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Objective:  To explore the correlation between diabetic cognitive impairment (DCI) and diabetic retinopathy (DR) through examining the cognitive function and the metabolism of the cerebrum in Type 2 diabetes mellitus (T2DM) by  1 H-MRS.   Methods:  Fifty-three patients with T2DM were enrolled for this study. According to the fundus examination, the patients were divided into the DR group ( n  = 26) and the T2DM without DR group (T2DM group,  n  = 27). Thirty healthy adults were selected as a control group (HC group,  n  = 30). Cognitive function was measured by Montreal Cognitive Assessment (MoCA). The peak areas of N-acetylaspartate (NAA), Cho-line (Cho), Creatine (Cr), and Myo-inositol (mI) as well as their ratios were detected by proton magnetic resonance spectroscopy ( 1 H-MRS). The difference analysis between the three groups was performed by one-way ANOVA. When  p  < 0.05, LSD-t was applied. A partial correlation analysis (with age as a covariate) was used to analyze the correlation between metabolites in the DR group and MoCA scores. Among all T2DM patients, Chi-square test age, gender, education level, BMI, SBP, DBP, FPG, HbA1c, TC, TG, HDL-C, LDL-C, DR, and DCI correlation were measured. Differences were statistically significant while  P  < 0.05.   Results:  1. The scores of MoCA in the DR group or in the T2DM group were significantly less than those in the HC group ( F  = 3.54,  P  < 0.05), and the scores of MoCA in the DR group were significantly less than those in the other groups ( F  = 3.61,  P  < 0.05). 2. There were significant differences for NAA in the bilateral hippocampus in DR patients, T2DM patients, and healthy controls ( P  < 0.05). 3. The NAA/Cr was significantly positively correlated with the score of MoCA in DR patients' left hippocampus ( r  = 0.781,  P  < 0.01). 4. Chi-square analysis found that there was a correlation between DR and DCI ( x  2  = 4.6, df = 1,  p  = 0.032, plt: 0.05). There was no correlation between other influencing factors and DCI ( P  > 0.05).   Conclusion:  DCI is closely correlated with the DR in patients with T2DM. Hippocampal brain metabolism may have some changes in two sides of NAA in patients with DR,  1 H-MRS may provide effective imaging strategies and methods for the early diagnosis of brain damage and quantitative assessment cognitive function in T2DM.

Correlation Between Diabetic Cognitive Impairment and Diabetic Retinopathy in Patients With T2DM by 1H-MRS