Glucose instability and neurocognitive outcomes in older adults

摘要 老年人维持体内平衡或维持生理稳定性的能力较低， 葡萄糖不稳定性在老年人中很常见，但葡萄糖不稳定性是一个未被充分认识的问题。糖尿病与以下因素密切相关： 越来越多的证据表明，血糖变异性有助于老年痴呆症的风险 和相关痴呆，与平均血糖或血红蛋白A1 c（HbA 1c）无关。耐磨连续 葡萄糖监测技术是一个严格描述老年人葡萄糖模式的机会 在血糖谱（从无糖尿病，糖尿病前期，糖尿病），并评估与 神经认知结果。拟议的项目将1）描述特定的中年和晚年风险因素， 老年人的血糖模式（血糖变异性、高血糖和低血糖）; 2）评估 伴有症状（头晕、注意力难以集中、视力障碍）的血糖模式; 3） 检查糖尿病、血糖控制和血糖模式与脑MRI测量的相关性， 通过florbetapir PET成像评估脑淀粉样蛋白β沉积;以及4）评估紊乱性脑淀粉样蛋白β沉积的相关性。 伴有认知能力下降进展和轻度认知功能障碍的血糖模式，或 痴呆这些目标的实现将推动我们对糖尿病与糖尿病之间联系的理解， 动态血糖监测：老年人中定义的血糖不稳定性与神经认知结局

Abstract Older adults are less able to maintain homeostasis or sustain physiological constancy and, although diabetes is common in old age, glucose instability is an underappreciated concern. Diabetes is strongly linked to dementia risk and there is growing evidence that glycemic variability contributes to risk of Alzheimer's disease and related dementias, independent of average glucose or hemoglobin A1c (HbA1c). Wearable continuous glucose monitoring technology is an opportunity to rigorously characterize glucose patterns in older adults across the glycemic spectrum (from no diabetes, to prediabetes, to diabetes) and evaluate associations with neurocognitive outcomes. The proposed project will 1) characterize midlife- and late-life risk factors for specific glucose patterns in old age (glycemic variability, hyperglycemia, and hypoglycemia); 2) evaluate associations of glucose patterns with concurrent symptoms (dizziness, difficulty concentrating, vision disturbances); 3) examine associations of diabetes, glycemic control, and glucose patterns with brain MRI measures and cerebral amyloid beta deposition via florbetapir PET imaging; and 4) evaluate the associations of disordered glucose patterns with progression of cognitive decline and development of mild cognitive impairment or dementia. Completion of these aims will move the field forward in our understanding of the link of diabetes and continuous glucose monitoring-defined glycemic instability with neurocognitive outcomes in older adults.