Geroldi Cristina, Frisoni Giovanni B, Paolisso Giuseppe, Bandinelli Stefania, Lamponi Marco, Abbatecola Angela Marie, Zanetti Orazio, Guralnik Jack M, Ferrucci Luigi
Laboratory of Epidemiology and Neuroimaging, Istituto de Ricovero e Cura a Carattere Scientifico San Giovanni de Dio-Fatebenefratelli, Brescia, Italy.
Arch Neurol. 2005 Jul;62(7):1067-72. doi: 10.1001/archneur.62.7.1067.
To test the association between cognitive impairment, with and without subcortical features, and insulin resistance in an elderly community-dwelling population.
Cross-sectional wave of an epidemiologic longitudinal study (InCHIANTI).
A total of 523 people, aged 70 to 90 years without diabetes mellitus or hyperglycemia, from the InCHIANTI cohort were included in the study. A total of 119 individuals had cognitive impairment (Mini-Mental State Examination [MMSE] score < 25), 21 of whom had both cognitive impairment and subcortical features (CI/SF+ group). Control groups contained 23 individuals with a history of stroke and 381 individuals with no cognitive impairment (no CI group, MMSE score > or = 25). Indicators of insulin resistance were the fasting plasma insulin level, insulin resistance index (Homeostasis Model Assessment of Insulin Resistance [HOMA-IR]), and insulin sensitivity index (Quantitative Insulin Sensitivity Check Index [QUICKI]).
The insulin resistance profile of patients in the CI/SF+ group was similar to that of individuals who had experienced stroke, whereas the profile of individuals with cognitive impairment without subcortical features (CI/SF- group) was similar to that of individuals in the no CI group. Patients in the CI/SF- group showed insulin resistance comparable to individuals in the no CI group (age-adjusted P = .27, .19, and .64, respectively, for difference in fasting blood insulin level, HOMA-IR, and QUICKI in linear regression models) and lower than patients with stroke (age-adjusted P = .01, .02, and .07, respectively). On the contrary, patients in the CI/SF+ group had insulin resistance and sensitivity values similar to those of the stroke group (age-adjusted P = .80, .84, and .75, respectively, for difference in fasting blood insulin level, HOMA-IR, and QUICKI) but significantly different from those in the no CI group (age-adjusted P = .01, .03, and .02, respectively).
Cognitive impairment with but not without subcortical features is associated with biochemical and clinical features of insulin resistance syndrome. In epidemiologic populations, insulin resistance might contribute to cognitive impairment through a vascular mechanism.
在老年社区居住人群中，检验伴有和不伴有皮质下特征的认知障碍与胰岛素抵抗之间的关联。
一项流行病学纵向研究（InCHIANTI）的横断面调查。
InCHIANTI队列中共有523名年龄在70至90岁之间、无糖尿病或高血糖的人被纳入研究。共有119人存在认知障碍（简易精神状态检查表[MMSE]评分<25），其中21人既有认知障碍又有皮质下特征（CI/SF+组）。对照组包括23名有中风病史的人和381名无认知障碍的人（无CI组，MMSE评分≥25）。胰岛素抵抗的指标包括空腹血浆胰岛素水平、胰岛素抵抗指数（胰岛素抵抗稳态模型评估[HOMA-IR]）和胰岛素敏感性指数（定量胰岛素敏感性检查指数[QUICKI]）。
CI/SF+组患者的胰岛素抵抗情况与中风患者相似，而无皮质下特征的认知障碍患者（CI/SF-组）的情况与无CI组患者相似。CI/SF-组患者的胰岛素抵抗与无CI组患者相当（线性回归模型中，空腹血糖胰岛素水平、HOMA-IR和QUICKI差异的年龄校正P值分别为0.27、0.19和0.64），且低于中风患者（年龄校正P值分别为0.01、0.02和0.07）。相反，CI/SF+组患者的胰岛素抵抗和敏感性值与中风组相似（空腹血糖胰岛素水平、HOMA-IR和QUICKI差异的年龄校正P值分别为0.80、0.84和0.75），但与无CI组有显著差异（年龄校正P值分别为0.01、0.03和0.02）。
伴有而非不伴有皮质下特征的认知障碍与胰岛素抵抗综合征的生化和临床特征相关。在流行病学人群中，胰岛素抵抗可能通过血管机制导致认知障碍。
