Influencing factors for mild cognitive impairment in type H hypertension patients combined with type 2 diabetes mellitus

doi:10.3969/j.issn.1004-583X.2023.10.004

Abstract

Abstract: Objective To study the influencing factors for cognitive dysfunction in type H hypertension patients combined with type 2 diabetes mellitus (T2DM). Methods A total of 163 type H hypertension patients combined with T2DM who were treated in the Anshan Central Hospital from September 2021 to September 2022 were recruited. All patients were surveyed with the Montreal Cognitive Assessment (MoCA) and the Mini Mental State Examination (MMSE). According to the scoring results, patients with MoCA < 26 points were included in the mild cognitive impairment group (MCI group), and those with MoCA ≥ 26 points were included in the normal cognitive function group (NMCI group). General data of the two groups of patients were collected, including age, gender, smoking history, drinking history, years of education, body mass index (BMI), duration of hypertension and diabetes, history of other diseases like coronary heart disease and dyslipidemia, systolic blood pressure (SBP) and diastolic blood pressure (DBP). In a fasting state, white blood cell count (WBC), red blood cell count (RBC), hemoglobin (Hb), platelet count (PLT), serum homocysteine (Hcy), total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (ApoA-1), apolipoprotein B (ApoB), lipoprotein a (LPa), glycated hemoglobin (HbA₁c), fasting plasma glucose (FPG), serum creatinine (Scr), serum uric acid (SUA), and urinary microalbumin (ALB) were measured. Carotid artery color ultrasound were performed to measure the carotid intima-media thickness (CIMT) and plaque formation. The influencing factors for MCI in type H hypertension patients combined with T2DM were analyzed by binary logistic regression, and their prediction values were assessed by the receiver operating characteristic (ROC) curves. Results The age, smoking, hypertension and diabetes course, SBP, FPG, HbA₁c, HDL-C, LDL-C, APOA-1, SUA, Hcy, CIMT and plaque detection rate in MCI group were significantly higher than those of NMCI group (P<0.05), and the education level was significantly lower (P<0.05). The results of binary logistic regression analysis showed that age, HDL-C, Hcy, and CIMT were independent risk factors for MCI in type H hypertension patients combined with T2DM. ROC curves showed that the area under the curve (AUC) of age, HDL-C, Hcy, and CIMT in predicting MCI in type H hypertension patients combined with T2DM was 0.975, 0.637, 0.647, and 0.842, respectively. Conclusion Elderly, low HDL-C, high Hcy and CIMT thickening are independent risk factors for MCI in type H hypertension patients combined with T2DM. Monitoring blood lipid and Hcy is beneficial to prevent MCI in this population.

Key words: diabetes, type 2, cognitive dysfunction, atherosclerosis, homocysteine, type H hypertension

CLC Number:

R544.1

Xu Yang, Xue Ling. Influencing factors for mild cognitive impairment in type H hypertension patients combined with type 2 diabetes mellitus[J]. Clinical Focus, 2023, 38(10): 887-892.

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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2023.10.004

https://huicui.hebmu.edu.cn/EN/Y2023/V38/I10/887

Figures/Tables 7

Tab. 1 Comparison of general information between groups ($\bar{x}$±s, n[%])

组别	例数(男/女)	年龄(岁)	受教育程度(年)	吸烟史	饮酒史	高血压病史(年)
MCI组	101(60/41)	74.880±7.658	8.140±2.054	51(50.2)	47(46.5)	11.510±6.437
NMCI组	62(46/16)	59.100±9.769	11.970±2.673	20(32.3)	32(51.6)	7.080±3.923
$t$ /χ²值	3.645	11.483	-10.281	5.197	0.397	5.465
$P$ 值	0.055	<0.001	<0.001	0.023	0.529	<0.001
组别	糖尿病病史(年)	冠心病病史	高脂血症史	BMI(kg/m²)	SBP(mmHg)	DBP(mmHg)
MCI组	10.900±6.900	34(33.7)	31(30.7)	24.670±3.175	149.190±12.335	85.800±13.369
NMCI组	5.630±3.838	20(32.3)	15(24.2)	25.150±3.578	145.320±15.982	83.980±12.570
$t$ /χ²值	5.511	0.034	0.801	-0.908	-2.457	1.732
$P$ 值	<0.001	0.853	0.371	0.365	0.015	0.085

