الفهرس 
Diabetes MellitusOnly 14 pages are availabe for public view
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Abstract
The present work was designed to evaluate cerebral functions in children and adolescents with type 1 diabetes using multidimensional profile, including electrophysiological studies, study of cerebral blood flow as well as assessment of intellectual functions, and psychological stastus.
Correlation between the different parameters of cerebral functions was done. The possible risk factors of cerebral impairment were assessed as well as their prognostic significance.
The work included 50 patients with type 1 diabetes. They were 32 females and 18 males, their ages range from 7 to 18 years. They were divided into three groups according to disease duration (group I : Disease duration < 5 years, group II : Disease duration 5 – 10 years. group III : Disease duration > 10 years). They were chosen randomly from the patients attending the Diabetes Clinic Children ’ Hospital, Faculty of Medicine, Ain Shams University. A group of 20 healthy children and adolescents age and sex matched, 10 males and 10 females constituted the control group of the study.
For all patients and controls included in this work, the following were done : Full history taking, thorough clinical examination, calculation of mean RBS, mean HbA1c over the preceding year of the study, laboratory investigations including : RBS, HbA1c, microalbumin excretion in urine, lipoprotein profile (s. cholesterol, triglycerides, HDL, LDL, VLDL, apoA1, apo B, lipoprotein (a), chol / HDL, LDL / HDL, apo B / apo A1 ratios), regional cerebral blood flow assessment using brain SPECT, electrophysiological assessment using EEG, P300, cognitive function assessment using Wechsler Adult Intelligence Scale-Revised (WAIS-R), psychiatric assessment using semistructural psychiatric interview used by Psychiatric department, Ain Shams University.
Regarding the electrophysiological assessment of the brain abnormal EEG (which were manifested as focal epileptic focus and dysrysthemia), prolonged P300 latency but normal P300 amplitude were observed in the three groups of diabetic patients. No significant correlation between the age of diabetic onset (whether preschool or school age), duration of diabetes frequency and severity of hypoglycemia, DKA (although there was a significant correlation to P300 latency P value < 0.05). mRBS, mHbA1c, symptomatic neurological complications, the presence microabluminuria which were both taken as a marker of diabetic microangiopathy.
Cognitive impairment was noticed in the three diabetic groups which was manifested as decrease in the three parameters of IQ compared to control group (P < 0.05). No significant correlation between age of diabetic onset , duration of diabetes, frequency and severity of hypoglycemia, DKA (although there was a significant correlation to verbal IQ (P value <0.05). mRBS, mHbA1c, symptomatic neurological complications, the presence microalbuminuria.
The present study showed also an increase in the percentage of diabetic patients who had depression in comparison to control group.
In addition they had poor metabolic control in comparison to psychologically free patients.
No significant correlation between P300 latency and amplitude regarding the presence or absence of depression.
Microangiopathy was manifested in the present study as a significant increase in frequency of diabetic patients with symptomatic neurological complications, microalbuminuria which were positively related to duration of diabetes. Although microalbuminuria was noticed in diabetic patients with disease duration < 5 years which may be attributed to this group include 85 % adolescents.
Macroangiopathy was manifested as a significant increase in systolic hypertension which was related to duration of diabetes. A significant increase in the prevalence of renal affection in diabetic patients with systolic hypertension in comparison to normotensive patients.
Regarding lipoprotein pattern in the present study:
• Diabetic patients with disease duration <5 years had a significant increase in serum cholesterol, VLDL, LDL, apoB and Chol/HDL, LDL/HDL ratios.
• Diabetic patients with disease duration 5-10 years had a significant increase in serum TG, apoB, Lp(a), and apoB/apoA1 ratio.
• Diabetic patients with disease duration >10 years had a significant increase serum cholesterol, LDL, apoB, Lp(a), Chol/HDL, LDL/HDL, and apoB/apoA1 ratios.
HDL, apo A1 did not differ between diabetic patients and control group.
A highly positive significant correlation between m.RBS, m.HbA1c in the last year (which are indicator of glycemic control) and Chol / HDL ratio. A significant correlation was observed between m.RBS and LDL / HDL ratio and also between RBS which was done during the study and Chol / HDL ratio.
The present study showed no significant difference in Lp (a) and atherogenic ratios (Chol / HDL, LDL / HDL and ApoB / Apo A1 ratios) in diabetic patients with or without microalbuminuria.
There was a high significant correlation between systolic hypertension and both LDL / HDL,Chol /HDL ratios but not with Apo B / Apo A1ratio or Lp (a).
Brain hypoperfusion was observed in type 1 diabetic patients in comparison to control group. The hypoperfusion was highly significantly more severe in occipital, basal ganglia, followed by cerebellar, frontal regions and whole brain which were manifested in patients with disease duration > 10 years who had more symptomatic neurological complications and microalbuminuria (although the present study demonstrated statistically no relation between the presence of microalbuminuria and cerebral blood flow changes).
Brain hyperfusion was noticed in left followed by right frontal and right cerebellar regions mostly in diabetic patients with disease duration 5 – 10 years, which was suggested to b a chronic adaptive response to protect vulnerable areas of the brain against the effect of severe hypoglycemia.
A high significant negative correlation was observed between the age of studied patients and cerebral blood flow in basal ganglia, parietal, occipital, and temporal regions. and to less extent in frontal regions.
A high significant negative correlation was observed between duration of diabetes and occipital blood flow.
In the present study no significant correlation was observed between RBS, HbA1c, m.RBS, or m.HbA1c or attacks of diabetic ketoacidosis and cerebral blood flow in different regions of the brain in the whole studied diabetic groups.
The present study demonstrated that mean frontal and mean basal ganglia blood flow were significantly reduced in patients with history of mild hypoglycemia >3 times / month and those with severe hypoglycemia.
The present study demonstrated also no correlation between systolic, diastolic blood pressure and mean regional cerebral blood flow
A high significant correlation between Lp (a) and m. total cerebral blood flow, followed by m. occipital blood flow, and a significant correlation between LDL/HDL ratio and mean frontal, mean basal ganglia, mean total brain blood flow. While chol / HDL ratio was significantly correlated to m.cerebellar blood flow. These data indicate that cerebral blood flow is affected by changes in lipoprotein pattern which indicate atherosclerotic changes in cerebrovascular tree.
There were no relation between frequency of abnormal EEG, depression in diabetic patients and m. regional cerebral blood flow.
Also no significant correlation was observed between P300 and different parameters of IQ and mean regional cerebral blood flow.