Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia.
Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia.
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DOI：
10.1001/archneurol.2012.1117
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发表时间：
2012-09
影响因子：
--
通讯作者：
Harris, Tamara B.
中科院分区：
文献类型：
--
作者：
Yaffe, Kristine;Falvey, Cherie;Hamilton, Nathan;Schwartz, Ann V.;Simonsick, Eleanor M.;Satterfield, Suzanne;Cauley, Jane A.;Rosano, Caterina;Launer, Lenore J.;Strotmeyer, Elsa S.;Harris, Tamara B.
虽然一些研究报告了流行的糖尿病 (DM) 与认知障碍之间的关联，但人们对晚年发生的糖尿病和认知能力下降知之甚少。患有糖尿病的老年人的血糖控制也可能与认知功能有关，但研究结果并不一致。确定流行的和偶发的糖尿病是否会增加认知能力下降的风险，以及在患有糖尿病的老年人中，血糖控制不良是否与较差的认知能力有关。前瞻性队列研究。两个社区诊所的健康老龄化和身体成分研究。共有 3,069 名长者（平均年龄 74.2 岁；42% 黑人；52% 女性）。参与者在基线和 10 年选定的时间间隔内完成了改良版简易精神状态检查 (3MS) 和数字符号替换测试 (DSST)。糖尿病状态是在基线和随访期间确定的。在第 1 年（基线）、第 4 年、第 6 年和第 10 年通过空腹全血测量糖化血红蛋白 A1c (HbA1c)。在基线时，717 名参与者 (23.4%) 患有普遍的糖尿病，2352 名参与者 (76.6%) 没有糖尿病，其中 159 名参与者在随访期间发生了糖尿病。患有普遍 DM 的参与者的基线测试分数低于没有 DM 的参与者（3MS：88.8 与 90.9；DSST：分别为 32.5 与 36.3；两项测试 |t|=6.09，p=0.001）。混合效应模型的结果显示了 9 年下降的类似模式（3MS：分别为 -6.0 与 -4.5 点下降；|t|=2.66，p=0.008；DSST：-7.9 与 -5.7，点下降；|t|=3.69，p=0.001）。患有糖尿病的参与者的基线评分和 9 年评分往往低于其他两组，但与未患糖尿病的组没有统计学差异。对人口统计和医疗合并症的多变量调整产生了类似的结果。在患有普遍 DM 的参与者中，HbA1c 水平与较低的平均认知得分相关（总体 3MS p=0.003；总体 DSST p=0.04），即使在多变量调整后也是如此。在功能良好的老年人中，糖尿病和糖尿病患者的血糖控制不佳与认知功能较差和更严重的衰退有关。这表明糖尿病的严重程度可能会加速认知衰老。
While several studies report an association between prevalent diabetes mellitus (DM) and cognitive impairment, less is known about incident DM in late life and cognitive decline. Glycemic control among elders with DM may also be associated with cognitive function, but findings are inconsistent. To determine if prevalent and incident DM increases risk of cognitive decline, and if, among elders with DM, poor glucose control is related to worse cognitive performance. Prospective cohort study. Health Aging and Body Composition Study at two community clinics. A total of 3,069 elders (mean age 74.2 years; 42% black; 52% female). Participants completed the Modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) at baseline and selected intervals over 10 years. DM status was determined at baseline and during follow-up visits. Glycosylated hemoglobin A1c (HbA1c) was measured at year 1 (baseline), 4, 6, and 10 from fasting whole blood. At baseline 717 (23.4%) participants had prevalent DM and 2352 (76.6%) were without diabetes, 159 of whom developed incident DM during follow-up. Participants with prevalent DM had lower baseline test scores than participants without DM (3MS: 88.8 vs. 90.9; DSST: 32.5 vs 36.3, respectively; |t|=6.09, p=0.001 for both tests). Results from mixed-effects models showed a similar pattern for 9-year decline (3MS: −6.0 vs. −4.5 point decline; |t|=2.66, p=0.008; DSST: −7.9 vs. −5.7, point decline; |t|=3.69, p=0.001, respectively). Participants with incident DM tended to have baseline and 9-year decline scores between the other two groups but were not statistically different from the group without diabetes. Multivariate adjustment for demographics and medical co-morbidities produced similar results. Among participants with prevalent DM, HbA1c level was associated with lower average mean cognitive scores (3MS p for overall=0.003; DSST p for overall=0.04), even after multivariate adjustment. Among well-functioning older adults, DM and poor glucose control among those with DM are associated with worse cognitive function and greater decline. This suggests severity of DM may contribute to accelerated cognitive aging.
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影响因子：
--
作者：
Kanaya, AM;Barrett-Connor, E;Yaffe, K
通讯作者：
Yaffe, K
影响因子：
6.3
作者：
Nguyen HT;Grzywacz JG;Arcury TA;Chapman C;Kirk JK;Ip EH;Bell RA;Quandt SA
通讯作者：
Quandt SA
影响因子：
--
作者：
Luchsinger, Jose A.;Reitz, Christiane;Mayeux, Richard
通讯作者：
Mayeux, Richard
影响因子：
5
作者：
Saczynski, Jane S.;Jonsdottir, Maria K.;Launer, Lenore J.
通讯作者：
Launer, Lenore J.
影响因子：
120.7
作者：
Yaffe, K;Kanaya, A;Newman, AB
通讯作者：
Newman, AB