Tab. 1 Comparison of general information between groups ($\bar{x}$±s, n[%])

组别	例数(男/女)	年龄(岁)	受教育程度(年)	吸烟史	饮酒史	高血压病史(年)
MCI组	101(60/41)	74.880±7.658	8.140±2.054	51(50.2)	47(46.5)	11.510±6.437
NMCI组	62(46/16)	59.100±9.769	11.970±2.673	20(32.3)	32(51.6)	7.080±3.923
$t$ /χ²值	3.645	11.483	-10.281	5.197	0.397	5.465
$P$ 值	0.055	<0.001	<0.001	0.023	0.529	<0.001
组别	糖尿病病史(年)	冠心病病史	高脂血症史	BMI(kg/m²)	SBP(mmHg)	DBP(mmHg)
MCI组	10.900±6.900	34(33.7)	31(30.7)	24.670±3.175	149.190±12.335	85.800±13.369
NMCI组	5.630±3.838	20(32.3)	15(24.2)	25.150±3.578	145.320±15.982	83.980±12.570
$t$ /χ²值	5.511	0.034	0.801	-0.908	-2.457	1.732
$P$ 值	<0.001	0.853	0.371	0.365	0.015	0.085

Tab. 2 Comparison of laboratory indexes between groups ($\bar{x}$±s)

组别	例数	WBC (10⁹/L)		RBC (10¹²/L)		HGB (g/L)		PLT (10⁹/L)		FBG (mmol/L)	HbA₁c (%)		TC (mmol/L)		TG (mmol/L)
MCI组	101	6.360±1.240		4.540±0.520		144.530±25.454		213.100±49.814		7.720±1.972	6.800±0.830		5.200±1.620		2.250±1.550
NMCI组	62	6.790±1.650		4.690±0.570		148.350±16.268		221.600±39.979		7.200±2.052	7.370±1.420		5.000±1.710		2.740±1.860
$t$ /χ²值		-1.888		-1.771		-1.056		-1.198		0.397	-2.865		0.785		-1.823
$P$ 值		0.061		0.078		0.293		0.233		0.038	0.005		0.434		0.070
组别	HDL-C (mmol/L)		LDL-C (mmol/L)		ApoA-1 (g/L)		ApoB (g/L)		LPa (mg/L)	Scr (μmol/L)		SUA (mmol/L)		Hcy (μmol/L)		ALB (mg/L)
MCI组	1.000±0.310		3.360±0.990		1.130±0.280		1.000±0.340		216.140±145.210	72.740±10.060		306.510±93.440		23.340±6.520		61.820±56.110
NMCI组	1.200±0.370		3.200±1.170		1.220±0.300		1.050±0.250		202.700±139.260	71.870±14.880		358.490±90.420		20.740±5.660		50.370±56.400
$t$ /χ²值	-3.743		-2.241		-1.989		-1.249		0.583	0.306		-3.420		2.598		0.469
$P$ 值	<0.001		0.025		0.048		0.214		0.561	0.760		0.001		0.010		0.640

Tab. 2 Comparison of laboratory indexes between groups ($\bar{x}$±s)

组别	例数	WBC (10⁹/L)		RBC (10¹²/L)		HGB (g/L)		PLT (10⁹/L)		FBG (mmol/L)	HbA₁c (%)		TC (mmol/L)		TG (mmol/L)
MCI组	101	6.360±1.240		4.540±0.520		144.530±25.454		213.100±49.814		7.720±1.972	6.800±0.830		5.200±1.620		2.250±1.550
NMCI组	62	6.790±1.650		4.690±0.570		148.350±16.268		221.600±39.979		7.200±2.052	7.370±1.420		5.000±1.710		2.740±1.860
$t$ /χ²值		-1.888		-1.771		-1.056		-1.198		0.397	-2.865		0.785		-1.823
$P$ 值		0.061		0.078		0.293		0.233		0.038	0.005		0.434		0.070
组别	HDL-C (mmol/L)		LDL-C (mmol/L)		ApoA-1 (g/L)		ApoB (g/L)		LPa (mg/L)	Scr (μmol/L)		SUA (mmol/L)		Hcy (μmol/L)		ALB (mg/L)
MCI组	1.000±0.310		3.360±0.990		1.130±0.280		1.000±0.340		216.140±145.210	72.740±10.060		306.510±93.440		23.340±6.520		61.820±56.110
NMCI组	1.200±0.370		3.200±1.170		1.220±0.300		1.050±0.250		202.700±139.260	71.870±14.880		358.490±90.420		20.740±5.660		50.370±56.400
$t$ /χ²值	-3.743		-2.241		-1.989		-1.249		0.583	0.306		-3.420		2.598		0.469
$P$ 值	<0.001		0.025		0.048		0.214		0.561	0.760		0.001		0.010		0.640

