Glycemic variability correlates with medial temporal lobe atrophy and decreased cognitive performance in patients with memory deficits

Shuangmei Zhang; Anrong Wang; Shen Liu; Hongyu Liu; Weifeng Zhu; Zhaoxu Zhang

doi:10.3389/fnagi.2023.1156908

Glycemic variability correlates with medial temporal lobe atrophy and decreased cognitive performance in patients with memory deficits

Front Aging Neurosci. 2023 Jul 18:15:1156908. doi: 10.3389/fnagi.2023.1156908. eCollection 2023.

Authors

Shuangmei Zhang^{1

2}, Anrong Wang³, Shen Liu^{3

4

5}, Hongyu Liu⁶, Weifeng Zhu⁶, Zhaoxu Zhang⁷

Affiliations

¹ Department of Pain Rehabilitation, Cancer Hospital of the University of Chinese Academy of Sciences, Zhejiang Cancer Hospital, Hangzhou, China.
² Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Hangzhou, China.
³ The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.
⁴ Department of Neurology of Traditional Chinese Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.
⁵ Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China.
⁶ Affiliated Hospital of Traditional Chinese Medicine of Guangzhou Medical University, Guangzhou, China.
⁷ Department of Neurology, Peking University People's Hospital, Beijing, China.

Abstract

Background: In the past, researchers have observed a significant link between glycemia and dementia. Medial temporal atrophy (MTA) is regarded as a common marker of dementia. The correlation between glycemic variability and MTA is unclear, and it has not been determined whether glycemic variability can be utilized as a biomarker of MTA and cognitive performance.

Methods: The patients in a memory clinic who underwent brain MRI scans and cognitive assessments within the first week of their hospital visit, were enrolled. All participants underwent three fasting blood glucose and one HBA1c assessments on three self-selected days within 1 week of their first visit. The variability independent of the mean (VIM) was employed. Validated visual scales were used to rate the MTA results. The mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales were employed to assess the cognitive functions of the participants. Spearman's correlation and regression models were used to examine the relationship between the MMSE and MoCA scales, and also determine the link between the MRI characteristics and cognitive status, where vascular risk factors, educational status, age, gender, and mean glucose parameters served as covariates.

Results: Four hundred sixty-one subjects completed the MMSE scale, while 447 participants completed the MoCA scale. Data analysis revealed that 47.72% of the participants were men (220/461), and the median age of the patients was 69.87 ± 5.37 years. The findings of Spearman's correlation analysis exhibited a strong negative relationship between the VIM and MMSE score (r = -0.729, P < 0.01), and the MoCA score (r = -0.710, P < 0.01). The VIM was regarded as an independent risk factor for determining cognitive impairment in both the MMSE and MoCA assessments. The results were unaffected by sensitivity analysis. In addition, a non-linear relationship was observed between the VIM and MTA scores.

Conclusion: The variability in the blood glucose levels, which was presented as VIM, was related to the reduced cognitive function, which was reflected by MMSE and MoCA scales. The relationship between the VIM and the MTA score was non-linear. The VIM was positively related to the MTA score when the VIM was less than 2.42.

Keywords: MMSE; MTA; MoCA; blood glucose variability; glycemic variability; medial temporal atrophy.

Grants and funding

This study was supported by the National Natural Science Foundation of China (Nos. 81303013 and 82004323), the China Postdoctoral Science Foundation (2022T50070), the Shandong Provincial Key Research and Development Program (2017G006021), the Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program (2023ZL281), and the Zhejiang Provincial Medicine and Health Science and Technology Program (2023KY613).