Association between prediabetes and early vascular cognitive impairment after acute cerebral infarction_West China Medical Journal

Authors：

 ZHAO Xuebin , ZHANG Canfei

Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471000, P. R. China;

Corresponding?author：

ZHAO Xuebin, Email: 284953310@qq.com

Keywords：

Prediabetes; acute cerebral infarction; vascular cognitive impairment

DOI：

10.7507/1002-0179.202005207

Video：

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Objective To explore the association between prediabetes and early vascular cognitive impairment (VCI) in patients with acute cerebral infarction. Methods Non-diabetes mellitus patients with first-ever acute cerebral infarction hospitalized in the Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology between January and April 2019 were retrospectively enrolled. The enrolled patients were divided into prediabetes group and normal blood glucose group according to the level of glycosylated hemoglobin, and the patients were divided into normal cognitive function group and cognitive impairment group according to the Montreal Cognitive Assessment score. The general information and clinical related data of the included patients were compared. Results A total of 129 patients were enrolled. Among them, 46 cases were in the prediabetes group and 83 cases were in the normal blood glucose group. There were 82 cases in the normal cognitive function group and 47 cases in the cognitive impairment group. Multivariate logistic regression analysis showed that compared with the normal blood glucose group, the prediabetes group was associated with early VCI in patients with acute cerebral infarction [odds ratio (OR)=4.172, 95% confidence interval (CI) (1.786, 9.754), P=0.001]; the higher the NationalInstitutes of Health Stroke Scale score at the first admission was, the higher the risk of early VCI was [OR=1.379, 95%CI (1.183, 1.650), P<0.001]. Conclusion In patients with first-ever acute cerebral infarction, prediabetes is associated with early VCI.

Citation： ZHAO Xuebin, ZHANG Canfei. Association between prediabetes and early vascular cognitive impairment after acute cerebral infarction. West China Medical Journal, 2022, 37(9): 1308-1313. doi: 10.7507/1002-0179.202005207 Copy

