Increased cortical atrophy in patients with Alzheimer's disease and type 2 diabetes mellitus

BACKGROUND: The risk of Alzheimer's disease (AD) is increased in type 2 diabetes (DM2). This increased risk has been attributed to vascular comorbidity, but other mechanisms, such as accelerated ageing of the brain, have also been implicated. OBJECTIVE: To determine whether AD in patients with DM2 is associated with an increased occurrence of vascular lesions in the brain, by increased cerebral atrophy, or a combination of both. METHODS: In total, 29 patients with AD and DM2 and 58 patients with AD and without DM2 were included in the study. Clinical characteristics were recorded, and a neuropsychological examination and magnetic resonance imaging (MRI) scan were performed. MRI scans were rated for cortical and subcortical atrophy, medial temporal lobe atrophy, white matter lesions, and infarcts. RESULTS: The neuropsychological profiles of the two groups were identical. Patients with AD and DM2 had increased cortical atrophy on MRI (p<0.05) compared with the non-DM2 group. In addition, infarcts were more common (odds ratio 2.4; 95% CI 0.8 to 7.8), but this effect did not account for the increased atrophy. The other MR measures did not differ between the groups. CONCLUSION: The results suggest that non-vascular mechanisms, leading to increased cortical atrophy, are also involved in the increased risk of AD in DM2.     

T2DM患者脑诱发电位失匹配负波的变化观察

目的观察T2DM患者脑诱发电位失匹配负波的变化特点。方法对50例T2DM患者、40例正常人进行失匹配负波(MMN)检查。结果与正常对照组比较,T2DM患者脑诱发电位的MMN潜伏期延长、波幅降低,2组比较差异有统计学意义(P<0.05)。结论T2DM患者存在认知功能损害,MMN是敏感的检测工具。     

2型糖尿病并发脑卒中患者血清学指标分析

目的探讨2型糖尿病并发脑卒中血清学指标的检测及临床意义。方法选取糖尿病合并脑卒中患者65例,其中脑出血20例,脑梗死45例以及30例正常健康对照,比较各组间、FIB、DD、WBC、RDW、PDW、TG、TC的差异。结果糖尿病脑卒中组WBC、FIB、DD、TC、TG与正常组比较,差异有统计学意义(P<0.05);糖尿病脑卒中组RDW、PDW与正常组比较,差异无统计学意义(P>0.05);WBC、FIB、DD、TC、TG、RDW、PDW在糖尿病脑梗死与糖尿病脑出血组比较,差异无统计学意义(P>0.05)。结论 FIB、DD、WBC、TG、TC作为2型糖尿病脑卒中的危险因素,对脑血管病的发生、发展及预后具有重要的参考价值。     

应用多普勒血流探测仪评估踝肱指数与2型糖尿病患者发生大血管病变的相关性★

目的：分析踝肱指数与2型糖尿病患者发生大血管并发症的相关性，验证踝肱指数作为评价或预测糖尿病大血管病变简易指标的可能性。 方法：对2006-04/2007-04在解放军第二炮兵总医院住院的2型糖尿病患者213例资料进行回顾性分析。糖尿病诊断均符合ADA（1997）标准，其中男性108例，女性105例；年龄25～86岁，平均（60.5±12.9）岁；病程1～600个月。采用日本林电器株式会社制造的 ES-1000SPM多普勒血流探测仪测定踝肱指数。患者入院后第1天清晨空腹均进行身高、体质量、血压测量，计算体质量指数，行糖化血红蛋白、总胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿素氮、肌酐、尿酸、尿微量白蛋白、踝肱指数、眼底检查，常规12导联心电图检查。将所有患者以踝肱指数比值大小分2组，分别为踝肱指数< 0.9组29例和踝肱指数≥ 0.9组184例。 结果：213例2型糖尿病患者中,周围动脉闭塞性疾病的发病率为13.6%,性别方面差异无显著性。踝肱指数< 0.9组患者年龄大，病程长，合并糖尿病肾病、冠心病、脑梗死率高于踝肱指数≥ 0.9组，差异有显著性意义（P < 0.05）。踝肱指数与年龄、糖尿病病程、糖化血红蛋白、低密度脂蛋白胆固醇呈负相关（P < 0.05）。logistic回归显示年龄、糖尿病病史、脑梗死是踝肱指数的独立危险因子。 结论：踝肱指数与2型糖尿病患者大血管病变发生率密切相关，是2型糖尿病患者进行周围动脉闭塞性疾病初筛的有效指标。     

