In the Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from April 2018 to May 2019, we assessed the cognition of T2DM inpatients according to T2DM Diagnostic Standards from the American Diabetes Association ( 13): fasting plasma glucose (FPG) ≥7.0 mmol/L and/or postprandial glucose (PPG) ≥11.1 mmol/L, or in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥11.1 mmol/L, or hemoglobin A1c (HbA1c) ≥6.5%, and clearly classified as type 2. Thus, our aims are to investigate the risk factors of cognitive dysfunction in T2DM patients with MCI and dementia, especially in the consideration of DR. Several studies have explored the association of DR with cognitive impairment, however, their conclusions were conflicting ( 11, 12). As the most specific microvascular complication of diabetes, diabetic retinopathy (DR) shares an overlapped pathophysiology with cognitive decline ( 10). In clinical practice, there are few reliable phenotypic indicators to determine whether T2DM patients are at risk of developing dementia. In addition, T2DM patients would be more vulnerable to cognitive impairment than control group, presenting a damaged self-management of diabetes ( 9). In this regard, early screening and intervention of MCI patients in time is of great importance for reducing the occurrence of dementia in T2DM. The annual conversion rate of MCI to dementia ranges from 5–20% in the general population ( 7), and it accelerates under the pathologic conditions of T2DM ( 8). Mild cognitive impairment (MCI) is the early stage of dementia, defined as a slight cognitive dysfunction which is noticeable and measurable decline in cognitive abilities assessment, but not impact the daily living yet ( 6). Therefore, some studies suggested that ADRDs may be type 3 diabetes mellitus (T3DM) ( 5). Interestingly, T2DM and ADRDs shared a wide range of pathophysiological mechanisms including oxidative stress, amyloidosis, aberrant enzymatic activity, endothelial dysfunction, brain insulin resistance and deficiency, and even shared genetic background ( 4). Epidemiological studies have shown that T2DM increases the risk of ADRDs by 1.5–2.5 times compared to age-matched non-diabetic subjects ( 2, 3). Accepted for publication Dec 06, 2019.Īs familiar chronic diseases, type 2 diabetes mellitus (T2DM), as well as Alzheimer’s disease-related dementias (ADRDs), have a major impact on the quality of life of the ageing populations ( 1). Keywords: Type 2 diabetes mellitus (T2DM) dementia mild cognitive impairment (MCI) diabetic retinopathy (DR) Waist circumference and DR are risk factors of dementia, LDL-C is a risk factor for MCI, and moderate drinking and age at T2DM onset are protective factors for MCI. Low-density lipoprotein cholesterol (LDL-C) was a risk factor for MCI (OR: 1.635, P=0.047), while age at T2DM onset and moderate drinking were protective factors for MCI (OR: 0.936, P=0.044 OR: 0.289, P=0.004).Ĭonclusions: MCI is common in T2DM patients. After adjustment for age, sex, and education level, waist circumference and DR were risk factors for dementia (OR: 1.057, P=0.011 OR: 2.197, P=0.040). Results: Among the 297 T2DM subjects, 47 were enrolled in the dementia group and 174 in the MCI group according to a battery of cognitive function tests, presenting a prevalence of 15.8% and 58.6% respectively. The factors contributing to cognitive dysfunction were analyzed. Patients with non-dementia were further classified into mild cognitive impairment (MCI) and normal cognition status based on MOCA. Firstly, cognition status was classified into dementia and non-dementia according to MMSE and CDR. We adopted the Clinical Dementia Rating (CDR), Mini-mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA) to evaluate the cognitive function. Methods: Two hundred and ninety-seven type 2 diabetes mellitus (T2DM) patients were enrolled in our study.
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