**1. Introduction**

One of the most significant in the social aspect of the categories in the population was and still is patients with diabetes mellitus (DM). According to the estimates of the International Diabetes Federation, there are 415 million people with diabetes in the world in 2015, and by 2040, it is projected to grow to 642 million people. In the last decade, it has been proven that diabetes mellitus causes disturbances in the functioning of regulatory systems and the psychological and emotional state has both direct and indirect effects on the development of

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

complications from the central nervous system, manifested by morphological and functional disorders. The reflection of brain neuroplasticity is the dynamics of cognitive impairment.

**2. Pilot study: identification of cognitive impairment markers** 

16–30 and signed informed consent of the patient to participate in the study.

refusal to sign an informed consent of the patient to participate in the study.

**with type 1 diabetes mellitus**

**(neurospecific proteins, magnetic resonance tomography) in patients** 

The study of cognitive dysfunction in patients with type 1 DM was carried out at the clinical bases of the Departments of Endocrinology and Diabetology, Neurology and Neurosurgery of the Siberian State Medical University, and the plan and the study were in full compliance with the principles of Good Clinical Practice (GCP) and Helsinki Declaration (including amendments).

Cognitive Impairment in Patients with Diabetes Mellitus http://dx.doi.org/10.5772/intechopen.74388 17

The study included 116 patients with type 1 diabetes mellitus at the age of 22.4 ± 4.6 years, 58 men and 58 women, and the duration of the disease was 6.6 ± 3.9 years. The control group consisted of 29 healthy people, aged 22.4 ± 4.8 years, 14 men and 15 women, without acute and chronic diseases. Inclusion criteria are patients with type 1 diabetes mellitus at the age of

Exclusion criteria are hypoglycemic and ketoacidotic coma for 1 year prior to study; presence of hematological, oncological, and serious infectious diseases; condition after severe craniocerebral injuries and surgeries; participation in other clinical trials in the last 30 days; and now

To detect violations of carbohydrate metabolism, glucose was determined by the glucose oxidase method on the biochemical analyzer "Hitachi 912" (Hoffmann-La Roche Ltd./Roche Diagnostics GmbH, Germany). HbA1c content was analyxed in capillary blood - by liquid chromatography method on DS5 Glycomat analyzer (Drew Scientific, the Netherlands).

With the biochemical methods of research, the content of neurospecific proteins in plasma was determined. To analyze the quantitative content of the S100 protein (S100A1B + S100BB), a kit was used (FujirebioS100 EIA, BioC himMak, Russia). GFAP was determined by enzyme immunoassay using a standard protocol using a reagent kit from the manufacturer (BioVendor Laboratory Medicine, Inc., Germany). The myelin basic protein (MBP) level was studied using the "DSL-10-58,200" kit (BioChimMak, Russia). The complex of mandatory diagnostic methods included magnetic resonance imaging of the brain on the Harmony 1.0 T apparatus (Siemens, Germany) by MDCS-Tomsk Ltd., which was carried out according to the standard procedure in the axial, sagittal, and coronal projections using T2 (TR (time of repetition) 4932 ms, TE (Echotime) 90 ms) and T1 (TR 280 ms, TE 6.1 ms) and using programs with free water signal suppression fluid-attenuated inversion recovery (FLAIR; TR 8000 ms, TE 105 ms, TI (time in version) 2200 ms). Evaluation of gliosis foci of brain substance was carried out according to the size and quantity in the frontal (subcortical, paraventricular), temporal (white matter, hippocampal area), parietal (subcortical, paraventricular), and occipital (subcortical, paraventricular) areas. Taking into account the classification of F. Fazekas, in the modification of NN Yakhno, a quantitative gradation of focal changes in the white matter was carried out [7]. The severity of leukoareosis was assessed in scores proposed by Liu et al. [8]. For the quantitative evaluation of

the expansion of perivascular spaces, the estimated scale of MacLullich [9] was used.

According to the latest revision of the international guidelines for the diagnosis of mental disorders, cognitive disorders include a decrease in one or more higher cerebral functions, in comparison with the premorbid level, that provide the processes of perception, preservation, transformation, and transmission of information. The presence of cognitive impairments has an extremely negative effect on the quality of life of the patient and their immediate family and complicates the treatment of concomitant diseases and the conduct of rehabilitation activities. Therefore, timely diagnostics and the earliest possible initiation of therapy for existing cognitive disorders are very important.

**Figure 1** shows that the effect of dysglycemia in the debut of type 1 diabetes mellitus, especially in childhood, leads to a statistically more significant pronounced cognitive impairment, as well as structural changes in the brain over time [1].

To date, it is urgent to search for a quick, simple, and well-tried method for diagnosing cognitive impairment, taking into account the minimum costs. One of the promising methods that can be considered is the identification of neurospecific proteins, which are signals of brain damage [2–4]. To diagnose central nervous system diseases, magnetic resonance methods of brain examination are used as additional techniques for detecting morphological changes [5, 6].

**Figure 1.** The trajectory of disorders from the brain's magnetic resonance imaging data in patients with type 1 diabetes mellitus is associated with loss of brain volume (blue line, evolution of brain volumes with age in the general population, and red line, estimated trajectories for type 1 diabetes mellitus (A), and brain atrophy is a loss of neuron communication (B)) [1].
