Cerebral perfusion in insulin resistance and type 2 diabetes

Cerebral perfusion was evaluated in 87 subjects prospectively enrolled in three study groups—healthy controls (HC), patients with insulin resistance (IR) but not with diabetes, and type 2 diabetes mellitus (T2DM). Participants received a comprehensive 8-hour clinical evaluation and arterial spin labeling magnetic resonance imaging (MRI). In order of decreasing significance, an association was found between cerebral blood flow (CBF) and sex, waist circumference, diastolic blood pressure (BP), end tidal CO₂, and verbal fluency score (R²=0.27, F=5.89, P<0.001). Mean gray-matter CBF in IR was 4.4 mL/100 g per minute lower than in control subjects (P=0.005), with no hypoperfusion in T2DM (P=0.312). Subjects with IR also showed no CO₂ relationship (slope=−0.012) in the normocapnic range, in contrast to a strong relationship in healthy brains (slope=0.800) and intermediate response (slope=0.445) in diabetic patients. Since the majority of T2DM but few IR subjects were aggressively treated with blood glucose, cholesterol, and BP lowering medications, our finding could be attributed to the beneficial effect of these drugs.     

Sensitivity of P300 auditory event-related potentials for assessing cognitive impairment in elderly type 2 diabetic patients

BACKGROUND：In previous studies, cognitive function in elderly type 2 diabetic patients was evaluated by psychometric tests. These studies have confirmed that P300 event-related potential is an objective way of assessing cognitive function. OBJECTIVE： To analyze the objectivity of P300 for assessment of cognitive function in elderly type 2 diabetic patients. DESIGN, TIME AND SETTING： This case-control experiment was performed at the Department of Endocrinology of the Fourth Affiliated Hospital, Guangxi Medical University from January 2004 to December 2006. PARTICIPANTS： Seventy-two patients （38 males and 34 females） with type 2 diabetes mellitus were enrolled in this study. The patients were divided according to those with diabetes alone （diabetes alone group） （n=38） and those with diabetes and cerebral ischemia （diabetes and cerebral ischemia group） （n=34）. A further 31 healthy individuals （16 males and 15 females）, who received health examinations over the same period, were included as normal controls （normal control group）. METHODS： All subjects were assessed by Mini-Mental State Examination （MMSE）. Abnormalities in cognitive functions were identified by analyzing the auditory P300 event-related potentials. MAIN OUTCOME MEASURES： Auditory event-related potentials and MMSE scores. Multiple linear regression analysis was conducted using the ＂enter method＂ with the 72 elderly patients with type 2 diabetes mellitus. P3 latency, P3 amplitude and N2 latency served as dependent variables. Age, sex, education, course of the disease, glycosylated hemoglobin, and ischemic brain damage were used as independent variables. RESULTS： No significant difference in scores of MMSE was detected between the diabetes alone and normal control groups （P 〉 0.05）. MMSE score was significantly lower in the diabetes and cerebral ischemia group （P 〈 0.01） than in the normal control group. N2 and P3 latencies of auditory event-related potential were significantly longer, and P3 a     

2型糖尿病患者轻度认知功能障碍的临床分析

目的探讨2型糖尿病患者轻度认知功能障碍的特点。方法将122例2型糖尿病患者分为伴2型糖尿病轻度认知功能障碍组(45例)、不伴2型糖尿病轻度认知功能障碍组(41例)和对照组(36例),使用蒙特利尔认知评估量表(montreal cognitive assessme,MoCA)对患者的命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆进行评分评估。结果与对照组比较,伴2型糖尿病轻度认知功能障碍组在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等评分比较差异具有统计学意义(P0.01)。与不伴2型糖尿病MCI组比较,伴2型糖尿病MCI组在总分、视空间/执行功能、注意、持续注意、延迟回忆等评分2组间差异有统计学意义(P0.05)。结论伴2型糖尿病的MCI患者在命名、注意、视空间/执行功能、持续注意、语言、计算、抽象、定向力、延迟回忆等方面有不同程度的损害;其总体认知功能损害较不伴2型糖尿病者严重,尤其在视空间/执行能力、注意、持续注意及记忆方面。     