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。     

2型糖尿病患者记忆功能及相关脑区代谢的改变

目的 探讨2型糖尿病患者记忆功能和相关脑区代谢的改变.方法 对以记忆减退为主诉的2型糖尿病患者(糖尿病组,73例)和无糖尿病患者(对照组,73例)进行简易精神状态检查(MMSE)、蒙特利尔认知评估量表(MoCA)、修订韦氏记忆量表中文版(RWMS-RC)检查.同时予左侧海马、额叶、基底节及丘脑磁共振质子波谱分析检查,采集N-乙酰天门冬氨酸(NAA)、胆碱复合物(Cho)、肌醇(mI)、肌酸复合物(Cr,Cr2)及谷氨酸复合物(CIx)峰下面积数值,并进行比较.结果 (1)糖尿病组MMSE、MoCA评分,以及MoCA中瞬时记忆及短时记忆评分明显低于对照组(P＜0.01～ 0.005);两组间WMS-RC评分差异无统计学意义.(2)与对照组相比,糖尿病组左侧海马Cr、mI峰下面积及左侧额叶Cr2峰下面积明显高于对照组(P＜0.05～0.01);左侧丘脑NAA、Cr2、Cho峰下面积明显低于对照组(均P＜0.05).两组间左侧基底节区各代谢物水平差异无统计学意义.结论 2型糖尿病损害记忆功能;与记忆功能有关的海马、额叶和丘脑存在代谢异常.     

Cognitive functioning and brain MRI in patients with type 1 and type 2 diabetes mellitus: a comparative study

BACKGROUND/AIMS: Diabetes mellitus (DM) may affect the central nervous system, resulting in cognitive impairments. It has been suggested that cognitive impairments are more pronounced in DM2 than in DM1, but studies that directly compare the effects of these 2 types of DM on cognition are lacking. METHODS: Forty patients with DM1 (mean duration: 34 years) were compared with 40 age- and education-matched patients who were known to have DM2 (mean duration: 7 years). Extensive neuropsychological assessment focussed on abstract reasoning, memory, attention and executive function, visuoconstruction and information processing speed. Psychological well-being was measured and brain MRIs were obtained. RESULTS: No systematic between-group differences were observed in neuropsychological measures or levels of psychological well-being. DM2 patients showed significantly more deep white matter lesions and cortical atrophy on MRI (p < 0.01). CONCLUSION: DM1 patients with more than 30 years of DM have a similar cognitive profile and better MRI ratings than age- and education-matched DM2 patients with only 7 years of DM.     

2型糖尿病患者交感皮肤反应分析

目的探讨交感皮肤反应(SSR)对检测2型糖尿病(T2DM)患者交感神经功能损害的诊断价值。方法选择本院收治的60例2型糖尿病患者进行交感皮肤反应检测,并与40例健康人进行对比。结果60例糖尿病患者交感皮肤反应与对照组比较,起始潜伏时差异有统计学意义(P<0.05),而波幅上下肢差异无统计学意义。结论SSR可以作为评价糖尿病患者交感神经功能的一个显著指标。     

