The metabolic syndrome, inflammation, and risk of cognitive decline
The metabolic syndrome, inflammation, and risk of cognitive decline
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DOI：
10.1001/jama.292.18.2237
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发表时间：
2004-11-10
影响因子：
120.7
通讯作者：
Newman, AB
中科院分区：
文献类型：
--
作者：
Yaffe, K;Kanaya, A;Newman, AB
背景几项研究已经报道了代谢综合征和心血管疾病之间的关联。尽管人们越来越意识到心血管危险因素会增加认知衰退和痴呆的风险，但关于代谢综合征和认知的数据很少。目的确定代谢综合征是否是认知衰退的危险因素，以及这种联系是否被炎症改变。设计和设置一项从1997年到2002年在2个地点的社区诊所进行的为期5年的前瞻性观察研究。参与者共有2632名黑人和白人老年人(平均年龄，主要观察指标代谢综合征(使用国家胆固醇教育计划指南测量)和高炎症(定义为高于血清白介素6和C反应蛋白中值水平)与认知变化(改良的简易智力状态检查[3MS])在3年和5年后的相关性。结果与无代谢综合征的老年人(n=1616)相比，有代谢综合征的老年人(n=1016)更容易发生认知损害(26%比21%，多变量调整后的相对危险度[RR]为1.20；95%可信区间[CI]为1.02~1.41)。在认知障碍方面，炎症和代谢综合征(P=0.03)之间的交互作用有统计学意义。在对炎症进行分层后，有代谢综合征和高度炎症(n=348)的人比没有代谢综合征的人认知障碍的可能性更高(多变量调整后的RR，1.66；95%CI，1.19-2.32)。那些有代谢综合征和低度炎症的患者(n=668)没有表现出损伤的可能性增加(多变量调整后的RR，1.08；95%CI，0.89-1.30)。分层多变量随机效应模型显示，与无代谢综合征和低炎症的参与者相比，有代谢综合征和高炎症的参与者在3MS上的4年下降更大(P=0.04)，而有代谢综合征和低炎症的参与者没有下降(P=.44)。结论这些发现支持代谢综合征导致老年人认知障碍的假设，但主要是在高炎症水平的人中。
Context Several studies have reported an association between the metabolic syndrome and cardiovascular disease. Despite an increasing awareness that cardiovascular risk factors increase risk of cognitive decline and dementia, there are few data on the metabolic syndrome and cognition.Objective To determine if the metabolic syndrome is a risk factor for cognitive decline and if this association is modified by inflammation.Design and Setting A 5-year prospective observational study conducted from 1997 to 2002 at community clinics at 2 sites.Participants A total of 2632 black and white elders (mean age, 74 years).Main Outcome Measures Association of the metabolic syndrome (measured using National Cholesterol Education Program guidelines) and high inflammation (defined as above median serum level of interleukin 6 and C-reactive protein) with change in cognition (Modified Mini-Mental State Examination [3MS]) at 3 and 5 years. Cognitive impairment was defined as at least a 5-point decline.Results Compared with those without the metabolic syndrome (n=1616), elders with the metabolic syndrome (n=1016) were more likely to have cognitive impairment (26% vs 21%, multivariate adjusted relative risk [RR], 1.20; 95% confidence interval [CI], 1.02-1.41). There was a statistically significant interaction with inflammation and the metabolic syndrome (P=.03) on cognitive impairment. After stratifying for inflammation, those with the metabolic syndrome and high inflammation (n=348) had an increased likelihood of cognitive impairment compared with those without the metabolic syndrome (multivariate adjusted RR, 1.66; 95% CI, 1.19-2.32). Those with the metabolic syndrome and low inflammation (n=668) did not exhibit an increased likelihood of impairment (multivariate adjusted RR, 1.08; 95% CI, 0.89-1.30). Stratified multivariate random-effects models demonstrated that participants with the metabolic syndrome and high inflammation had greater 4-year decline on 3MS (P=.04) compared with those without the metabolic syndrome, whereas those with the metabolic syndrome and low inflammation did not (P=.44).Conclusion These findings support the hypothesis that the metabolic syndrome contributes to cognitive impairment in elders, but primarily in those with high level of inflammation.