Diabetic neuropathy in elderly Type 2 diabetic patients: effects of insulin treatment

Objectives - To study the occurrence of diabetic neuropathy and the effect of insulin treatment in elderly Type 2 diabetic patients. Material and methods -In 38 patients and 20 controls symptoms and neurophysiological examinations including electroneurography, vibration perception and temperature discrimination thresholds were investigated. Patients were randomized to insulin ( n = 18) or sulfonylurea ( n = 16) treatment and were re-investigated after 1 year. Results - Neuropathy was present in 21/38 patients (56%). It was asymptomatic in 17/38 (45%) and symptomatic in 4/38 (11%). The occurrence of neuropathy was less common in healthy controls, 3/20 (15%) ( P <0.01). Temperature discrimination thresholds was the test that most often revealed pathology. The metabolic control after 1 year was significantly improved in the insulin treated group and unchanged in the sulfonylurea treated group. There were no changes as regards occurrence of neuropathy between or within the two treatment groups after 1 year. Conclusion - Diabetic neuropathy is common among elderly Type 2 diabetic patients. It is mostly asymptomatic. Improvement was not seen after 1 year of insulin treatment.     

双相障碍患者胰岛素抵抗的研究

目的:探讨不伴糖尿病的双相障碍(BD)患者糖代谢水平。方法:对111例BD患者(BD组)及41名正常对照者(NC组)进行体质量指数(BMI)、空腹血糖、胰岛素及糖化血红蛋白水平测定,计算胰岛素抵抗指数(IR);分析影响BD患者糖代谢的因素。结果:BD组空腹胰岛素(6.5 vs 4.3 ug/ml,P0.001)、IR(0.9 vs 0.7,P=0.002)及IR发生率(44.1%vs 22.4%,P=0.027)显著高于NC组;在控制BMI因素后,BD组与NC组IR发生率差异无统计学意义。结论:不伴糖尿病的BD患者高胰岛素血症及IR发生率高,肥胖影响BD患者的糖代谢。     

游离脂肪酸与老年2型糖尿病患者轻度认知功能障碍的研究

目的探讨游离脂肪酸(FFA)与老年2型糖尿病(T2DM)患者轻度认知功能障碍(MCI)的关系。方法选择85例老年T2DM患者,应用蒙特利尔认知评估(MoCA)量表评定认知功能,分为T2DM认知功能正常组(T2DM-NC)45例和T2DM认知功能障碍组(T2DM-MCI)40例,另选择糖耐量正常且认知功能正常者35例为对照组(NC)。测定3组FFA、糖化血红蛋白(HbA1c)、血脂等。结果 T2DM-MCI组FFA水平(7.45±0.13)mmol/L高于T2DM-NC组(6.32±0.13)mmol/L及NC组(4.56±0.11)mmol/L。T2DM-MCI患者的MoCA评分与糖尿病病程(r=-0.507,P=0.001)、FPG(r=-0.581,P0.001)、HOMA-IR(r=-0.360,P=0.022)、HbA1c(r=-0.533,P0.001)、TC(r=-0.358,P=0.023)、TG(r=-0.408,P=0.009)、LDL-C(r=-0.377,P=0.016)、FFA水平(r=-0.566,P0.001)呈负相关,与HDL-C(r=0.365,P=0.021)呈正相关。多重线性回归分析结果示,FPG(β=-0.290,P=0.015)、HbA1c(β=-0.272,P=0.019)、FFA(β=-0.375,P=0.001)、病程(β=-0.248,P=0.037)是MoCA评分的危险因素。结论血清FFA是T2DM患者MCI的危险因素。     

2型糖尿病伴抑郁症状患者的脑诱发电位研究

目的了解2型糖尿病伴抑郁症状患者的认知功能及脑诱发电位的变化。方法102例2型糖尿病患者,按照汉密尔顿抑郁量表（HAMD）评分结果,50例合并抑郁症状者为研究组,52例不合并抑郁症状者为对照组,比较2组脑诱发电位P300、失匹配负波（MMN）、血脂及脑部核磁共振显像检查。结果2组患者血脂、脑部核磁共振显像及脑诱发电位P300无统计学差异。与对照组比较,研究组脑诱发电位失匹配负波潜伏期延长,波幅降低。结论抑郁症状进一步加重糖尿病患者认知功能及脑诱发电位改变,MMN是敏感的早期检测手段。     

