Yaffe Kristine, Kanaya Alka, Lindquist Karla, Simonsick Eleanor M, Harris Tamara, Shorr Ronald I, Tylavsky Frances A, Newman Anne B
Department of Psychiatry, University of California, San Francisco, CA 94121, USA.
JAMA. 2004 Nov 10;292(18):2237-42. doi: 10.1001/jama.292.18.2237.
Several studies have reported an association between the metabolic syndrome and cardiovascular disease. Despite an increasing awareness that cardiovascular risk factors increase risk of cognitive decline and dementia, there are few data on the metabolic syndrome and cognition.
To determine if the metabolic syndrome is a risk factor for cognitive decline and if this association is modified by inflammation.
A 5-year prospective observational study conducted from 1997 to 2002 at community clinics at 2 sites.
A total of 2632 black and white elders (mean age, 74 years).
Association of the metabolic syndrome (measured using National Cholesterol Education Program guidelines) and high inflammation (defined as above median serum level of interleukin 6 and C-reactive protein) with change in cognition (Modified Mini-Mental State Examination [3MS]) at 3 and 5 years. Cognitive impairment was defined as at least a 5-point decline.
Compared with those without the metabolic syndrome (n = 1616), elders with the metabolic syndrome (n = 1016) were more likely to have cognitive impairment (26% vs 21%, multivariate adjusted relative risk [RR], 1.20; 95% confidence interval [CI], 1.02-1.41). There was a statistically significant interaction with inflammation and the metabolic syndrome (P = .03) on cognitive impairment. After stratifying for inflammation, those with the metabolic syndrome and high inflammation (n = 348) had an increased likelihood of cognitive impairment compared with those without the metabolic syndrome (multivariate adjusted RR, 1.66; 95% CI, 1.19-2.32). Those with the metabolic syndrome and low inflammation (n = 668) did not exhibit an increased likelihood of impairment (multivariate adjusted RR, 1.08; 95% CI, 0.89-1.30). Stratified multivariate random-effects models demonstrated that participants with the metabolic syndrome and high inflammation had greater 4-year decline on 3MS (P = .04) compared with those without the metabolic syndrome, whereas those with the metabolic syndrome and low inflammation did not (P = .44).
These findings support the hypothesis that the metabolic syndrome contributes to cognitive impairment in elders, but primarily in those with high level of inflammation.
多项研究报告了代谢综合征与心血管疾病之间的关联。尽管人们越来越意识到心血管危险因素会增加认知能力下降和痴呆的风险，但关于代谢综合征与认知的研究数据却很少。
确定代谢综合征是否为认知能力下降的危险因素，以及这种关联是否会因炎症而改变。
1997年至2002年在两个地点的社区诊所进行的一项为期5年的前瞻性观察研究。
共有2632名黑人和白人老年人（平均年龄74岁）。
代谢综合征（采用美国国家胆固醇教育计划指南进行测量）和高炎症（定义为血清白细胞介素6和C反应蛋白水平高于中位数）与3年和5年时认知变化（改良简易精神状态检查表[3MS]）之间的关联。认知障碍定义为至少下降5分。
与无代谢综合征者（n = 1616）相比，患有代谢综合征者（n = 1016）更易出现认知障碍（26%对21%，多变量调整相对风险[RR]为1.20；95%置信区间[CI]为1.02 - 1.41）。炎症与代谢综合征在认知障碍方面存在统计学上的显著交互作用（P = 0.03）。在按炎症分层后，与无代谢综合征者相比，患有代谢综合征且炎症水平高者（n = 348）出现认知障碍的可能性增加（多变量调整RR为1.66；95% CI为1.19 - 2.32）。患有代谢综合征且炎症水平低者（n = 668）未表现出障碍可能性增加（多变量调整RR为1.08；95% CI为0.89 - 1.30）。分层多变量随机效应模型表明，与无代谢综合征者相比，患有代谢综合征且炎症水平高者在3MS上4年的下降幅度更大（P = 0.04），而患有代谢综合征且炎症水平低者则不然（P = 0.44）。
这些发现支持了以下假设，即代谢综合征会导致老年人认知障碍，但主要是在炎症水平高的人群中。
