Analysis of the cognitive impairment of type 2 diabetic patients combined with acute cerebral infarction and the related factors

摘要

Objective To explore the cognitive impairment of type 2 diabetes mellitus (DM) patients with acute cerebral infarction and the influencing factors. Methods A total of 145 patients with acute cerebral infarction were divided into 2 groups: simple cerebral infarction group (SCI group, n = 60) and diabetes combined with cerebral infarction (DCI group, n = 85). According to Oxfordshire Community Stroke Project (OCSP) classification, cerebral infarctions were classified as following subtypes: total or partial anterior circulation infarct (TACI/PACI), posterior circulation infarct (POCI) and lacunar infarct (LACI). Plasma homocysteine (Hcy) concentration was determined by enzyme amplified chemiluminometry. Mini?Mental State Examination (MMSE) was used to assess cognitive status. Results Plasma Hcy level in DCI group [(17.06 ± 4.41) μmol/L] was significantly higher than that in SCI group [(15.49 ± 4.11) μmol/L; t = 2.185, P = 0.031]. MMSE score in DCI group (25.36 ± 3.11) was lower than that in SCI group (26.48 ± 2.26; t = 2.502, P = 0.013). Plasma Hcy level was the highest, and MMSE score was the lowest in TACI/PACI patients, and were followed by POCI and LACI patients in successive order. In DCI group MMSE score was significantly negatively correlated with age (r = ? 0.696, P = 0.000), systolic blood pressure (r = ? 0.406, P = 0.000), diastolic blood pressure (r = ? 0.371, P = 0.000), total cholesterol (r = ? 0.477, P = 0.000), triglyceride (r = ? 0.384, P = 0.000), low density lipoprotein?cholesterol (r = ? 0.487, P = 0.000), plasma Hcy (r = ? 0.923, P = 0.000), DM duration (r = ? 0.653, P = 0.000), and glycosylated hemoglobin (HbA1c; r = ? 0.663, P = 0.000); but was positively correlated with smoking (rs = 0.238, P = 0.028), cardiovascular disease (rs = 0.626, P = 0.000), years of education (r = 0.426, P = 0.000), and high density lipoprotein?cholesterol (r = 0.360, P = 0.001). MMSE score was also related to the stroke subtypes (rs = ? 0.557, P = 0.000). Conclusion Cognitive impairment of DCI patients may be closely related to homocysteinemia ? induced neurotoxicity, stroke subtype, related risk factors for cerebrovascular disease, diabetic duration and glycemic control status. DOI：10.3969/j.issn.1672-6731.2011.02.013.