Cognitive function in community-dwelling elderly with chronic medical conditions

Objectives. The aim of this study was to examine the effect of chronic medical conditions on cognitive function in a sample of community-dwelling elderly (N = 4528). Methods. A checklist of 18 chronic medical conditions was used to determine whether respondents were suffering from specific disease states. The Mini Mental Status Examination (MMSE) was administered to assess cognitive functioning. Results. Statistically controlling for the effects of age, education and depression, respondents with asthma/bronchitis and stroke had a tendency to perform worse on the MMSE than those without these conditions. None of the 18 medical conditions was associated with a greater proportion of respondents scoring below the cutoff for cognitive dysfunction. Conclusion. It appears that—with the possible exception of stroke and asthma/bronchitis—cognitive function in community-dwelling elderly is not consistently affected by specific disease states. © 1997 John Wiley & Sons, Ltd.     

Factors associated with cognitive impairment in patients with newly diagnosed type 2 diabetes: a cross-sectional study

Objectives: Type 2 diabetes (T2DM) is strongly associated with cognitive impairment but the factors within T2DM that predispose to cognitive impairment are less well understood, while previous studies have investigated samples with T2DM of widely varying duration. We aimed to investigate the factors associated with cognitive impairment in patients with newly diagnosed T2DM.

Method: In a multi-ethnic sample with T2DM diagnosed in the last 6 months, we assessed cognitive function using the 13-item modified telephone interview for cognitive status (TICS-M). Cognitive function was assessed both categorically (impairment defined as lowest 10% of scores with the remainder as controls) and as continuous TICS-M score. Its associations were tested in univariate and multivariate analyses with a range of biological, psychological and sociodemographic factors.

Results: Of 1790 participants, 1680 had a complete TICS-M assessment at baseline. After controlling for covariates, older age (p < 0.001) and lower verbal intelligence (p < 0.001) were associated with both cognitive impairment and lower TICS-M scores, while non-white ethnicity (p < 0.001), female gender (p = 0.02) and higher HbA1c (p = 0.002) were associated with lower TICS-M scores. Depression (defined as Patient Health Questionnaire-9 score ≥10), elevated inflammatory markers and body mass index were not associated with cognitive function after controlling for covariates.

Conclusion: Age, verbal intelligence, female gender and HbA1c are associated with cognitive performance in T2DM soon after diagnosis. Previously reported associations with depression and inflammatory markers may occur later as causes or consequences of T2DM. Longitudinal analyses are needed to assess potentially modifiable factors predicting cognitive decline in early T2DM.     

Cognitive impairment among the elderly in a Korean rural community

ABSTRACT— Cognitive function among the elderly aged 65 or older was studied in a rural community of Korea. The prevalence rates of cognitive impairment were significantly higher in females (64%) than in males (33%). Sex differences of prevalence of both mild impairment (25% in males vs 45% in females) and severe (8% in males vs 19% in females) reached statistically significant levels. The prevalence of severe impairment increased with age, and the age-related increase was steeper after 80 in males and after 75 in females. The prevalence of mild impairment, on the other hand, did not increase so prominently with aging. From this point of view, it could be assumed that severe cognitive impairment may be highly related to real dementia, and that the elderly with mild impairment may consist of heterogenous groups associated with cognitive dysfunction of mild degree.     

