Diabetic Children Grow Up: Cognitive Complications

糖尿病儿童的成长：认知并发症

• 批准号: 7092530
• 负责人: Christopher M. Ryan
• 金额: $ 33.66万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2008-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7092530
• 关键词: child behavior; child mental disorders; child psychology; children; clinical research; cognition; cognition disorders; developmental psychology; disease /disorder onset; disease /disorder proneness /risk; early experience; human data; human middle age (35-64); human subject; hypoglycemia; insulin dependent diabetes mellitus; longitudinal human study; medical complication; neuropsychological tests; occupations; quality of life; social psychology

DESCRIPTION (provided by applicant): In 1980, we initiated a series of neuropsychological studies of children, 10 to 19 years of age, with and without type 1 diabetes. We found that those who developed diabetes within the first 5 or 6 years of life were more likely to manifest widespread, clinically significant cognitive impairment, as compared to those with a later age at diagnosis, or to nondiabetic comparison subjects. Although the underlying pathophysiological mechanism remains controversial, we now believe that occurrence of diabetes-associated chronic hyperglycemia during a critical period of brain" development adversely affects the central nervous system, and increases its vulnerability to subsequent brain insults, particularly those associated with moderately severe hypoglycemic episodes. Whether these deficits reflect reversible developmental delays, or whether they are evidence of permanent brain damage (which may worsen over time) remains unknown, as does their effect on adult functioning. The goal of our proposed study is to re-contact those individuals first seen by us between 1980 and 1983 (Mean age = 14.5 yrs; initial number: 226) and invite them to complete a detailed neuropsychological assessment, a psychiatric diagnostic interview, and measures of quality of life and vocational adjustment. Diabetic subjects will also have a physical examination with tests to ascertain biomedical complications and review of prior hypoglycemic episodes. Our study has two broad aims: First, to test the early onset vulnerability hypothesis, predicting that adults diagnosed with diabetes before 6 years of age will show greater deterioration in cognitive functioning over time, compared to those with a later onset of diabetes, that all cognitive domains will be affected, that this will eventuate in less vocational attainment and poorer quality of life, and that this will be predicted by number of intercurrent episodes of hypoglycemia, as well as by the incidence of diabetic complications. Second, we aim to provide a comprehensive profile of diabetic patients' neuropsychiatric status in middle-adulthood, with determination of the extent to which hypoglycemic events as well as other biomedical and psychosocial factors predict those outcomes. This will be the first study of diabetic patients to delineate changes in cognitive functioning from late childhood into middle-adulthood, and the first to link functional changes to diabetes-related biomedical variables.

描述(申请人提供)：1980年，我们开始了一系列的儿童神经心理学研究，年龄在10到19岁之间，有无1型糖尿病。我们发现，与确诊年龄较晚的人或未患糖尿病的对照对象相比，那些在出生后5或6年内患上糖尿病的人更有可能表现出广泛的、临床上显著的认知障碍。尽管潜在的病理生理机制仍然存在争议，但我们现在认为，在大脑发育的关键时期发生糖尿病相关的慢性高血糖会对中枢神经系统产生不利影响，并增加其对随后的大脑损伤的易感性，特别是与中度严重低血糖发作相关的损伤。这些缺陷是否反映了可逆的发育迟缓，或者它们是否是永久性脑损伤(可能会随着时间的推移而恶化)的证据，以及它们对成人功能的影响，目前尚不清楚。我们建议的研究的目标是重新联系那些我们在1980至1983年间首次见到的患者(平均年龄=14.5岁；初始人数：226人)，并邀请他们完成详细的神经心理评估、精神病学诊断访谈以及生活质量和职业适应的测量。糖尿病患者还将进行体检，以确定生物医学并发症，并回顾以前的低血糖发作。我们的研究有两个广泛的目标：首先，测试早发性易感性假说，预测6岁之前被诊断为糖尿病的成年人随着时间的推移，与那些较晚发病的糖尿病患者相比，认知功能将表现出更大的恶化，所有认知领域都将受到影响，这最终将导致较低的职业成就和较差的生活质量，这将通过并发低血糖发作的次数以及糖尿病并发症的发生率来预测。其次，我们的目标是提供糖尿病患者中年神经精神状态的全面概况，并确定低血糖事件以及其他生物医学和心理社会因素预测这些结果的程度。这将是第一项对糖尿病患者进行的研究，描述从儿童期晚期到成年中期认知功能的变化，也是第一次将功能变化与糖尿病相关的生物医学变量联系起来。