中青年2型糖尿病患者认知障碍与语言及视空间异常的关系

Association of cognitive impairment with language and visuospatial abnormalities in young and middle-aged patients with diabetes mellitus type 2

摘要:

目的 探讨中青年2型糖尿病（diabetes mellitus type 2，T2DM）患者认知障碍与语言及视空间异常的关系。方法 选取2020年10月至2021年10月在河北省沧州市人民医院就诊的124例中青年T2DM患者作为研究对象，按照有无认知障碍进行分组，将糖尿病合并认知障碍者纳入观察组［蒙特利尔认知量表（Montreal Cognitive Assessment，MoCA）评分<26分］，单纯糖尿病者纳入对照组（MoCA评分≥26分），各62例。比较2组的执行功能［词汇流畅性测验、斯特鲁普色词测验（Stroop color word test，CWT）、数字颜色连线测验（trail making test，TMT）］、视空间能力、语言能力评分（阅读能力、书写能力、听理解能力、复述能力）。采用皮尔逊相关系数分析MoCA评分与空腹血糖、餐后2 h血糖的相关性；采用分层回归模型分析执行功能、语言能力与认知功能的关系；采用Logistic回归模型分析视空间能力与认知功能的关系。结果 观察组的词汇流畅性测验、CWT正确数低于对照组，而CWT耗时数、TMT-A耗时、TMT-B耗时数高于对照组（P<0.05）。观察组的视空间能力评分、语言能力评分低于对照组（P<0.05）。皮尔逊相关系数分析显示，MoCA评分与入组空腹血糖、入组餐后2 h血糖呈相关（分别r=-0.366、-0.338，均P<0.001）。分层回归分析显示，词汇流畅性测验、CWT正确数、阅读能力、书写能力对MoCA评分产生显著的正向影响（P<0.001），TMT-A耗时数、TMT-B耗时数对MoCA评分产生显著的负向影响（P<0.001）。Logistic回归模型分析显示，视空间能力评分为影响T2DM患者认知功能的独立危险因素（P<0.05）。结论 对中青年T2DM患者语言能力和视觉空间能力的动态观察可为识别患者的认知障碍提供依据。 [国际神经病学神经外科学杂志, 2023, 50(3): 41-46]

Abstract:

Objective To investigate the association of cognitive impairment with language and visuospatial abnormalities in young and middle-aged patients with diabetes mellitus type 2 （T2DM）.Methods A total of 124 young and middle-aged patients with T2DM who attended Cangzhou People's Hospital from October 2020 to October 2021 were enrolled as subjects， and according to the presence or absence of cognitive impairment， they were divided into observation group and control group （n=62 each）. The 62 patients with diabetes and cognitive impairment were enrolled as the observation group， with a Montreal Cognitive Assessment （MoCA） score of <26 points， and the 62 patients with diabetes alone were enrolled as the control group， with an MoCA score of ≥26 points. The two groups were compared in terms of executive function ［verbal fluency test， Stroop color word test （CWT）， and trail making test （TMT）］， visuospatial ability， and language ability （reading ability， writing ability， listening comprehension ability， and retelling ability）. The Pearson correlation coefficient was used to analyze the correlation of MoCA score with fasting plasma glucose （FPG） and 2-hour postprandial blood glucose （2hPBG）； the hierarchical regression model was used to analyze the association of executive function and language ability with cognitive function， and the logistic regression model was used to analyze the association between visuospatial ability and cognitive function.Results Compared with the control group， the observation group had significantly lower right numbers of verbal fluency test and CWT and significantly longer CWT time， TMT-A time， and TMT-B time （P<0.05）. The observation group had significantly lower scores of visuospatial ability and language ability than the control group （P <0.05）. The Pearson correlation analysis showed that MoCA score was correlated with FPG and 2hPBG （r=-0.366 and -0.338 respectively， both P<0.001）. The hierarchical regression analysis showed that verbal fluency test， CWT right number， reading ability， and writing ability had a significant positive impact on MoCA score （P<0.001）， while TMT-A time and TMT-B time had a significant negative impact on MoCA score （P<0.001）. The logistic regression analysis showed that visuospatial ability score was an independent risk factor for cognitive function in patients with T2DM （P<0.05）.Conclusions Dynamic observation of language ability and visuospatial ability can provide a basis for identifying cognitive impairment in young and middle-aged patients with T2DM. ［Journal of International Neurology and Neurosurgery, 2023, 50(3): 41-46］