Aging, Diabetes, Obesity, and Cognitive Decline: A Population-Based Study.
Aging, Diabetes, Obesity, and Cognitive Decline: A Population-Based Study.
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DOI：
10.1111/jgs.16321
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发表时间：
2020-05
影响因子：
6.3
通讯作者：
Rao RH
中科院分区：
文献类型：
--
作者：
Ganguli M;Beer JC;Zmuda JM;Ryan CM;Sullivan KJ;Chang CH;Rao RH
在一项以人群为基础的研究中，研究糖尿病和肥胖与认知能力下降之间已经确立的关系的潜在机制。10年人群队列研究。65岁以上478人。我们检测了空腹血液中血糖（葡萄糖、糖化血红蛋白）、胰岛素抵抗（胰岛素、HOMA-IR）、肥胖（抵抗素、脂联素、GLP-1）和炎症（c反应蛋白）的标志物。在整个样本的多变量回归分析中，我们将这些指标建模为全球认知下降斜率的预测因子，调整了年龄、性别、教育程度、APOE*4基因型、抑郁症状、腰臀比（WHR）和收缩压，并按性别特异性中位腰臀比分层。然后，我们对相同的变量进行了whr分层机器学习（分类和回归树，CART）分析。在多变量回归分析中，在整个样本中，HbA1c与认知能力下降显著相关。按中位腰宽比分层后，在腰宽比较高的患者中，HbA1c仍与认知能力下降有关。在WHR较低的人群中，没有代谢指标与认知能力下降相关。交叉验证的whr分层CART分析在年龄大于87-88岁的参与者中没有选择预测因子。在低WHR <87岁的参与者中，脂联素≥11，认知能力下降更快；高WHR参与者<88岁，HbA1c≥6.2%。我们基于人群的数据表明，在88岁以下的中心性肥胖患者中，即使是中等程度的高血糖也可能独立地倾向于更快的认知能力下降。相比之下，在87岁以下无中枢性肥胖的人群中，脂联素可能是认知能力下降的一个新的独立危险因素。
To investigate potential mechanisms underlying the well-established relationship of diabetes and obesity with cognitive decline, among older adults participating in a population-based study. 10-year population-based cohort study. 478 individuals aged 65+. We assayed fasting blood for markers of glycemia (glucose, HbA1c), insulin resistance (insulin, HOMA-IR), obesity (resistin, adiponectin, GLP-1), and inflammation (C-reactive protein). We modeled these indices as predictors of the slope of decline in global cognition, adjusting for age, sex, education, APOE*4 genotype, depressive symptoms, waist:hip ratio (WHR), and systolic blood pressure, in multivariable regression analyses of the entire sample and stratified by sex-specific median WHR. We then conducted WHR-stratified machine-learning (Classification and Regression Tree, CART) analyses of the same variables. In multivariable regression analyses, in the entire sample, HbA1c was significantly associated with cognitive decline. After stratifying by median WHR, HbA1c remained associated with cognitive decline in those with higher WHR. No metabolic indices were associated with cognitive decline in those with lower WHR. Cross-validated WHR-stratified CART analyses selected no predictors in participants older than 87–88 years. Faster cognitive decline was associated , in lower WHR participants <87 years, with adiponectin ≥ 11; and in higher WHR participants <88 years, with HbA1c ≥ 6.2%. Our population-based data suggest that, in individuals <88 years with central obesity, even modest degrees of hyperglycemia might independently predispose to faster cognitive decline. In contrast, among those <87 years without central obesity, adiponectin may be a novel independent risk factor for cognitive decline.
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DOI：
10.1038/nrneurol.2017.185
发表时间：
2018-03
期刊：
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影响因子：
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作者：
Arnold SE;Arvanitakis Z;Macauley-Rambach SL;Koenig AM;Wang HY;Ahima RS;Craft S;Gandy S;Buettner C;Stoeckel LE;Holtzman DM;Nathan DM
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发表时间：
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期刊：
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影响因子：
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