Tab. 3 Comparison of carotid artery ultrasound results between groups ($\bar{x}$±s, n[%])

组别	例数	CIMT(mm)	颈动脉斑块检出率
MCI组	101	2.06±0.77	66(60.0)
NMCI组	62	1.32±0.31	29(46.0)
$t$ /χ²值		7.318	5.450
$P$ 值		<0.001	0.020

Tab. 3 Comparison of carotid artery ultrasound results between groups ($\bar{x}$±s, n[%])

组别	例数	CIMT(mm)	颈动脉斑块检出率
MCI组	101	2.06±0.77	66(60.0)
NMCI组	62	1.32±0.31	29(46.0)
$t$ /χ²值		7.318	5.450
$P$ 值		<0.001	0.020

Tab. 4 Comparison of cognitive function scores between MCI group and NMCI group ($\bar{x}$±s, Score)

组别	例数	MMSE	MOCA	视空间与执行能力	命名	注意力	语言	抽象	延迟记忆	定向力
MCI组	101	23.140±1.710	20.580±2.132	2.640±0.810	2.750±0.430	2.610±0.790	2.770±0.420	1.950±0.220	2.380±0.750	5.480±0.540
NMCI组	62	27.600±0.640	26.160±0.410	3.940±0.770	2.870±0.340	4.790±0.520	2.890±0.320	1.960±0.210	4.100±0.590	5.630±0.490
$t$ 值		-23.660	-25.523	-10.114	-1.947	-21.305	-1.969	-0.032	-16.273	-1.877
$P$ 值		<0.01	<0.01	-10.114	0.053	<0.01	0.051	0.975	<0.01	0.063

Tab. 4 Comparison of cognitive function scores between MCI group and NMCI group ($\bar{x}$±s, Score)

组别	例数	MMSE	MOCA	视空间与执行能力	命名	注意力	语言	抽象	延迟记忆	定向力
MCI组	101	23.140±1.710	20.580±2.132	2.640±0.810	2.750±0.430	2.610±0.790	2.770±0.420	1.950±0.220	2.380±0.750	5.480±0.540
NMCI组	62	27.600±0.640	26.160±0.410	3.940±0.770	2.870±0.340	4.790±0.520	2.890±0.320	1.960±0.210	4.100±0.590	5.630±0.490
$t$ 值		-23.660	-25.523	-10.114	-1.947	-21.305	-1.969	-0.032	-16.273	-1.877
$P$ 值		<0.01	<0.01	-10.114	0.053	<0.01	0.051	0.975	<0.01	0.063

Tab. 5 Logistic regression analysis of risk factors for MCI in type H hypertension patients combined with T2DM

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
年龄	-1.821	0.631	8.335	0.004	0.162	0.047~0.557
受教育程度	-2.966	1.578	3.532	0.060	0.052	0.002~1.136
高血压病程	0.081	0.155	0.271	0.603	1.084	0.799~1.471
T2DM病程	0.002	0.168	0.001	0.990	1.002	0.721~1.392
吸烟史	0.908	1.060	0.734	0.392	2.478	0.311~4.950
HbA₁c	0.577	0.618	0.873	0.350	1.781	0.531~5.974
HDL-C	1.333	0.622	4.583	0.032	3.791	1.119~12.841
ApoA-1	0.660	0.680	0.941	0.322	1.934	0.510~7.332
SUA	0.010	0.007	2.300	0.129	1.010	0.997~1.024
Hcy	-0.075	0.031	6.214	0.013	0.928	0.875~0.984
CIMT	-3.047	0.686	25.329	<0.01	0.032	0.008~0.121

