Albuminuria and Cognitive Decline in People with Diabetes and Normal Renal Function
Albuminuria and Cognitive Decline in People with Diabetes and Normal Renal Function
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DOI：
10.2215/cjn.11321112
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发表时间：
2013-11-07
影响因子：
9.8
通讯作者：
Launer, Lenore J.
中科院分区：
文献类型：
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作者：
Barzilay, Joshua I.;Lovato, James F.;Launer, Lenore J.
背景和目的糖尿病与认知功能损害的风险增加有关。本研究通过对基线肾小球滤过率正常的糖尿病患者进行3.3年随访，检测微血管疾病（通过蛋白尿和肾小球滤过率估计值（eGFR）下降来衡量）是否与认知功能下降相关（每1.73 m（2）约90 ml/min）。设计、设置、参与者，参与者来自控制糖尿病心血管风险的行动糖尿病记忆研究（N=2977;平均年龄62.55.8岁;招募时间为2003年8月至2005年12月，随访至2009年6月），研究了强化血糖控制与标准血糖控制对认知功能的相关性。参与者在基线、20个月和40个月时接受了三项神经心理学测试。测试包括信息处理速度，非文字记忆和执行功能。混合效应模型用于评估白蛋白尿和eGFR在每个测试中下降百分比的相关性。（持续性蛋白尿）（-5.8% [95%置信区间（CI），-7.3至-4.2]）和随访时有蛋白尿但基线时无蛋白尿的受试者（进行性白蛋白尿）（-4.1% [95%CI，-5.6至-2.7]）的信息处理速度下降百分比大于基线和随访时无蛋白尿（无蛋白尿）的参与者（-2.6% [95%CI，-3.4至-1.9]）（P=0.001和P=0.10）。言语记忆测试中有临界百分比变化（4.8% [95%CI，2.4 - 7.1]和4.7% [95%CI，2.5 - 7.0] vs 7.1% [95%CI，6.0 - 8.3]; P=0.11和P=0.08）。在逻辑回归分析中，持续性白蛋白尿（比值比，1.37 [95%CI，1.09 - 1.72]）和进行性白蛋白尿（比值比，1.25 [95%CI，1.02 - 1.56]）与信息处理速度评分下降5%相关，但与言语记忆或执行功能表现无关。eGFR下降1 ml/min/1.73 m2/年与认知功能测试下降呈临界相关。结论持续性白蛋白尿和进行性白蛋白尿与eGFR未受损的相对年轻糖尿病患者认知功能下降相关。这些发现并不排除其他过程导致认知能力下降的可能性。
Background and objectivesDiabetes mellitus is associated with increased risk of cognitive impairment. This study examines whether microvascular disease, as measured by albuminuria and decline in estimated GFR (eGFR), is associated with cognitive decline during 3.3 years of follow-up in individuals with diabetes with a normal baseline eGFR (approximately 90 ml/min per 1.73 m(2)).Design, setting, participants, & measurementsParticipants were from the Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes study (N=2977; mean age 62.55.8 years; recruitment from August 2003 to December 2005, followed through June 2009), which examined the association of intensive versus standard glucose control on cognitive function. Participants underwent three neuropsychologic tests at baseline, 20 months, and 40 months. Tests included information processing speed, verbal memory, and executive function. Mixed-effects models were used to assess the association of albuminuria and eGFR on the percentage decline in each test.ResultsParticipants with albuminuria at baseline and follow-up (persistent albuminuria) (-5.8% [95% confidence interval (CI), -7.3 to -4.2]) and participants with albuminuria at follow-up but none at baseline (progressive albuminuria) (-4.1% [95% CI, -5.6 to -2.7]) had greater percentage declines on information processing speed than participants without albuminuria at baseline and at follow-up (no albuminuria) (-2.6% [95% CI, -3.4 to -1.9]) (P=0.001 and P=0.10, respectively). There were borderline percentage changes in the test of verbal memory (4.8% [95% CI, 2.4 to 7.1] and 4.7% [95% CI, 2.5 to 7.0] versus 7.1% [95% CI, 6.0 to 8.3]; P=0.11 and P=0.08, respectively). On logistic regression analysis, persistent albuminuria (odds ratio, 1.37 [95% CI, 1.09 to 1.72]) and progressive albuminuria (odds ratio, 1.25 [95% CI, 1.02 to 1.56]) were associated with a 5% decline in information processing speed scores but not with verbal memory or executive function performance. A 1 ml/min per 1.73 m(2) per year eGFR decline had a borderline association with decline in tests of cognitive function.ConclusionsPersistent albuminuria and progressive albuminuria are associated with a decline in cognitive function in relatively young individuals with diabetes with unimpaired eGFR. These findings do not rule out the possibility of other processes causing cognitive decline.