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腾讯登录Arch Neurol：糖尿病可能会加速认知功能下降
| 导读 | <span>研究者们发现糖尿病或加速老年人认知功能障碍。</span><span>Kristine Yaffe, MD</span><span>（</span><span>University of California San Francisco</span><span>）和其同事在<... |
<span>研究者们发现糖尿病或加速老年人认知功能障碍。</span><span>Kristine Yaffe, MD</span><span>（</span><span>University of California San Francisco</span><span>）和其同事在</span><span>Archives of Neurology</span><span>上报道，在</span><span>9</span><span>年里，那些患有糖尿病的个体在两项单独认知测试上的表现要远差于那些没有糖尿病的人</span><span>(P=0.008 and P=0.001)</span><span>。</span>
<span>该发现提示预防糖尿病能帮助维持老年人的认知功能。</span>
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<span>Yaffe</span><span>和他的同事为了评价糖尿病是否会加速认知功能减退以及血糖控制不佳是否与会在老年人中造成认知功能变差，而在两个社区里进行了前瞻性</span><span>Health, Aging, and Body Composition (Health ABC)</span><span>研究，总共纳入了</span><span>3069</span><span>名平均年龄为</span><span>74.2</span><span>岁的患者。患者在入组时首先完成两个测试——改良简易精神状态检查（</span><span>3MS</span><span>）和数字符号替换测试（</span><span>DSST</span><span>），并在随访的十年中定期进行复测。他们也在入组时、第四年、第六年和第十年时进行糖化血红蛋白测定。在入组时，</span><span>23.4%</span><span>的患者诊断为糖尿病，有</span><span>159</span><span>名患者或</span><span>5.2%</span><span>在研究过程中发展为糖尿病。研究者们发现在入组时，那些确诊为糖尿病的患者两项认知功能测试的分数较没有糖尿病的受试者而言显著降低</span><span>(</span><span>两项测试</span><span>P=0.001)</span><span>，并且在调整了年龄、种族、性别和受教育程度等因素后，结果未发生任何变化。在</span><span>9</span><span>年后，</span><span>Yaffe</span><span>和其同事发现比起那些入组时没有糖尿病的患者，患有糖尿病的受试者认知功能减退更明显</span><span>(3MS </span><span>：</span><span>P=0.008 </span><span>，</span><span>DSST</span><span>：</span><span> P=0.001)</span><span>，在混合效应模型中得到类似的结果。</span>
<span>研究过程中发展成糖尿病的受试者的得分界于两组间，但是与没有糖尿病的受试者组相比不存在统计学差异。研究者们同时发现在入组时即患有糖尿病的受试者中，高糖化血红蛋白水平与低认知评分相关。在大约</span><span>3.5</span><span>年时，糖化血红蛋白水平中度（</span><span>7%</span><span>至</span><span>8%</span><span>）或高度（大于等于</span><span>8%</span><span>）升高的患者的平均认知评分要低于轻度（小于等于</span><span>7%</span><span>）升高的受试者</span><span>(3MS </span><span>：</span><span>P=0.003 , DSST </span><span>：</span><span>P=0.04 )</span><span>。在经过调整后，</span><span>3Ms</span><span>评分还是存在显著差异但是</span><span>DSST</span><span>评分不存在显著性差异。</span>
<span>Yaffe</span><span>和其同事指出他们的研究发现和既往研究结果一致，提示糖尿病的严重程度会加速认知功能的减退。糖尿病导致认知减退的机制包括炎症和微血管病变，也包括糖尿病患者易患肾脏病变、抑郁、卒中、高血压、高脂血症和心血管疾病，所有这些都会导致认知功能受损。延迟或预防糖尿病的发生有益于保持老年人的认知功能。</span>
<span>本研究的不足之处在于在研究过程中发展成为糖尿病患者的受试者人数较少，并且缺乏在研究开始时糖尿病患者的病程和严重程度的相关数据。其他的不足之处包括仅使用两种方法评价认知功能，组间认知功能差异小以及由于在不同时间使用不同的方法评价糖化血红蛋白。</span>
<span>研究者们指出需要进行进一步的研究来确定对糖尿病的早期诊断和治疗能否降低其对认知功能的损害。</span>
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<h2>相关文献</h2>
<h3>Diabetes, Glucose Control, and 9-Year Cognitive Decline Among Older Adults Without DementiaDiabetes and Risk of Cognitive Decline.</h3>
Yaffe K Falvey C Hamilton N Schwartz AV Simonsick EM Satterfield S Cauley JA Rosano C Launer LJ Strotmeyer ES Harris TB
<br/><strong>Abstract</strong><br/>
