Abstract
Diabetes mellitus is a risk factor for mild cognitive impairment (MCI) and dementia. However, how the clinical characteristics of MCI patients with type 2 diabetes mellitus are linked to sarcopenia and/or its criteria remain to be elucidated. Japanese patients with type 2 diabetes mellitus were categorized into the MCI group for MoCA-J (the Japanese version of the Montreal cognitive assessment) score <26, and into the non-MCI group for MoCA-J ≥26. Sarcopenia was defined by a low skeletal mass index along with low muscle strength (handgrip strength) or low physical performance (walking speed <1.0 m/s). Univariate and multivariate-adjusted odds ratio models were used to determine the independent contributors for MoCA-J <26. Among 438 participants, 221 (50.5%) and 217 (49.5%) comprised the non-MCI and MCI groups, respectively. In the MCI group, age (61 ± 12 vs. 71 ± 10 years, p < 0.01) and duration of diabetes mellitus (14 ± 9 vs. 17 ± 9 years, p < 0.01) were higher than those in the non-MCI group. Patients in the MCI group exhibited lower hand grip strength, walking speed, and skeletal mass index, but higher prevalence of sarcopenia. Only walking speed (rather than muscle loss or muscle weakness) was found to be an independent determinant of MCI after adjusting for multiple factors, such as age, gender, body mass index (BMI), duration of diabetes mellitus, hypertension, dyslipidemia, smoking, drinking, estimated glomerular filtration rate (eGFR), HbA1c, and history of coronary heart diseases and stroke. In subgroup analysis, a group consisting of male patients aged ≥65 years, with BMI <25, showed a significant OR for walking speed. This study showed that slow walking speed is a sole determinant criterion of sarcopenia of MCI in patients with type 2 diabetes mellitus. It was suggested that walking speed is an important factor in the prediction and prevention of MCI development in patients with diabetes mellitus.
Highlights
Dementia refers to a condition in which cognitive function, which has reached a normal level, is sustainably reduced due to acquired brain damage, thereby interfering with daily life and social life (International Classification of Diseases (ICD11)) [1], Diagnostic & Statistical Manual of Mental Disorders, 5th ed. (DSM-5) [2])
Hand grip strength, walking speed, and skeletal mass index were all lower and the prevalence of sarcopenia was higher in the mild cognitive impairment (MCI) group compared to the non-MCI group (13% vs. 4%)
There were no significant differences in the levels of plasma glucose and HbA1c between the two groups; the levels of albumin, low-density lipoprotein (LDL)-cholesterol, and estimated glomerular filtration rate (eGFR) were lower in the MCI group
Summary
Dementia refers to a condition in which cognitive function, which has reached a normal level, is sustainably reduced due to acquired brain damage, thereby interfering with daily life and social life (International Classification of Diseases (ICD11)) [1], Diagnostic & Statistical Manual of Mental Disorders, 5th ed. (DSM-5) [2]). In the Japanese population, the risk of developing Alzheimer’s disease and vascular dementia is approximately twice as high in patients with type 2 diabetes mellitus as it is in healthy individuals [10]. The risk factors for MCI in patients with type 2 diabetes mellitus may include hypertension, obesity, presence of dyslipidemia, effects of exogenous and endogenous insulin associated with the treatment of diabetes, degree of chronic hyperglycemia, duration of diabetes, and presence of hypoglycemia [7,8,11]. There are three criteria for sarcopenia diagnosis: low muscle mass, low muscle strength, and low physical performance [15,17] It remains unclear how the diagnosis of sarcopenia and/or its three criteria are associated with the presence of MCI in patients with type 2 diabetes mellitus. The main objectives of this study included assessing the clinical characteristics of type 2 diabetes patients with MCI and elucidating whether the diagnosis of sarcopenia and/or its criteria could act as its explanatory factors
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