2型糖尿病合并急性腔隙性脑梗死患者颅内动脉搏动指数的临床意义

目的 探讨2型糖尿病合并急性腔隙性脑梗死患者的颅内动脉搏动指数(PI)的临床意义.方法 应用经颅多普勒(TCD)分别检测48例2型糖尿病合并急性腔隙性脑梗死者(DM-L组)、65例2型糖尿病无脑梗死患者(DM-N组)及59例健康对照者(正常对照组)的大脑中动脉(MCA),记录其血流速度及PI.对检查结果进行比较.结果 排除颞窗探测失败和平均流速明显增高并提示有显著大动脉狭窄的患者18例,其中DM-L组7例、DM-N组5例、正常对照组6例.DM-L组和DM-N组双侧PI均显著高于正常对照组(均P ＜0.001).DM-L组双侧PI显著高于DM-N组(均P＜0.05).结论 颅内动脉PI增高可以反映2型糖尿病患者微血管病变程度.PI可以作为2型糖尿病并发急性腔隙性脑梗死的预测指标.     

米氮平对2型糖尿病患者合并抑郁症的疗效观察

目的 探讨果氮平对2型糖尿病患者合并抑郁症的疗效.方法 将120例合并抑郁症的2型糖尿病患者,随机分为研究组和对照组,每组60例.对照组仅用降糖药治疗,研究组在常规降糖药治疗基础上联用米氮平( 15～45mg/d)治疗,治疗8周.在治疗前和治疗8周末均进行汉密尔顿抑郁量表(HAMD)评定和空腹血糖、餐后2h血糖、糖化血...     

Brain lesions on MRI in elderly patients with type 2 diabetes mellitus

BACKGROUND AND PURPOSE: Diabetes mellitus (DM) type 2 has been associated with poor cognitive performance and dementia, particularly in elderly patients. The exact mechanisms underlying the cognitive dysfunction in DM remain unclear. Imaging studies of the brain could be helpful to give more insight into possible structural brain lesions underlying these cognitive dysfunctions. Therefore, we performed a study in independently living patients with DM type 2 in order to investigate the association between DM and brain imaging abnormalities. METHODS: The study population consisted of 45 patients with DM type 2 without hypertension (mean age 73.4 +/- 5.1 years, mean duration 16.5 +/- 11.5 years), 45 patients with DM type 2 and hypertension (mean age 73.5 +/- 6.1 years, mean duration 11.9 +/- 9.2 years) and 44 control subjects (mean age 73.1 +/- 5.4 years). All patients and control subjects underwent an MRI of the brain. White matter lesions (WML), cerebral atrophy and medial temporal lobe atrophy were rated by a standardized visual rating scale. Lacunar infarcts were defined as focal hypo-intensities on fluid-attenuated inversion recovery sequences with a hyperintense rim around it. RESULTS: WML occurred more frequently in diabetic patients with hypertension as well as without hypertension. Significantly more deep WML were found in DM patients with and without hypertension when compared to control subjects, whereas no difference was found in the occurrence of periventricular hyperintensities. In all 3 groups, lacunar infarcts occurred sporadically. A trend towards higher atrophy scores was seen in patients with DM compared to control subjects. CONCLUSIONS: The data of this cross-sectional study suggest that type 2 DM is an independent risk factor for deep WML in the independently living elderly patients.     

Glycemic control and major depression in patients with type 1 and type 2 diabetes mellitus.

The current study evaluated the association of glycemic control and major depression in 33 type 1 and 39 type 2 diabetes mellitus patients. Type 1 patients with a lifetime history of major depression showed significantly worse glycemic control than patients without a history of psychiatric illness (t = 2.09; df = 31, p < 0.05). Type 2 diabetes patients with a lifetime history of major depression did not have significantly worse control than those with no history of psychiatric illness. Findings from this study indicate different relationships between lifetime major depression and glycemic control for patients with type 1 and type 2 diabetes. Treatment implications for glycemic control in type 1 and type 2 diabetes patients are discussed.     