OBJECTIVES To determine if prevalent and incident diabetes mellitus (DM) increase risk of cognitive decline and if, among elderly adults with DM, poor glucose control is related to worse cognitive performance. DESIGN Prospective cohort study. SETTING Health, Aging, and Body Composition Study at 2 community clinics. PARTICIPANTS A total of 3069 elderly adults (mean age, 74.2 years; 42% black; 52% female). MAIN OUTCOME MEASURES Participants completed the Modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) at baseline and selected intervals over 10 years. Diabetes mellitus status was determined at baseline and during follow-up visits. Glycosylated hemoglobin A1c level was measured at years 1 (baseline), 4, 6, and 10 from fasting whole blood. RESULTS At baseline, 717 participants (23.4%) had prevalent DM and 2352 (76.6%) were without DM, 159 of whom developed incident DM during follow-up. Participants with prevalent DM had lower baseline test scores than participants without DM (3MS: 88.8 vs 90.9; DSST: 32.5 vs 36.3, respectively; t = 6.09; P = .001 for both tests). Results from mixed-effects models showed a similar pattern for 9-year decline (3MS: -6.0- vs -4.5-point decline; t = 2.66; P = .008; DSST: -7.9- vs -5.7-point decline; t = 3.69; P = .001, respectively). Participants with incident DM tended to have baseline and 9-year decline scores between the other 2 groups but were not statistically different from the group without DM. Multivariate adjustment for demographics and medical comorbidities produced similar results. Among participants with prevalent DM, glycosylated hemoglobin A1c level was associated with lower average mean cognitive scores (3MS: F = 8.2; P for overall = .003; DSST: F = 3.4; P for overall = .04), even after multivariate adjustment. CONCLUSION Among well-functioning older adults, DM and poor glucose control among those with DM are associated with worse cognitive function and greater decline. This suggests that severity of DM may contribute to accelerated cognitive aging.
<br/>来源：丁香园
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<span>该发现提示预防糖尿病能帮助维持老年人的认知功能。</span>
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<span>Yaffe</span><span>和他的同事为了评价糖尿病是否会加速认知功能减退以及血糖控制不佳是否与会在老年人中造成认知功能变差，而在两个社区里进行了前瞻性</span><span>Health, Aging, and Body Composition (Health ABC)</span><span>研究，总共纳入了</span><span>3069</span><span>名平均年龄为</span><span>74.2</span><span>岁的患者。患者在入组时首先完成两个测试——改良简易精神状态检查（</span><span>3MS</span><span>）和数字符号替换测试（</span><span>DSST</span><span>），并在随访的十年中定期进行复测。他们也在入组时、第四年、第六年和第十年时进行糖化血红蛋白测定。在入组时，</span><span>23.4%</span><span>的患者诊断为糖尿病，有</span><span>159</span><span>名患者或</span><span>5.2%</span><span>在研究过程中发展为糖尿病。研究者们发现在入组时，那些确诊为糖尿病的患者两项认知功能测试的分数较没有糖尿病的受试者而言显著降低</span><span>(</span><span>两项测试</span><span>P=0.001)</span><span>，并且在调整了年龄、种族、性别和受教育程度等因素后，结果未发生任何变化。在</span><span>9</span><span>年后，</span><span>Yaffe</span><span>和其同事发现比起那些入组时没有糖尿病的患者，患有糖尿病的受试者认知功能减退更明显</span><span>(3MS </span><span>：</span><span>P=0.008 </span><span>，</span><span>DSST</span><span>：</span><span> P=0.001)</span><span>，在混合效应模型中得到类似的结果。</span>
<span>研究过程中发展成糖尿病的受试者的得分界于两组间，但是与没有糖尿病的受试者组相比不存在统计学差异。研究者们同时发现在入组时即患有糖尿病的受试者中，高糖化血红蛋白水平与低认知评分相关。在大约</span><span>3.5</span><span>年时，糖化血红蛋白水平中度（</span><span>7%</span><span>至</span><span>8%</span><span>）或高度（大于等于</span><span>8%</span><span>）升高的患者的平均认知评分要低于轻度（小于等于</span><span>7%</span><span>）升高的受试者</span><span>(3MS </span><span>：</span><span>P=0.003 , DSST </span><span>：</span><span>P=0.04 )</span><span>。在经过调整后，</span><span>3Ms</span><span>评分还是存在显著差异但是</span><span>DSST</span><span>评分不存在显著性差异。</span>
