Kristine Yaffe, Cherie Falvey, Nathan Hamilton, Ann V Schwartz, Eleanor M Simonsick, Suzanne Satterfield, Jane A Cauley, Caterina Rosano, Lenore J Launer, Elsa S Strotmeyer, Tamara B Harris
{"title":"无痴呆老年人的糖尿病、血糖控制和9年认知能力下降","authors":"Kristine Yaffe, Cherie Falvey, Nathan Hamilton, Ann V Schwartz, Eleanor M Simonsick, Suzanne Satterfield, Jane A Cauley, Caterina Rosano, Lenore J Launer, Elsa S Strotmeyer, Tamara B Harris","doi":"10.1001/archneurol.2012.1117","DOIUrl":null,"url":null,"abstract":"OBJECTIVES\nTo 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.\n\n\nSETTING\nHealth, Aging, and Body Composition Study at 2 community clinics.\n\n\nPARTICIPANTS\nA total of 3069 elderly adults (mean age, 74.2 years; 42% black; 52% female).\n\n\nMAIN OUTCOME MEASURES\nParticipants 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.\n\n\nRESULTS\nAt 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.\n\n\nCONCLUSION\nAmong 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.","PeriodicalId":8321,"journal":{"name":"Archives of neurology","volume":"69 9","pages":"1170-5"},"PeriodicalIF":0.0000,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archneurol.2012.1117","citationCount":"289","resultStr":"{\"title\":\"Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia.\",\"authors\":\"Kristine Yaffe, Cherie Falvey, Nathan Hamilton, Ann V Schwartz, Eleanor M Simonsick, Suzanne Satterfield, Jane A Cauley, Caterina Rosano, Lenore J Launer, Elsa S Strotmeyer, Tamara B Harris\",\"doi\":\"10.1001/archneurol.2012.1117\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"OBJECTIVES\\nTo 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.\\n\\n\\nSETTING\\nHealth, Aging, and Body Composition Study at 2 community clinics.\\n\\n\\nPARTICIPANTS\\nA total of 3069 elderly adults (mean age, 74.2 years; 42% black; 52% female).\\n\\n\\nMAIN OUTCOME MEASURES\\nParticipants 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.\\n\\n\\nRESULTS\\nAt 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.\\n\\n\\nCONCLUSION\\nAmong well-functioning older adults, DM and poor glucose control among those with DM are associated with worse cognitive function and greater decline. 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引用次数: 289
摘要
目的:确定糖尿病(DM)是否会增加认知能力下降的风险，以及在老年糖尿病患者中，血糖控制不良是否与认知能力下降有关。前瞻性队列研究。环境:在2个社区诊所进行健康、衰老和身体成分研究。参与者:共3069名老年人(平均年龄74.2岁;42%是黑人;52%的女性)。主要结果测量:参与者在基线和10年的选定间隔完成修改后的迷你精神状态检查(3MS)和数字符号替换测试(DSST)。在基线和随访期间确定糖尿病状况。在第1年(基线)、第4年、第6年和第10年从空腹全血中测量糖化血红蛋白A1c水平。结果:基线时，717名参与者(23.4%)患有糖尿病，2352名参与者(76.6%)没有糖尿病，其中159名在随访期间发生了糖尿病。糖尿病患者的基线测试分数低于非糖尿病患者(3MS: 88.8 vs 90.9;DSST:分别为32.5 vs 36.3;T = 6.09;两项检验的P = .001)。混合效应模型的结果显示了类似的9年下降模式(3MS: -6.0 vs -4.5点下降;T = 2.66;P = 0.008;DSST: -7.9 vs -5.7点下降;T = 3.69;P = 0.001)。在其他两组中，偶发性糖尿病患者的基线评分和9年下降评分趋于一致，但与非糖尿病患者的评分没有统计学差异。人口统计学和医学合并症的多变量调整也产生了类似的结果。在糖尿病患者中，糖化血红蛋白A1c水平与较低的平均认知评分相关(3MS: F = 8.2;总体P = 0.003;Dsst: f = 3.4;总体P = 0.04)，甚至在多变量调整后也是如此。结论:在功能良好的老年人中，糖尿病和糖尿病患者血糖控制不良与认知功能恶化和更大的衰退有关。这表明糖尿病的严重程度可能会加速认知老化。
Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia.
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.
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