.35F = 1.556
p = 0.219
SCWT-C
performance time (s)
73.20 ± 20.3692.83 ± 50.3568.88 ± 21.50F = 1.547
p = 0.220
SCWT-C
correct number (50)
46.10 ± 6.5744.10 ± 8.9547.00 ± 2.51F = 0.595
p = 0.555
Table 4  Comparison of cognitive functions between insulin, oral anti-diabetic therapy and combined therapy groups
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