Tab. 5 Logistic regression analysis of risk factors for MCI in type H hypertension patients combined with T2DM

变量	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
年龄	-1.821	0.631	8.335	0.004	0.162	0.047~0.557
受教育程度	-2.966	1.578	3.532	0.060	0.052	0.002~1.136
高血压病程	0.081	0.155	0.271	0.603	1.084	0.799~1.471
T2DM病程	0.002	0.168	0.001	0.990	1.002	0.721~1.392
吸烟史	0.908	1.060	0.734	0.392	2.478	0.311~4.950
HbA₁c	0.577	0.618	0.873	0.350	1.781	0.531~5.974
HDL-C	1.333	0.622	4.583	0.032	3.791	1.119~12.841
ApoA-1	0.660	0.680	0.941	0.322	1.934	0.510~7.332
SUA	0.010	0.007	2.300	0.129	1.010	0.997~1.024
Hcy	-0.075	0.031	6.214	0.013	0.928	0.875~0.984
CIMT	-3.047	0.686	25.329	<0.01	0.032	0.008~0.121

Tab. 6 AUC and 95% CI of age, HDL-C, Hcy, and CIMT

变量
年龄	0.975	0.901	0.903	0.804	66.500	0.957~0.993
HDL-C	0.637	0.931	0.355	0.286	0.745	0.546~0.728
Hcy	0.647	0.733	0.532	0.265	18.550	0.557~0.736
CIMT	0.842	0.644	0.903	0.547	1.625	0.701~0.902

Tab. 6 AUC and 95% CI of age, HDL-C, Hcy, and CIMT

变量
年龄	0.975	0.901	0.903	0.804	66.500	0.957~0.993
HDL-C	0.637	0.931	0.355	0.286	0.745	0.546~0.728
Hcy	0.647	0.733	0.532	0.265	18.550	0.557~0.736
CIMT	0.842	0.644	0.903	0.547	1.625	0.701~0.902

Fig. 1 ROC curve of the predictive value of MCI in type H hypertension patients combined with T2DM