<span>Yaffe</span><span>和其同事指出他们的研究发现和既往研究结果一致，提示糖尿病的严重程度会加速认知功能的减退。糖尿病导致认知减退的机制包括炎症和微血管病变，也包括糖尿病患者易患肾脏病变、抑郁、卒中、高血压、高脂血症和心血管疾病，所有这些都会导致认知功能受损。延迟或预防糖尿病的发生有益于保持老年人的认知功能。</span>
<span>本研究的不足之处在于在研究过程中发展成为糖尿病患者的受试者人数较少，并且缺乏在研究开始时糖尿病患者的病程和严重程度的相关数据。其他的不足之处包括仅使用两种方法评价认知功能，组间认知功能差异小以及由于在不同时间使用不同的方法评价糖化血红蛋白。</span>
<span>研究者们指出需要进行进一步的研究来确定对糖尿病的早期诊断和治疗能否降低其对认知功能的损害。</span>
<div>
<div id="article_share">
</div>
</div>
<div id="wrap">
<div id="paper">
<h2>相关文献</h2>
<h3>Diabetes, Glucose Control, and 9-Year Cognitive Decline Among Older Adults Without DementiaDiabetes and Risk of Cognitive Decline.</h3>
Yaffe K Falvey C Hamilton N Schwartz AV Simonsick EM Satterfield S Cauley JA Rosano C Launer LJ Strotmeyer ES Harris TB
<br/><strong>Abstract</strong><br/>
OBJECTIVES To determine if prevalent and incident diabetes mellitus (DM) increase risk of cognitive decline and if, among elderly adults with DM, poor glucose control is related to worse cognitive performance. DESIGN Prospective cohort study. SETTING Health, Aging, and Body Composition Study at 2 community clinics. PARTICIPANTS A total of 3069 elderly adults (mean age, 74.2 years; 42% black; 52% female). MAIN OUTCOME MEASURES Participants completed the Modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) at baseline and selected intervals over 10 years. Diabetes mellitus status was determined at baseline and during follow-up visits. Glycosylated hemoglobin A1c level was measured at years 1 (baseline), 4, 6, and 10 from fasting whole blood. RESULTS At baseline, 717 participants (23.4%) had prevalent DM and 2352 (76.6%) were without DM, 159 of whom developed incident DM during follow-up. Participants with prevalent DM had lower baseline test scores than participants without DM (3MS: 88.8 vs 90.9; DSST: 32.5 vs 36.3, respectively; t = 6.09; P = .001 for both tests). Results from mixed-effects models showed a similar pattern for 9-year decline (3MS: -6.0- vs -4.5-point decline; t = 2.66; P = .008; DSST: -7.9- vs -5.7-point decline; t = 3.69; P = .001, respectively). Participants with incident DM tended to have baseline and 9-year decline scores between the other 2 groups but were not statistically different from the group without DM. Multivariate adjustment for demographics and medical comorbidities produced similar results. Among participants with prevalent DM, glycosylated hemoglobin A1c level was associated with lower average mean cognitive scores (3MS: F = 8.2; P for overall = .003; DSST: F = 3.4; P for overall = .04), even after multivariate adjustment. CONCLUSION Among well-functioning older adults, DM and poor glucose control among those with DM are associated with worse cognitive function and greater decline. This suggests that severity of DM may contribute to accelerated cognitive aging.
<br/>来源：丁香园
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