Change in cognitive function by glucose tolerance status in older adults - A 4-year prospective study of the Rancho Bernardo Study Cohort
Change in cognitive function by glucose tolerance status in older adults - A 4-year prospective study of the Rancho Bernardo Study Cohort
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DOI：
10.1001/archinte.164.12.1327
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发表时间：
2004-06-28
影响因子：
--
通讯作者：
Yaffe, K
中科院分区：
文献类型：
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作者：
Kanaya, AM;Barrett-Connor, E;Yaffe, K
背景：一些研究已经检查了糖尿病状态下认知能力的变化，结果不同。我们研究了4年的变化，在老年人的认知性能根据葡萄糖耐量status.Methods：三个认知测试（简易精神状态检查，言语流畅性[VF]测试，和线索制作测试B）进行了测量，4年，在999白色男性和女性，年龄在42至89岁，谁参加了兰乔贝尔纳多研究。参与者分为正常（NGT），受损（IGT）或糖尿病葡萄糖耐量。性别特异性线性回归模型校正了年龄、教育、抑郁评分、载脂蛋白E ε 4等位基因和当前雌激素使用情况。我们通过进一步调整总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和甘油三酯水平、血压、糖化血红蛋白水平和微量白蛋白尿、视网膜病变、中风或冠心病等因素来检查中介作用。与非糖尿病女性相比，糖尿病女性在4年后VF测试中出现主要认知能力下降的风险增加了4倍。多变量校正后，随访时糖尿病女性VF测试评分为15.2 +/- 0.6，IGT女性为16.7 +/- 0.4，NGT女性为17.2 +/- 0.2（P = 0.007）。糖化血红蛋白减弱这种作用，但血脂水平，血压，微血管或大血管疾病没有。简易精神状态检查和线索制作测试B的性能没有不同的基线glucose status.Conclusions：老年白色女性糖尿病患者有一个更快的VF测试的性能下降与IGT或NGT的女性相比。更好的血糖控制可能会改善这种下降。
Background: A few studies have examined change in cognitive performance by diabetes status with disparate results. We examined the 4-year change in cognitive performance among older adults according to glucose tolerance status.Methods: Three cognitive tests (Mini-Mental State Examination, Verbal Fluency [VF] test, and Trail-Making Test B) were measured 4 years apart in 999 white men and women aged 42 to 89 years, who were enrolled in the Rancho Bernardo Study. Participants were classified with normal (NGT), impaired (IGT) or diabetic glucose tolerance. Sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E epsilon4 allele, and current estrogen use. We checked for mediation by further adjusting for total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglyceride levels; blood pressure; glycohemoglobin level; and microalbuminuria, retinopathy, stroke, or coronary heart disease.Results: At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes mellitus had a 4-fold increased risk of a major cognitive decline on the VF test after 4 years compared with nondiabetic women. After multivariate adjustment, VF test scores at follow-up for women were 15.2 +/- 0.6 for those with diabetes, 16.7 +/- 0.4 for those with IGT, and 17.2 +/- 0.2 for those with NGT (P = .007). Glycohemoglobin attenuated this effect, but lipid levels, blood pressure, and microvascular or macrovascular disease did not. Performance on Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status.Conclusions: Elderly white women with diabetes had a more rapid decline in performance on the VF test compared with women with IGT or NGT. Better glucose control might ameliorate this decline.