References 25

[1]	Jia L, Du Y, Chu L, et al. Prevalence, risk factors, and management of dementia and mild cognitive impairment in adults aged 60 years or older in China: A cross-sectional study[J]. The Lancet Public health, 2020, 5(12): e661-e671. doi: 10.1016/S2468-2667(20)30185-7 URL
[2]	Ye Z, Wang C, Zhang Q, et al. Prevalence of homocysteine-related hypertension in patients with chronic kidney disease[J]. J Clin Hypertens (Greenwich), 2017, 19(2): 151-160. doi: 10.1111/jch.12881 pmid: 27440006
[3]	Zheng Y, Ley SH, Hu HB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications[J]. Nat Rev Endocrinol, 2018, 14(2): 88-98. doi: 10.1038/nrendo.2017.151 pmid: 29219149
[4]	Antal B, McMahon LP, Sultan SF, et al. Type 2 diabetes mellitus accelerates brain aging and cognitive decline: complementary findings from UK biobank and meta-analyses[J]. ELife, 2022, 5(11):e73138.
[5]	Wang X, Qiao T, Liu M, et al. Homocysteine associated with low cognitive function independent of asymptomatic intracranial and carotid arteries stenoses in Chinese elderly patients: An outpatient-based cross-sectional study[J]. J Geriatr Psychiatry Neurol, 2022, 35(3): 302-308. doi: 10.1177/0891988720988914 URL
[6]	Chang WW, Fei SZ, Pan N, et al. Incident Stroke and its influencing factors in patients with type 2 diabetes mellitus and/or hypertension: A prospective cohort study[J]. Front Cardiovasc Med, 2022, 9(9): 770025. doi: 10.3389/fcvm.2022.770025 URL
[7]	Byeon G, Byun MS, Yi D, et al. Synergistic effect of serum homocysteine and diabetes mellitus on brain alterations[J]. J Alzheimers Dis, 2021, 81(1): 287-295. doi: 10.3233/JAD-210036 URL
[8]	Unger T, Borghi C, Charchar F, et al. 2020 International society of hypertension global hypertension practice guidelines[J]. Hypertension (Dallas, Tex: 1979), 2020, 75(6): 1334-1357.
[9]	Zeña-Huancas PA, Iparraguirre-López H, Gamboa-Cárdenas RV, et al. Homocysteine levels are independently associated with damage accrual in systemic lupus erythematosus patients from a Latin-American cohort[J]. Clin Rheumatol, 2019, 38(4): 1139-1146. doi: 10.1007/s10067-018-4389-3 pmid: 30539353
[10]	中国2型糖尿病防治指南(2020年版)(上)[J]. 中国实用内科杂志, 2021, 41(8): 668-695.
[11]	郭琼, 张建起, 石蕊. 高血压合并糖尿病与老年人认知功能的关系[J]. 中华老年多器官疾病杂志, 2017, 16(1): 38-42.
[12]	Wang YY, Zhang M, Wang XX, et al. Correlates of cognitive impairment in the elderly in China: A cross-sectional study[J]. Front Public Health, 2022, 20(10): 973661.
[13]	Li W, Sun L, Li G, et al. Prevalence, influence factors and cognitive characteristics of mild cognitive impairment in type 2 diabetes mellitus[J]. Front Aging Neurosci, 2019, 30(11): 180.
[14]	李晗, 赵晨, 林中樵, 等. 老年原发性高血压病人认知功能障碍的临床特点及其危险因素分析[J]. 中西医结合心脑血管病杂志, 2022, 20(3): 565-569.
[15]	Fu J, Liu Q, Du Y, et al. Age-and sex-specific prevalence and modifiable risk factors of mild cognitive impairment among older adults in China: A population-based observational study[J]. Front Aging Neurosci, 2020, 30(12): 578742.
[16]	Anusheel? Avula SN, Joseph KN, et al. the role of high-density lipoprotein in lowering risk of dementia in the elderly: A review[J]. Cureus, 2022, 14(4): e24374.
[17]	Lee J, Lee S, Min JY, et al. Association between serum lipid parameters and cognitive performance in older adults[J]. J Clin Med, 2021, 10(22):5405. doi: 10.3390/jcm10225405 URL
[18]	Wang Y, Liu J, Jiang Y, et al. Hyperhomocysteinemia is associated with decreased apolipoprotein AI levels in normal healthy people[J]. BMC Cardiovasc Disord, 2016, 13(16): 10. doi: 10.1186/1471-2261-13-10 URL
[19]	Washida K, Hattori Y, Ihara M. Animal models of chronic cerebral hypoperfusion: From mouse to primate[J]. Int J Mol Sci, 2019, 20(24):6176. doi: 10.3390/ijms20246176 URL
[20]	Chen WH, Jin W, Lyu PY, et al. Carotid atherosclerosis and cognitive impairment in nonstroke patients[J]. Chin Med J, 2017, 130(19): 2375-2379.
[21]	Zhou H, Zhong X, Chen B, et al. Interactive effects of elevated homocysteine and late-life depression on cognitive impairment[J]. J Affect Disord, 2020, 277: 212-217. doi: 10.1016/j.jad.2020.08.022 URL
[22]	Biessels GJ, Despa F. Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications[J]. Nat Rev Endocrinol, 2018, 14(10): 591-604. doi: 10.1038/s41574-018-0048-7 pmid: 30022099
[23]	Wan C, Zong RY, Chen XS. The new mechanism of cognitive decline induced by hypertension: High homocysteine-mediated aberrant DNA methylation[J]. Front Cardiovasc Med, 2022, 24(9): 928701.
[24]	Platt DE, Hariri E, Salameh P, et al. Type II diabetes mellitus and hyperhomocysteinemia: A complex interaction[J]. Diabetol Metab Syndr, 2017, 9(21):19. doi: 10.1186/s13098-017-0218-0 URL
[25]	Yang Y, Xu P, Liu Y, et al. Vascular inflammation, atherosclerosis, and lipid metabolism and the occurrence of non-high albuminuria diabetic kidney disease: A cross-sectional study[J]. Diabetes Vasc Dis Re, 2021, 18(1): 1479164121992524.