上海社区老年抑郁障碍与遗忘型轻度认知功能损害患者的认知功能对照研究

目的:探讨上海社区老年抑郁障碍与遗忘型轻度认知功能损害(aMCI)患者之间认知功能的神经心理学差异。方法:1 068例社区老人中符合美国精神障碍诊断与统计手册第4版临床定式检查(SCID)的老年抑郁障碍患者13例及亚临床抑郁患者7例,共20例作为抑郁障碍组(DD组),并选取性别、年龄、教育程度均匹配的aMCI患者20例(aMCI组)及正常老人20名(NC组)作为对照,采用简明精神状态量表(MMSE)、蒙特利尔认知评估量表(MoCA)进行认知功能的测评。结果:3组在MMSE总分及地点定向力、计算与注意力、三步指令评分,以及MoCA总分、复制图、注意、计算、延迟回忆、时间定向评分差异有统计学意义(P0.05或P0.001)。DD组MMSE总分(P=0.034)、计算力与注意力(P=0.009)以及MoCA总分(P=0.002)、计算(P=0.006)、抽象思维(P=0.030)、时间定向(P=0.044)评分明显好于aMCI组。结论:社区老年抑郁障碍患者认知功能受损程度较老年aMCI患者轻。     

合并糖尿病的精神分裂症患者认知功能研究

目的：探讨合并糖尿病的精神分裂症患者认知功能缺损特征。方法：40例合并糖尿病（合并组）及40例无糖尿病（单纯组）的精神分裂症患者,采用阳性和阴性症状量表（PANSS）、重复性成套神经心理状态测验（RBANS）及治疗中出现的症状量表（TESS）进行评定;同时以40名健康志愿者（对照组）采用RBANS量表评定进行对照。结果：合并组与单纯组PANSS及TESS评分比较差异均无显著性（P均〉0.05）。RBANS评分以合并组总分（129.9±23.8）分明显低于对照组（218.2±25.0）分（P〈0.01）;且RBANS评分中即刻记忆因子评分（20.1±8.17）分显著低于单纯组（24.4±8.4）分（P〈0.05）。结论：慢性精神分裂症患者存在严重的认知功能损害,合并糖尿病的患者即刻记忆损害更为明显。     

认知行为疗法在2型糖尿病中的临床应用

目的探讨贝克认知行为疗法在2型糖尿病中的治疗效果。方法对61例2型糖尿病人随机分为2组。综合治疗组32例采用贝克认知行为治疗配合常规药物治疗;对照组29例单纯用药物治疗。分别在入组前、后8周及6个月后进行贝克抑郁量表(BDI)、贝克焦虑量表(BAI)和症状自评量表(SCL-90)测评,并监测血糖变化。结果综合治疗组疗效优于对照组,且起效快;追踪6个月观察显示综合治疗组并发症1例,对照组2例。结论贝克认知行为疗法有作为2型糖尿病辅助治疗的临床价值。     

血清脑源性神经营养因子在老年2型糖尿病中的表达及对认知功能的影响

目的观察BNDF在老年2型糖尿病患者的表达及对认知功能的影响。方法选取100例老年糖尿病患者（DM组）,100例正常老年人（对照组）,年龄均〉65岁。采用MMSE量表评估2组患者认知功能差别,同时测定外周血BD-NF。结果 DM组MMSE评分及外周血BDNF水平显著低于Control组（P〈0.05）;DM组中患病病程〉20a的患者MMSE评分及外周血BDNF水平显著低于对照组（P〈0.05）,组间年龄及HbA1C比较差异无统计学意义（P〉0.05）。结论老年糖尿病患者认知功能显著低于正常人群,BDNF水平降低参与了认知功能下降过程。     

脑卒中患者胰岛素抵抗的初步研究

目的 探讨脑梗死、脑出血患者与胰岛素抵抗的相关性。方法 对16例脑梗死、11例脑出血及15例对照组者的空腹血糖、血胰岛素、C-肽和胰岛素敏感性指数的测值进行比较和分析。结果 脑梗死组所测空腹血胰岛素(16.82±8.32μIU/ml)、C-肽(2.44+1.13ng/ml)显著高于对照组(8.89±6.84μIU/ml,1.59±0.96ng/ml)(P<0.05),胰岛素敏感性指数(-4.43±0.57)显著低于对照组(-3.67±0.69)(P<0.01);脑出血组的空腹血胰岛素(21.47±16.27μIU/ml)、C-肽(2.51±0.87ng/ml)和胰岛素敏感性指数(-4.57+0.70)与对照组相比有显著性差异(P<0.05,P<0.01);脑梗死组和脑出血组之间的空腹血糖、血胰岛素、C-肽、胰岛素敏感性指数无显著性差异(P>0.05)。结论 胰岛素抵抗在脑梗死和脑出血的急性期有重要作用,是脑卒中的危险因素。     

