Inflammation, long-term diabetes characteristics, and cognitive decline

这项为期5年的前瞻性研究将探讨2型糖尿病的长期特征和 炎症影响1000名认知功能完整的队列中认知功能下降的发展（在 招募）居住在以色列特拉维夫的65岁及以上的糖尿病患者。这项研究是一项合作 西奈山医学院精神病学系（MSSM），纽约， 以色列Sheba医疗中心精神病学和马卡比社区卫生部 卫生服务部（MHS）是以色列第二大HMO。它为代表提供医疗保健 170万以色列公民，其中11 000人患有糖尿病，年龄在15岁以上， 特拉维夫地区有65个。研究这一人群的好处是：a）长达10年的数据， 非常丰富的MHS糖尿病登记，包括HbA 1c，抗糖尿病和其他药物， 疾病持续时间、高血压和其他糖尿病相关特征; B）完全计算机化 集中处理MHS医疗记录，方便数据访问和分析; c）免费 由MHS集中实验室进行分析的患者，确保完全使用; d）显著 MHS药房的补贴药物，记录每次购买（与受试者相比， e）由于生病的受试者由MHS护理，因此接触损失最小; 和f）通过终止客户资金及时通知死亡。痴呆症的诊断程序 Sheba将与MSSM阿尔茨海默病研究中心（ADRC）的研究中心完全整合。 将每隔18个月对受试者进行随访。诊断共识电话会议，包括 以色列和ADRC的医生将有临床，神经心理学和MRI数据收集， 除了完整的MHS实验室和医疗数据外，DNA将被收集， 共享计划已经到位。具体目的是研究基线1）炎症，2） 长期血糖控制不良，3）糖尿病药物，特别是二甲双胍，和4）MRI 对认知能力下降的影响。此外，炎症或MRI的作用 血糖控制或糖尿病药物使用与认知功能的相关性 将审查结果。除了研究糖尿病认知能力下降的关系， 在这种关系中，确定炎症的影响--一种可改变的风险因素--具有意义 在一般人群中早期痴呆症的潜在机制，并可以提供基础， 未来的干预研究具有潜在的巨大公共卫生影响。展示大脑如何 将糖尿病特征与认知能力下降联系起来的异常将支持一个病因或贡献 这些特征在认知妥协中的作用。

This prospective 5-year study will examine how long-term type 2 diabetes characteristics and inflammation affect the development of cognitive decline in a cohort of 1000 cognitively intact (at recruitment) diabetic individuals 65 years and older living in Tel-Aviv, Israel. This study is a collaboration of the Department of Psychiatry at the Mount Sinai School of Medicine (MSSM), NY, the Department of Psychiatry at the Sheba Medical Center, Israel, and the Department of Community Health of the Maccabi Health Services (MHS), the second largest HMO in Israel. It provides health care to a representative cross section of 1.7 million Israeli citizens, 11,000 of whom have diabetes and are above the age of 65 in the area of Tel-Aviv. The benefits of studying this population are: a) up to 10 years of data from the extraordinarily rich MHS Diabetes Registry, including HbA1c, anti-diabetic and other medication, duration of disease, hypertension and other diabetes related characteristics; b) fully computerized centrally processed MHS medical records, facilitating data access and analysis; c) no charge to patients for analyses by the MHS centralized laboratory, ensuring complete use; d) significantly subsidized medication from MHS pharmacies, which record every purchase (in contrast to subject report of medication prescribed); e) minimal loss to contact since ill subjects are cared for by MHS; and f) prompt death notification by ending of client funding. The dementia diagnostic procedures at Sheba will be fully integrated with those of the MSSM Alzheimer's Disease Research Center (ADRC). Subjects will be followed at 18-month intervals. Diagnostic consensus teleconferences including both Israeli and ADRC physicians will have clinical, neuropsychological, and MRI data collected by this project in addition to complete MHS laboratory and medical data. DNA will be collected and a data sharing plan is in place. The specific aims are to investigate the impact of baseline 1) inflammation, 2) poor long-term glycemic control, 3) diabetes medication, specifically metformin, and 4) MRI abnormalities, on the rate of cognitive decline. Additionally, the contribution of inflammation or MRI abnormalities to the associations of glycemic control or diabetes medication use with cognitive outcomes will be examined. Beyond investigating the relationship of cognitive decline in diabetes, identifying the impact of inflammation-a modifiable risk factor-within this relationship, has implications for mechanisms underlying incipient dementia in the general population, and could provide the basis for future intervention studies with potential great public health impact. Demonstrating how brain abnormalities link diabetes characteristics to cognitive decline would support a causative or contributive role of these characteristics in cognitive compromise.