The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus
The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus
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DOI：
10.3233/jad-180914
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发表时间：
2019-01-01
影响因子：
4
通讯作者：
Weinstein, H. C.
中科院分区：
文献类型：
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作者：
Groeneveld, Onno N.;Moneti, Costanza;Weinstein, H. C.
背景：2型糖尿病（T2 DM）可增加血管性认知功能障碍（VCI）的风险。目前尚不清楚哪种类型的血管病变和共病病因，特别是阿尔茨海默病的病理学，与VCI患者的T2 DM相关，以及这与认知和预后的关系。目的：比较可能伴有和不伴有T2 DM的VCI患者的脑MRI和脑脊液（CSF）标记物、认知和预后。我们纳入了851例MRI显示血管性脑损伤的记忆诊所患者（即，可能的VCI）（T2 DM：n = 147，68.4 ± 7.9岁，63%男性;非T2 DM：n = 704，67.6 ± 8.5岁，52%男性）。在基线时，我们评估了脑MRI异常、阿尔茨海默病CSF标志物和认知特征的组间差异。经过两年的随访，我们比较了认知能力下降，中风和death.Results的发生率：临床诊断的分布并没有与T2 DM和非T2 DM患者之间的差异。2型糖尿病患者有更明显的脑萎缩（总体积和白色体积），更多的腔隙性梗死，而微出血较少见（所有p < 0.05）。两组之间的CSF淀粉样蛋白-β水平相似。2型糖尿病患者的工作记忆（效应量：-0.17，p = 0.03）比非糖尿病患者差，而其他领域的表现相似。结论：在可能存在VCI的患者中，T2 DM的存在与更明显的脑萎缩和更高的腔隙性梗死负担有关，但T2 DM对认知功能和预后没有重大影响。
Background: Type 2 diabetes mellitus (T2DM) increases the risk of vascular cognitive impairment (VCI). It is unknown which type of vascular lesions and co-morbid etiologies, in particular Alzheimer's disease pathology, are associated with T2DM in patients with VCI, and how this relates to cognition and prognosis.Objective: To compare brain MRI and cerebrospinal fluid (CSF) markers, cognition, and prognosis in patients with possible VCI with and without T2DM.Methods: We included 851 memory clinic patients with vascular brain injury on MRI (i.e., possible VCI) from a prospective cohort study (T2DM: n = 147, 68.4 +/- 7.9 years, 63% men; no T2DM: n = 704, 67.6 +/- 8.5 years, 52% men). At baseline, we assessed between-group differences in brain MRI abnormalities, CSF markers of Alzheimer's disease, and cognitive profile. After two years follow-up, we compared occurrence of cognitive decline, stroke, and death.Results: The distribution of clinical diagnoses did not differ between patients with and without T2DM. T2DM patients had more pronounced brain atrophy (total and white matter volume), and more lacunar infarcts, whereas microbleeds were less common (all p < 0.05). CSF amyloid-beta levels were similar between the groups. T2DM patients performed worse on working memory (effect size: -0.17, p = 0.03) than those without, whereas performance on other domains was similar. During follow-up, risk of further cognitive decline was not increased in T2DM.Conclusion: In patients with possible VCI, presence of T2DM is related to more pronounced brain atrophy and a higher burden of lacunar infarcts, but T2DM does not have a major impact on cognitive profile or prognosis.