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16.	Ciudin A, Espinosa A, Simó-Servat O, et al. Type 2 diabetes is an independent risk factor for dementia conversion in patients with mild cognitive impairment. J Diabetes Complications, 2017, 31(8): 1272-1274.
17.	Marseglia A, Dahl Aslan AK, Fratiglioni L, et al. Cognitive trajectories of older adults with prediabetes and diabetes: a population-based cohort study. J Gerontol A Biol Sci Med Sci, 2018, 73(3): 400-406.
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19.	Milman S, Crandall JP. Mechanisms of vascular complications in prediabetes. Med Clin North Am, 2011, 95(2): 309-325, vii.
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24.	Farris W, Mansourian S, Chang Y, et al. Insulin-degrading enzyme regulates the levels of insulin, amyloid beta-protein, and the beta-amyloid precursor protein intracellular domain in vivo. Proc Natl Acad Sci USA, 2003, 100(7): 4162-4167.
25.	Hardy J, Selkoe DJ. The amyloid hypothesis of Alzheimer’s disease: progress and problems on the road to therapeutics. Science, 2002, 297(5580): 353-356.
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1. 國家衛計委腦卒中防治工程委員會. 中國血管性認知障礙診療指導規范(2016年). 全科醫學臨床與教育, 2016, 14(5): 484-487.
2. Nys GM, van Zandvoort MJ, de Kort PL, et al. The prognostic value of domain-specific cognitive abilities in acute first-ever stroke. Neurology, 2005, 64(5): 821-827.
3. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care, 2013, 36 (Suppl 1): S67-S74.
4. Tabák AG, Herder C, Rathmann W, et al. Prediabetes: a high-risk state for diabetes development. Lancet, 2012, 379(9833): 2279-2290.
5. Nathan DM, Kuenen J, Borg R, et al. Translating the A1C assay into estimated average glucose values. Diabetes Care, 2008, 31(8): 1473-1478.
6. Lyons TJ, Basu A. Biomarkers in diabetes: hemoglobin A1c, vascular and tissue markers. Transl Res, 2012, 159(4): 303-312.
7. Ben Assayag E, Eldor R, Korczyn AD, et al. Type 2 diabetes mellitus and impaired renal function are associated with brain alterations and poststroke cognitive decline. Stroke, 2017, 48(9): 2368-2374.
8. Maan HB, Meo SA, Rouq FA, et al. Impact of glycated hemoglobin (HbA1c) on cognitive functions in type 2 diabetic patients. Eur Rev Med Pharmacol Sci, 2021, 25(19): 5978-5985.
9. 中華醫學會神經病學分會, 中華醫學會神經病學分會腦血管病學組. 中國急性缺血性腦卒中診治指南2014. 中華神經科雜志, 2015, 48(4): 246-257.
10. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care, 2014, 37 (Suppl 1): S81-S90.
11. Nasreddine ZS, Phillips NA, Bédirian V, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 2005, 53(4): 695-699.
12. Levine DA, Davydow DS, Hough CL, et al. Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke. Circ Cardiovasc Qual Outcomes, 2014, 7(6): 863-871.
13. Mijajlovi? MD, Pavlovi? A, Brainin M, et al. Post-stroke dementia-a comprehensive review. BMC Med, 2017, 15(1): 11.
14. Roquer J, Rodríguez-Campello A, Cuadrado-Godia E, et al. Ischemic stroke in prediabetic patients. J Neurol, 2014, 261(10): 1866-1870.
15. Alexandrova ML, Danovska MP. Cognitive impairment one year after ischemic stroke: predictorsand dynamics of significant determinants. Turk J Med Sci, 2016, 46(5): 1366-1373.
16. Ciudin A, Espinosa A, Simó-Servat O, et al. Type 2 diabetes is an independent risk factor for dementia conversion in patients with mild cognitive impairment. J Diabetes Complications, 2017, 31(8): 1272-1274.
17. Marseglia A, Dahl Aslan AK, Fratiglioni L, et al. Cognitive trajectories of older adults with prediabetes and diabetes: a population-based cohort study. J Gerontol A Biol Sci Med Sci, 2018, 73(3): 400-406.
18. Messier C. Glucose improvement of memory: a review. Eur J Pharmacol, 2004, 490(1/2/3): 33-57.
19. Milman S, Crandall JP. Mechanisms of vascular complications in prediabetes. Med Clin North Am, 2011, 95(2): 309-325, vii.
20. Schaefer C, Biermann T, Schroeder M, et al. Early microvascular complications of prediabetes in mice with impaired glucose tolerance and dyslipidemia. Acta Diabetol, 2010, 47(Suppl 1): 19-27.
21. Ertan C, Ozeke O, Gul M, et al. Association of prediabetes with diffuse coronary narrowing and small-vessel disease. J Cardiol, 2014, 63(1): 29-34.
22. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol, 2010, 9(7): 689-701.
23. Biessels GJ, van der Heide LP, Kamal A, et al. Ageing and diabetes: implications for brain function. Eur J Pharmacol, 2002, 441(1/2): 1-14.
24. Farris W, Mansourian S, Chang Y, et al. Insulin-degrading enzyme regulates the levels of insulin, amyloid beta-protein, and the beta-amyloid precursor protein intracellular domain in vivo. Proc Natl Acad Sci USA, 2003, 100(7): 4162-4167.
25. Hardy J, Selkoe DJ. The amyloid hypothesis of Alzheimer’s disease: progress and problems on the road to therapeutics. Science, 2002, 297(5580): 353-356.
26. Nunnari D, Bramanti P, Marino S. Cognitive reserve in stroke and traumatic brain injury patients. Neurol Sci, 2014, 35(10): 1513-1518.
27. Kessels RP, Eikelboom WS, Schaapsmeerders P, et al. Effect of formal education on vascular cognitive impairment after stroke: a meta-analysis and study in young-stroke patients. J Int Neuropsychol Soc, 2017, 23(3): 223-238.

West China Medical Journal

Association between prediabetes and early vascular cognitive impairment after acute cerebral infarction

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