Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study.
Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study.
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预测2型糖尿病患者10年痴呆风险的风险评分：一项队列研究。
DOI：
10.1016/s2213-8587(13)70048-2
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发表时间：
2013-11
影响因子：
44.5
通讯作者：
Whitmer, Rachel A.
中科院分区：
文献类型：
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作者：
Exalto, Lieza G.;Biessels, Geert Jan;Karter, Andrew J.;Huang, Elbert S.;Katon, Wayne J.;Minkoff, Jerome R.;Whitmer, Rachel A.
2型糖尿病（T2 DM）患者患痴呆症的可能性是其他患者的两倍，尽管很难预测谁的未来风险最高。我们创建并验证了一个实用的汇总风险评分，该评分提供了T2 DM患者10年痴呆风险的个体化估计。两个纵向队列的T2 DM患者年龄60岁以上，随访10年，用于创建（糖尿病和衰老研究N= 29，961）和验证（途径研究N= 2，413）风险评分。我们通过使用考克斯比例风险模型评估45个候选预测因子建立了我们的预测模型，并根据预测因子β系数的大小开发了风险评分的积分系统。模型预测进行了测试的歧视和校准方法。采用Kaplan-Meier估计法计算痴呆风险/总分。微血管疾病、糖尿病足、脑血管疾病、心血管疾病、急性代谢事件、抑郁症、年龄和教育程度是痴呆的最强预测因素，并构成风险评分（c-统计量= 0.73创建队列，c统计量=0.74验证队列）。最低（-1）和最高（≥12）总分之间观察到的痴呆风险存在15倍差异（5% vs. 73%）。这是第一个能够预测T2 DM患者10年个体化痴呆风险的风险评分。风险评分可用于提高对认知恶化的警惕性，并选择高风险患者进行临床试验。NIH DK 081796，Kaiser Permanente社区福利补助金，乌得勒支大学高潜力补助金，ZonMw和富布赖特奖学金的VIDI补助金91711384。
Patients with type 2 diabetes (T2DM) are twice as likely to develop dementia though it’s difficult to predict who has the highest future risk. We created and validated a practical summary risk score providing an individualized estimate of the 10-year dementia risk in T2DM patients. Two longitudinal cohorts T2DM patients aged 60 + with ten years follow-up were used to create (Diabetes and Aging Study N=29,961) and validate (Pathways Study N=2,413) the risk score. We built our prediction model by evaluating 45 candidate predictors using Cox proportional hazard models and developed a point system for the risk score based on the size of the predictor’s beta coefficient. Model prediction was tested by discrimination and calibration methods. Dementia risk per sum score was calculated with Kaplan-Meier estimates. Microvascular disease, diabetic foot, cerebrovascular disease, cardiovascular disease, acute metabolic events, depression, age and education most strongly predicted dementia and constitute the risk score (c-statistic= 0.73 creation cohort, c statistic =0.74 validation cohort). There was a 15-fold difference (5% vs. 73%) in observed dementia risk between the lowest (-1) and the highest (≥12) sum score. This is the first risk score capable of predicting 10-year individualized dementia risk in patients with T2DM. The risk score can be used to increase vigilance for cognitive deterioration and to selection of high risk patients for clinical trials. NIH DK081796, Kaiser Permanente Community Benefit grant, Utrecht University high potential grant, VIDI grant 91711384 from ZonMw and Fulbright Fellowship.