title: [Correlation between cognitive impairment and diabetic nephropathy in patients with Type 2 diabetes mellitus].
abstract: OBJECTIVE
  To explore the correlation between diabetic nephropathy (DN) and cognitive impairment through examining the cognitive function and the metabolism of the cerebrum in Type 2 diabetes mellitus patients at different stages of renal function.
  
  
  METHODS
  Eighty six patients with Type 2 diabetes mellitus (T2DM) were enrolled for this study. According to the urinary albumin excretion rate (UAER), the patients were divided into a T2DM without DN group (DM group, n=33), an early DN group (DN-III group, n=26) and a clinical stage group (DN-IV group, n=27). Thirty healthy adults were selected as a control group (NC group). Biochemical indexes and UAER were measured, and glomerular filtration rate (GFR) was detected by single-photon emission computed tomography (SPECT). The cognitive function was measured by Montreal Cognitive Assessment (MoCA, Beijing version) and mini-mental state examination (MMSE). The peak areas of N-acetylasparte (NAA), creatine (Cr), choline-containing compounds (Cho) were detected by proton magnetic resonance spectroscopy (1H-MRS).
  
  
  RESULTS
  1) There was no statistical difference in MMSE scores between the DM group and the control group. The scores of MoCA in the DN-III group or in the DN-IV group were significant less than that in the NC group (F=3.66, P<0.05); 2) There was significant difference in left N-acetylaspartate (LNAA), left choline (LCho) among the diabetes groups. Compared with the DM group, the level of LNAA was decreased significantly (t=3.826, P<0.05) while the LCho was increased significantly (t=4.373, P<0.05) in the DN groups, with statistic difference between the 2 groups (t=3.693, P<0.05); 3) The MoCA scores of T2DM patients were negatively correlated with UAER (r=-0.285, P<0.05), while positively correlated with GFR (r=0.379, P<0.05); 4) Logistic regression analysis indicated that UAER and GFR were the major risky factors for diabetic cognitive impairment.
  
  
  CONCLUSIONS
  Diabetic cognitive impairment is closely correlated with the nephropathy in patients with Type 2 diabetes. With the decline in glomerular filtration function, the cognitive disorder tends to be aggravated. The hippocampal brain metabolism may have some changes in left side of Cho/Cr in patients with diabetic nephropathy.
authors.affiliation: Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Xiajie
authors.initials: X
authors.lastname: Shi
authors.affiliation: Department of Endocrinology, Jinjiang Hospital, Quanzhou Fujian 362200, China.
authors.forename: Yuren
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Hongtao
authors.initials: H
authors.lastname: Niu
authors.affiliation: Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Ran
authors.initials: R
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Jinjing
authors.initials: J
authors.lastname: Shen
authors.affiliation: Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Shanlei
authors.initials: S
authors.lastname: Zhou
authors.affiliation: Department of Anesthesiology, Xiangya Boai Rehabilitation Hospital, Changsha 410100, China.
authors.forename: Haobo
authors.initials: H
authors.lastname: Yang
authors.affiliation: Department of Pharmaceutical Engineering, College of Chemistry and Chemical Engineering, Central South University, Changsha 410083, China.
authors.forename: Shan
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Endocrinology, Xiangya Hospital, Central South University, Changsha 410008, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Wu
mesh_terms: D000328:Adult; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D016022:Case-Control Studies; D054022:Cerebrum / Q000378:metabolism; D002794:Choline / Q000378:metabolism; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology*; D003401:Creatine / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000453:epidemiology*; D005919:Glomerular Filtration Rate; D006801:Humans; D009483:Neuropsychological Tests
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline