Type 2 diabetes mellitus, brain atrophy and cognitive decline in older people: a longitudinal study
Type 2 diabetes mellitus, brain atrophy and cognitive decline in older people: a longitudinal study
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DOI：
10.1007/s00125-018-4778-9
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发表时间：
2019-03-01
期刊：
影响因子：
8.2
通讯作者：
Srikanth, Velandai K.
中科院分区：
文献类型：
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作者：
Callisaya, Michele L.;Beare, Richard;Srikanth, Velandai K.
目的/假设本研究的目的是研究2型糖尿病是否与更严重的脑萎缩和认知能力下降有关，以及脑萎缩是否介导了2型糖尿病和认知能力下降之间的联系。方法来自老年塔斯马尼亚人认知与糖尿病（CDOT）研究的55-90岁无痴呆的参与者在4.6年的三个时间点接受了脑MRI（心室和总脑容量）和神经心理学测量（整体功能和7个认知域）。混合模型用于检查2型糖尿病与认知和MRI测量的纵向关联，调整协变量。一项中介测试被用来确定脑萎缩是否解释了2型糖尿病和认知能力下降之间的联系。结果基线时共有705名参与者（糖尿病患者：n=348，平均年龄68.2岁[SD 7.0]；非糖尿病患者：n=357，平均年龄72.5岁[SD 7.1]）。调整年龄、性别、教育程度和血管危险因素后，在言语记忆（-0.06;95% CI -0.09, -0.02）和言语流畅性（-0.03;95% CI -0.06, -0.00）方面存在显著的糖尿病x时间交互作用。虽然糖尿病患者在基线时脑容量较低（-14.273;95% CI -21.197, -6.580），心室容量较大（2.672;95% CI 0.152, 5.193），但没有显著的糖尿病x时间相互作用（p < 0.05），也没有脑萎缩中介糖尿病-认知关系的证据。结论/解释在老年社区居民中，2型糖尿病与5年内言语记忆和流畅性下降有关。糖尿病对脑萎缩的影响可能开始得更早（中年）。
Aims/hypothesisThe aims of the study were to examine whether type 2 diabetes mellitus is associated with greater brain atrophy and cognitive decline, and whether brain atrophy mediates associations between type 2 diabetes and cognitive decline.MethodsParticipants without dementia aged 55-90years from the Cognition and Diabetes in Older Tasmanians (CDOT) study underwent brain MRI (ventricular and total brain volume) and neuropsychological measures (global function and seven cognitive domains) at three time points over 4.6years. Mixed models were used to examine longitudinal associations of type 2 diabetes with cognitive and MRI measures, adjusting for covariates. A test of mediation was used to determine whether brain atrophy explained associations between type 2 diabetes and cognitive decline.ResultsA total of 705 participants (diabetes: n=348, mean age 68.2years [SD 7.0]; no diabetes: n=357, mean age 72.5years [SD 7.1]) were available at baseline. Adjusting for age, sex, education and vascular risk factors, there were significant diabetes x time interactions for verbal memory ( -0.06; 95% CI -0.09, -0.02) and verbal fluency ( -0.03; 95% CI -0.06, -0.00). Although people with diabetes had lower brain ( -14.273; 95% CI -21.197, -6.580) and greater ventricular ( 2.672; 95% CI 0.152, 5.193) volumes at baseline, there were no significant diabetes x time interactions (p>0.05) or evidence of mediation of the diabetes-cognition relationship by brain atrophy.Conclusions/interpretationIn older community-dwelling people, type 2 diabetes is associated with decline in verbal memory and fluency over 5years. The effect of diabetes on brain atrophy may begin earlier (midlife).