100例2型糖尿病患者交感神经皮肤反应研究

目的探讨交感神经皮肤反应(SSR)检测在评价2型糖尿病(T2DM)自主神经损害中的价值.方法对100例T2DM患者进行SSR检测,30例健康志愿者作为对照.结果2组SSR的起始潜伏期、N波潜伏期、波幅、面积比较差异有显著性意义(P＜0.05),P波潜伏期差异无显著性意义(P＞0.05).T2DM组72例(72%)患者至少有一肢SSR异常.血糖控制满意组和血糖控制不良组比较,起始和N波潜伏期差异有统计学意义(P＜0.05),波幅和面积无显著性意义(P＞0.05).T2DM组病程＜5年与病程≥5年比较,潜伏期、波幅、面积差异均无统计学意义(P＞0.05).结论SSR可作为评价T2DM自主神经损害的客观电生理指标;T2DM患者SSR与血糖控制水平相关,与病程无关.     

Clinical determinants of carotid intima-media thickness in patients with diabetes mellitus type 2

Background and purposeEarly atherosclerotic changes in carotid arteries can be detected using ultrasound examination. The aim of this study was to assess correlations between intima-media thickness (IMT) and gender, age and clinical features of diabetes mellitus (DM).Material and methodsThe study group consisted of 73 patients with type 2 DM (mean age: 63.6 ± 7.5 years), and 74 controls without DM (mean age 62.2 ± 7.5 years). Analysed clinical features of diabetes included disease duration, anti-diabetic treatment, glycaemic control (HbA_1c level), presence of metabolic syndrome, and complications of macroand microangiopathy. IMT was measured using ultrasonography in the carotid arteries (common – CCA, bifurcation, internal – ICA) bilaterally.ResultsMean and maximum IMT in the CCA was greater in diabetic patients than in controls. Age and male sex, but not vascular risk factors, were independent predictors of increased IMT in all segments. Macroangiopathy correlated with IMT within both CCA in univariate analysis. After adjusting for age and gender, this relationship remained significant in the right CCA in middle-aged patients (59–67 years; p = 0.01 for mean IMT, p = 0.02 for maximum IMT). In patients without metabolic syndrome, IMT in the right CCA bifurcation correlated with HbA_1c level (p = 0.05). Patients treated simultaneously with insulin and oral antidiabetic drugs had smaller IMT in the right ICA than those treated with insulin only (0.471 ± 0.105 vs. 0.678 ± 0.209 mm; p = 0.04).ConclusionsIn diabetic patients, ultrasound IMT measurement can be used to assess the cardiovascular risk and to determine indications for intensified anti-diabetic treatment. IMT is a sensitive marker of early carotid atherosclerosis, particularly on the right side.     

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。     

Motor-evoked potentials in patients with diabetes mellitus type 1

BACKGROUND AND PURPOSE: The aim of the study was to assess the function of the central motor pathway in young patients with diabetes mellitus type 1 by use of transcranial and paravertebral magnetic stimulation. MATERIALS AND METHODS: MEPs were recorded in 68 young patients (25+/-5.69 years), with diabetes mellitus type 1, from muscles: abductor digiti minimi and abductor hallucis (AH). Central motor conduction time (CMCT) was calculated by subtracting cortical latency (CL) after transcranial stimulation from the motor nerve conduction time (MNCT) after paravertebral stimulation. The obtained results were compared with normative data from the group of 36 healthy volunteers, matched for age and height. Statistical comparison of CMCT between diabetic and control groups was performed. RESULTS: There were no significant differences between the diabetics and control means of CMCT. Also, we were unable to elicit the MEPs cortically from AH muscle in 19 (27.9%) of diabetic patients and only in 3 (8.3%) controls. CONCLUSION: CMCT is normal in patients below 40 years of age, in whom the MEPs after transcranial stimulation can be elicited. Lack of MEPs in lower limb muscles following transcranial stimulation in almost 30% of patients in the presence of MEPs in upper limbs may indirectly suggest the dysfunction of central motor conduction in those cases.