Diabetic Children Grow Up: Cognitive Complications

描述（由申请人提供）：1980年，我们开始了一系列的神经心理学研究的儿童，10至19岁，有和没有1型糖尿病。我们发现，与诊断时年龄较晚的人或非糖尿病对照受试者相比，在生命的前5或6年内患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存在争议，但我们现在认为，在大脑发育的关键时期，糖尿病相关的慢性高血糖症的发生对中枢神经系统产生不利影响，并增加其对后续脑损伤的脆弱性，特别是与中度严重低血糖发作相关的脑损伤。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的证据（可能会随着时间的推移而恶化）仍然未知，它们对成人功能的影响也是如此。我们研究的目的是重新接触那些在1980年至1983年之间首次被我们发现的人（平均年龄= 14.5岁;初始人数：226），并邀请他们完成详细的神经心理学评估，精神病诊断访谈，以及生活质量和职业适应的测量。糖尿病受试者还将进行体格检查，检查以确定生物医学并发症并审查既往低血糖发作。我们的研究有两大目标：首先，为了检验早发性脆弱性假说，预测6岁之前诊断出患有糖尿病的成年人与那些晚发糖尿病的人相比，随着时间的推移，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，这将导致职业成就降低和生活质量下降，并且这将通过低血糖的并发发作次数以及糖尿病并发症的发生率来预测。其次，我们的目标是提供一个全面的档案糖尿病患者的神经精神状态在中年，确定在何种程度上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。这将是第一项针对糖尿病患者的研究，以描述从儿童晚期到中年的认知功能变化，也是第一项将功能变化与糖尿病相关生物医学变量联系起来的研究。

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.