A randomized,double‐blind,controlled trial evaluating the effect of intranasal insulin on neurocognitive function in euthymic patients with bipolar disorder

McIntyre RS, Soczynska JK, Woldeyohannes HO, Miranda A, Vaccarino A, MacQueen G, Lewis GF, Kennedy SH. A randomized, double‐blind, controlled trial evaluating the effect of intranasal insulin on neurocognitive function in euthymic patients with bipolar disorder. Bipolar Disord 2012: 14: 697–706. © 2012 John Wiley & Sons A/S. Background: Neurocognitive deficits are prevalent, persistent, and implicated as mediators of functional impairment in adults with bipolar disorder. Notwithstanding progress in the development of pharmacological treatments for various phases of bipolar disorder, no available treatment has been proven to be reliably efficacious in treating neurocognitive deficits. Emerging evidence indicates that insulin dysregulation may be pertinent to neurocognitive function. In keeping with this view, we tested the hypothesis that intranasal insulin administration would improve measures of neurocognitive performance in euthymic adults with bipolar disorder. Methods: Sixty‐two adults with bipolar I/II disorder (based on the Mini International Neuropsychiatric Interview 5.0) were randomized to adjunctive intranasal insulin 40 IU q.i.d. (n = 34) or placebo (n = 28) for eight weeks. All subjects were prospectively verified to be euthymic on the basis of a total score of ≤ 3 on the seven‐item Hamilton Depression Rating Scale (HAMD‐7) and ≤ 7 on the 11‐item Young Mania Rating Scale (YMRS) for a minimum of 28 consecutive days. Neurocognitive function and outcome was assessed with a neurocognitive battery. Results: There were no significant between‐group differences in mean age of the subjects {i.e., mean age 40 [standard deviation (SD) = 10.15] years in the insulin and 39 [SD = 10.41] in the placebo groups, respectively}. In the insulin group, n = 27 (79.4%) had bipolar I disorder, while n = 7 (21.6%) had bipolar II disorder. In the placebo group, n = 25 (89.3%) had bipolar I disorder, while n = 3 (10.7%) had bipolar II disorder. All subjects received concomitant medications; medications remained stable during study enrollment. A significant improvement versus placebo was noted with intranasal insulin therapy on executive function (i.e., Trail Making Test–Part B). Time effects were significant for most California Verbal Learning Test indices and the Process Dissociation Task–Habit Estimate, suggesting an improved performance from baseline to endpoint with no between‐group differences. Intranasal insulin was well tolerated; no subject exhibited hypoglycemia or other safety concerns. Conclusions: Adjunctive intranasal insulin administration significantly improved a single measure of executive function in bipolar disorder. We were unable to detect between‐group differences on other neurocognitive measures, with improvement noted in both groups. Subject phenotyping on the basis of pre‐existing neurocognitive deficits and/or genotype [e.g., apolipoprotein E (ApoE)] may possibly identify a more responsive subgroup.     

蒙特利尔认知评估量表在轻度认知功能障碍筛查中的应用

目的 探讨蒙特利尔认知评估量表(MoCA)在轻度认知功能障碍(MCI)患者筛查中的应用.方法 应用简易精神状态检查量表(MMSE)、MoCA对32例MCI患者和50例健康对照者进行神经心理评估,比较二者筛查MCI的效果.结果 以26分为分界值,MoCA筛查MCI的敏感性为96.87%、特异性为76%,MMSE筛查MCI的敏感性为56.25%、特异性为96%;MoCA中除抽象思维、地点定向两项外,其余各亚项的评分在MCI组和对照组间差异均有统计学意义(P＜0.05):MMSE中仅计算与注意力、延迟回忆两项在MCI组和对照组间差异有统计学意义(P＜0.05),其余各项差异均无统计学意义(P＞0.05).结论 MoCA为高敏感性的MCI筛查工具,能全面评估MCI患者的认知功能.且可用于筛查MMSE得分正常的MCI患者.