Diabetes, Alzheimer disease, and vascular dementia A population-based neuropathologic study
Diabetes, Alzheimer disease, and vascular dementia A population-based neuropathologic study
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DOI：
10.1212/wnl.0b013e3181f4d7f8
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发表时间：
2010-09-01
期刊：
影响因子：
9.9
通讯作者：
Kivipelto, M.
中科院分区：
文献类型：
--
作者：
Ahtiluoto, S.;Polvikoski, T.;Kivipelto, M.
目的：通过分析发病率、死亡率和神经病理学结果，探讨糖尿病与痴呆、阿尔茨海默病（AD）和血管性痴呆（VaD）的关系。这项前瞻性的以人群为基础的研究对年龄最大的老年人进行了研究。方法：万塔85岁以上的研究包括553名居住在芬兰万塔市的居民，1991年4月1日年龄>85岁。1994年、1996年、1999年和2001年对幸存者进行了复查。在随访期间死亡的291人（占总人口的48%）中进行了尸检。根据自我报告、医生诊断的糖尿病病历或抗糖尿病药物的使用情况评估糖尿病。从大脑半球的1 cm冠状切片、5 mm脑干横切面切片和矢状小脑切片中识别肉眼可见的梗死。β-淀粉样蛋白采用乌洛托品银染色，神经纤维缠结采用乌洛托品银Bodian染色，神经炎斑采用改良Bielschowsky法。考克斯比例风险和多元Logistic回归模型被用来分析糖尿病与痴呆和神经病理学的关联，分别为：糖尿病在基线痴呆，AD和VaD的发病率增加了一倍，并增加死亡率。糖尿病患者不太可能有β-淀粉样蛋白（风险比[HR] [95%置信区间（CI）]为0.48 [0.23-0.98]）和缠结（HR [95% CI] 0.72 [0.39-1.33]）但更可能发生脑梗死（HR [95%CI] 1.88 [1.06-3.34]）。结论：老年糖尿病患者发生更广泛的血管病变，单独或与AD型病变（特别是APOE β 4携带者）一起导致痴呆风险增加。神经病学（R）2010; 75：1195-1202
Objective: To investigate the relation of diabetes to dementia, Alzheimer disease (AD), and vascular dementia (VaD), through analyses of incidence, mortality, and neuropathologic outcomes in a prospective population-based study of the oldest old.Methods: The Vantaa 85+ study included 553 residents living in the city of Vantaa, Finland, and aged >85 years on April 1, 1991. Survivors were reexamined in 1994, 1996, 1999, and 2001. Autopsies were performed in 291 persons who died during the follow-up (48% of total population). Diabetes was assessed according to self-report, medical record of physician-diagnosed diabetes, or use of antidiabetic medication. Macroscopic infarcts were identified from 1-cm coronal slices of cerebral hemispheres, 5-mm transverse brainstem slices, and sagittal cerebellum slices. Methenamine silver staining was used for beta-amyloid, methenamine silver-Bodian staining for neurofibrillary tangles, and modified Bielschowsky method for neuritic plaques. Cox proportional hazards and multiple logistic regression models were used to analyze the association of diabetes with dementia and neuropathology, respectively.Results: Diabetes at baseline doubled the incidence of dementia, AD, and VaD, and increased mortality. Individuals with diabetes were less likely to have beta-amyloid (hazard ratio [HR] [95% confidence interval (CI)] was 0.48 [0.23-0.98]) and tangles (HR [95% CI] 0.72 [0.39-1.33]) but more likely to have cerebral infarcts (HR [95% CI] 1.88 [1.06-3.34]) after all adjustments.Conclusion: Elderly patients with diabetes develop more extensive vascular pathology, which alone or together with AD-type pathology (particularly in APOE epsilon 4 carriers) results in increased dementia risk. Neurology (R) 2010; 75: 1195-1202