Inflammation, long-term diabetes characteristics, and cognitive decline

这项为期5年的前瞻性研究将考察长期的2型糖尿病特征和 在1000名认知正常的队列中，炎症影响认知能力下降的发展(在 招募)居住在以色列特拉维夫的65岁及以上糖尿病患者。这项研究是一项合作 纽约西奈山医学院精神病学系 以色列Sheba医学中心和马卡比社区卫生部门的精神病学 卫生服务(MHS)，以色列第二大卫生保健组织。它为一名代表提供医疗保健 170万以色列公民的横截面，其中11,000人患有糖尿病，年龄超过 65人在特拉维夫地区。研究这一人群的好处是：a)长达10年的数据来自 非常丰富的MHS糖尿病注册，包括HbA1c，抗糖尿病和其他药物， 病程、高血压和其他与糖尿病有关的特征；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 病人供卫生部中央实验室分析，确保完全使用；d)显著 来自MHS药房的补贴药物，记录每次购买(与受试者相反 开药报告)；e)接触损失最小，因为病人是由卫生和卫生局照顾的； 以及f)通过终止对客户的资助来及时通知死亡。痴呆症诊断程序在 SHEBA将与MSSM阿尔茨海默病研究中心(ADRC)的研究人员完全整合。 受试者将每隔18个月进行一次跟踪调查。诊断共识电话会议，包括两者 以色列和ADRC的医生将拥有由该中心收集的临床、神经心理学和核磁共振数据 该项目除了完整的MHS实验室和医疗数据外。DNA将被收集和一份数据 共享计划已经到位。具体目的是调查基线1)炎症的影响，2) 长期血糖控制不佳，3)糖尿病药物，特别是二甲双胍，以及4)核磁共振 在认知功能减退的速度上。此外，炎症或MRI的作用 血糖控制或糖尿病药物使用与认知相关的异常 将对结果进行检查。除了研究糖尿病患者认知能力下降的关系外， 确定炎症的影响--一种可修改的风险因素--在这种关系中具有重要意义 对普通人群中早期痴呆的潜在机制，并可提供基础 未来可能对公众健康产生重大影响的干预研究。演示大脑如何 将糖尿病特征与认知能力下降联系起来的异常将支持一种病因或致病因素 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.