Lower cerebral vasoreactivity as a predictor of gait speed decline in type 2 diabetes mellitus
Lower cerebral vasoreactivity as a predictor of gait speed decline in type 2 diabetes mellitus
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DOI：
10.1007/s00415-018-8981-x
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发表时间：
2018-10-01
影响因子：
6
通讯作者：
Novak, Vera
中科院分区：
文献类型：
--
作者：
Chung, Chen-Chih;Maldonado, Daniela A. Pimentel;Novak, Vera
步态速度是整体功能健康的一个指标，与老年人的存活率有关。我们前瞻性地评估了患有和不患有2型糖尿病(T2 DM)的老年人在正常步行(NW)和双重任务步行(DTW)时脑血管反应性和步速之间的长期相关性。40名参与者(年龄67.3+/-8.8岁，20名2型糖尿病患者)完成了一项为期两年的前瞻性研究，包括核磁共振成像、采血和步态评估。用连续动脉自旋标记MRI对全脑血管反应性进行定量。DTW过程中的步态速度通过减去序列7来评估。双任务成本以步态速度从NW到DTW的百分比变化来计算。在整个队列中，较高的血糖水平与较慢的步速有关。在糖尿病组中，血管反应性降低与NW(=0.3，p=0.019)和DTW(=0.35，p=0.01)期间的步速减慢以及2年随访时较高的双重任务成本(=0.69，p=0.009)有关。T2 DM和脑血管反应性低下的参与者在2年后的NW和DTW中步速下降幅度更大(分别为=0.17，p=0.04和=0.28，p=0.03)。糖尿病病程越长，进行双重任务的成本越高(=0.19，p=0.04)，NW期间步速下降越大(=0.17，p=0.02)。这些发现表明，在患有2型糖尿病的老年人中，步态表现高度依赖于脑血管调节的完整性。
Gait speed is an indicator of overall functional health and is correlated with survival in older adults. We prospectively evaluated the long-term association between cerebral vasoreactivity and gait speed during normal walking (NW) and dual-task walking (DTW) in older adults with and without type 2 diabetes mellitus (T2DM). 40 participants (aged 67.3 +/- 8.8 years, 20 with T2DM) completed a 2-year prospective study consisting of MRI, blood sampling, and gait assessments. The whole brain vasoreactivity was quantified using continuous arterial spin labeling MRI. Gait speed during DTW was assessed by subtracting serial sevens. Dual-task cost was calculated as the percent change in gait speed from NW to DTW. In the entire cohort, higher glycemic profiles were associated with a slower gait speed. In the diabetic group, lower vasoreactivity was associated with a slower gait speed during NW ( = 0.30, p = 0.019) and DTW ( = 0.35, p = 0.01) and a higher dual-task cost ( = 0.69, p = 0.009) at 2-year follow-up. The participants with T2DM and lower cerebral vasoreactivity had a greater decrease in gait speed during NW and DTW after the 2-year follow-up ( = 0.17, p = 0.04 and = 0.28, p = 0.03, respectively). Longer diabetes duration was associated with a higher dual-task cost ( = 0.19, p = 0.04) and a greater decrease in gait speed during NW ( = 0.17, p = 0.02). These findings indicate that in older adults with type 2 diabetes, gait performance is highly dependent on the integrity of cerebrovascular regulation.