Does Type 2 Diabetes Increase Rate of Cognitive Decline in Older Mexican Americans?
Does Type 2 Diabetes Increase Rate of Cognitive Decline in Older Mexican Americans?
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DOI：
10.1097/wad.0000000000000083
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发表时间：
2015-07-01
影响因子：
2.1
通讯作者：
Neuhaus, John
中科院分区：
文献类型：
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作者：
Mayeda, Elizabeth R.;Haan, Mary N.;Neuhaus, John
估计糖尿病对老年墨西哥裔美国人认知变化的影响很重要，但也很有挑战性，因为糖尿病和认知能力下降都可以预测死亡率，这可能导致生存偏差。1998年至2007年，萨克拉门托地区拉美裔老龄化研究中的墨西哥裔美国老年人（n=1634）完成了多达7次的修正迷你精神状态测试（3MSE）和糖尿病评估。我们用联合纵向生存模型检查了基线和新发糖尿病和认知能力下降，以解释死亡。在基线时，32.4%的参与者患有糖尿病，15.8%的参与者在研究期间患上了糖尿病。在研究期间，22.8%的参与者死亡。在联合纵向生存模型中，基线糖尿病患者比无糖尿病患者认知能力下降更快（P=0.003），死亡率更高（风险比=1.88；95%可信区间为1.48-2.38）。新发糖尿病患者和非糖尿病患者的认知能力下降和死亡率相似。对于一个典型的人来说，在过去6年的研究中，无糖尿病患者的3MSE得分下降了2.3分，基线糖尿病患者的3MSE得分下降了4.3分。忽略死亡的影响，基线糖尿病对认知能力下降的影响估计减少了17.0%。忽视认知能力下降和死亡率之间关系的分析可能低估了糖尿病对认知老化的影响。
Estimating effects of diabetes on cognitive change among older Mexican Americans is important, yet challenging, because diabetes and cognitive decline both predict mortality, which can induce survival bias. Older Mexican Americans in the Sacramento Area Latino Study on Aging (n=1634) completed Modified Mini-Mental State Exams (3MSE) and diabetes assessments up to 7 times (from 1998 to 2007). We examined baseline and new-onset diabetes and cognitive decline with joint longitudinal-survival models to account for death. At baseline, 32.4% of participants had diabetes and 15.8% developed diabetes during the study. During the study period, 22.8% of participants died. In joint longitudinal-survival models, those with baseline diabetes experienced faster cognitive decline (P=0.003) and higher mortality (hazards ratio=1.88; 95% confidence interval, 1.48-2.38) than those without diabetes. Cognitive decline and mortality were similar for those with new-onset diabetes and those without diabetes. For a typical person, 3MSE scores declined by 2.3 points among those without diabetes and 4.3 points among those with baseline diabetes, during the last 6 years of study. Ignoring the impact of death yielded a 17.0% smaller estimate of the effect of baseline diabetes on cognitive decline. Analyses that overlook the association between cognitive decline and mortality may underestimate the effect of diabetes on cognitive aging.