康复干预对老年2型糖尿病伴轻度认知障碍患者认知功能的影响

Effect of rehabilitation intervention on mild cognitive impairment in elderly patients with type 2 diabetes mellitus

摘要:

目的 观察认知功能训练和有氧运动对老年2型糖尿病伴轻度认知障碍(MCI)患者认知功能的影响。方法 选取2014年5月至2016年7月上海市徐汇区大华医院老年2型糖尿病伴MCI患者为研究对象,随机分为对照组(n=38)、认知组(n=35)、有氧组(n=36)。对照组予常规治疗(包括饮食控制和口服降糖药物)；在常规治疗基础上,认知组增加计算机认知功能训练,3次/周,共3个月；有氧组增加健身步行,≥3次/周,共3个月。评估3组患者治疗前后蒙特利尔认知评估(MoCA)总分；分别检测治疗前后各组患者空腹血糖(FBG)、糖化血红蛋白(HbA1c)、甘油三酯(TG)、总胆固醇(TC)等血清学指标；采用稳态模型方法评估胰岛素抵抗(IR)。结果 治疗后认知组和有氧组的MoCA总分均较对照组提高(P<0.05),认知组FBG、HbA1c较对照组下降(P<0.05),有氧组FBG、HbA1c、TG和稳态模型IR指数(HOMA-IR)均较对照组明显下降(分别为P<0.01,P<0.01,P<0.05和P<0.05)。MoCA总分与FBG、HbA1c及HOMA-IR呈负相关(分别为r=－0.235, P<0.01；r=－0.358,P<0.01；r=－0.263,P<0.01)。结论 认知训练及有氧运动可在一定程度上提高老年2型糖尿病MCI患者的认知能力,其机制可能与影响糖代谢有关。

Abstract:

Objective To determine the effect of cognitive training and aerobic exercise on the cognition function in elderly type 2 diabetes mellitus (T2DM) patients with mild cognitive impairment (MCI). Methods The elderly T2DM patients with MCI admitted in our hospital from May 2014 to July 2016 were enrolled in this study. They were randomly divided into control group (n=38), cognition training group (n=35) and aerobic exercise group (n=36). The patients from the control group were given conventional treatment (including diet control and oral hypoglycemic drugs). Besides the conventional treatment, those of cognition training group received computer cognitive function training (3 times/week, for 3 months), and those of the aerobic exercise group had fitness walking (≥3 times/week, for 3 months). Montreal cognitive assessment (MoCA) was carried out for the 3 groups before and after the treatment. Fasting blood glucose (FBG), glycosylated hemoglobin A1c (HbA1c), triglycerides (TG) and total cholesterol (TC) were also detected. The insulin resistance (IR) was estimated by the homeostasis model. Results After the treatment, the MoCA scores were significantly higher in the cognition training group and aerobic exercises group than the control group (P<0.05). The levels of FBG and HbA1c were decreased in the cognition training group after the treatment (P<0.05), and the values of FBG, HbA1c, TG and homeostasis model assessment IR (HOMA-IR) were obviously lower in the aerobic exercise group than the control group (P<0.01, P<0.01, P<0.05 and P<0.05, respectively). The total MoCA score was negatively correlated with FBG, HbA1c and HOMA-IR (r=-0.235,-0.358, and -0.263, respectively,P<0.01). Conclusion Cognition training and aerobic exercise improve the cognitive function in the elderly T2DM patients with MCI to some extent, which might be due to their effect on glucose metabolism.