Accelerated progression from mild cognitive impairment to dementia in people with diabetes.
Accelerated progression from mild cognitive impairment to dementia in people with diabetes.
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DOI：
10.2337/db10-0539
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发表时间：
2010-11
期刊：
影响因子：
7.7
通讯作者：
Fratiglioni L
中科院分区：
文献类型：
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作者：
Xu W;Caracciolo B;Wang HX;Winblad B;Bäckman L;Qiu C;Fratiglioni L
糖尿病对轻度认知障碍（MCI）及其向痴呆的转化的影响仍存在争议。我们试图研究糖尿病和糖尿病前期是否与MCI相关，并加速从MCI到痴呆的进展。在Kungsholmen项目中，在基线时确定了963名认知完整的参与者和302名年龄≥75岁的MCI受试者（120名遗忘型MCI [aMCI ]和182名其他认知障碍无痴呆[oCIND]）。两个队列随访9年，以检测符合国际标准的MCI和痴呆事件。根据医学检查、降糖药物使用和随机血糖水平≥11.0 mmol/l确定糖尿病。糖尿病前期定义为无糖尿病参与者的随机血糖水平为7.8-11.0 mmol/l。使用标准和时间依赖性考克斯比例风险模型分析数据。在随访期间，在认知完整的队列中，182人发展为MCI（42 aMCI和140 oCIND），212人发展为痴呆。在MCI队列中，155例受试者进展为痴呆，糖尿病痴呆的多重校正风险比（95%CI）为2.87（1.30-6.34），糖尿病前期为4.96（2.27-10.84）。在Kaplan-Meier生存分析中，糖尿病和糖尿病前期使MCI向痴呆的进展加速了3.18年。糖尿病和糖尿病前期与MCI既没有横截面也没有纵向相关性。糖尿病和糖尿病前期大大加速了从轻度认知障碍向痴呆症的进展，预计轻度认知障碍患者发生痴呆症的时间将超过3年。糖尿病与MCI发展的关联在老年人中不太明显。
The effect of diabetes on mild cognitive impairment (MCI) and its conversion to dementia remains controversial. We sought to examine whether diabetes and pre-diabetes are associated with MCI and accelerate the progression from MCI to dementia. In the Kungsholmen Project, 963 cognitively intact participants and 302 subjects with MCI (120 with amnestic MCI [aMCI ] and 182 with other cognitive impairment no dementia [oCIND]) age ≥75 years were identified at baseline. The two cohorts were followed for 9 years to detect the incident MCI and dementia following international criteria. Diabetes was ascertained based on a medical examination, hypoglycemic medication use, and random blood glucose level ≥11.0 mmol/l. Pre-diabetes was defined as random blood glucose level of 7.8–11.0 mmol/l in diabetes-free participants. Data were analyzed using standard and time-dependent Cox proportional-hazards models. During the follow-up period, in the cognitively intact cohort, 182 people developed MCI (42 aMCI and 140 oCIND), and 212 developed dementia. In the MCI cohort, 155 subjects progressed to dementia, the multi-adjusted hazard ratio (95% CI) of dementia was 2.87 (1.30–6.34) for diabetes, and 4.96 (2.27–10.84) for pre-diabetes. In a Kaplan-Meier survival analysis, diabetes and pre-diabetes accelerated the progression from MCI to dementia by 3.18 years. Diabetes and pre-diabetes were neither cross-sectionally nor longitudinally associated with MCI. Diabetes and pre-diabetes substantially accelerate the progression from MCI to dementia, and anticipate dementia occurrence by more than 3 years in people with MCI. The association of diabetes with the development of MCI is less evident in old people.