McGuire Lisa C, Ford Earl S, Ajani Umed A
Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Highway, NE,, MS K-66, Atlanta, GA 30328, USA.
BMC Geriatr. 2006 May 1;6:8. doi: 10.1186/1471-2318-6-8.
For older adults without diabetes, cognitive functioning has been implicated as a predictor of death and functional disability for older adults and those with mild to severe cognitive impairment. However, little is known about the relationship between cognition functioning on mortality and the development of functional disability in late life for persons with diabetes. We examined the relative contribution of cognitive functioning to mortality and functional disability over a 2-year period in a sample of nationally representative older US adults with diabetes who were free from cognitive impairment through secondary data analyses of the Second Longitudinal Study of Aging (LSOA II).
Participants included 559 US adults (232 males and 327 females) >or= 70 years old who had diabetes and who were free from cognitive impairment were examined using an adapted Telephone Interview of Cognitive Status (TICS), Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL).
Multivariate logistic regression was conducted to investigate the independent contribution of cognitive functioning to three mutually exclusive outcomes of death and two measures of functional disability status. The covariates included in the model were participants' sex, age, race, marital status, educational level, duration of diabetes, cardiovascular disease (CVD) status, and self-rated health. Persons with diabetes who had the lowest levels of cognitive functioning relative to the highest level of cognitive functioning had a greater odds of dying (AOR = 0.80, 95% CI = 0.67-0.96) or becoming disabled (AOR = 0.87, 95% CI = 0.78-0.97) compared to those people who were disability free.
Older adults with diabetes and low normal levels of cognition, yet within normal ranges, were approximately 20% more likely to die and 13% more likely to become disabled than those with higher levels of cognitive functioning over a 2-year period. Brief screening measures of cognitive functioning could be used to identify older adults with diabetes who are at increased risk for mortality and functional disability, as well as those who may benefit from interventions to prevent or minimize further disablement and declines in cognitive functioning.
对于无糖尿病的老年人，认知功能已被视为老年人以及轻度至重度认知障碍者死亡和功能残疾的预测指标。然而，对于糖尿病患者晚年认知功能与死亡率及功能残疾发展之间的关系，人们知之甚少。我们通过对第二次老龄化纵向研究（LSOA II）的二次数据分析，研究了在美国具有全国代表性的无认知障碍的老年糖尿病患者样本中，认知功能在两年时间里对死亡率和功能残疾的相对贡献。
参与者包括559名年龄≥70岁的美国成年人（232名男性和327名女性），他们患有糖尿病且无认知障碍，通过采用改良的认知状态电话访谈（TICS）、日常生活活动（ADL）和工具性日常生活活动（IADL）进行检查。
进行多变量逻辑回归以研究认知功能对死亡这一相互排斥的三种结果以及两种功能残疾状态测量指标的独立贡献。模型中纳入的协变量包括参与者的性别、年龄、种族、婚姻状况、教育水平、糖尿病病程、心血管疾病（CVD）状况和自评健康状况。与无残疾者相比，认知功能水平相对于最高水平最低的糖尿病患者死亡几率更高（调整后比值比[AOR]=0.80，95%置信区间[CI]=0.67 - 0.96）或致残几率更高（AOR = 0.87，95% CI = 0.78 - 0.97）。
在两年时间里，认知水平处于正常范围但较低的老年糖尿病患者，比认知功能水平较高的患者死亡可能性高出约20%，致残可能性高出13%。认知功能的简短筛查措施可用于识别死亡和功能残疾风险增加的老年糖尿病患者，以及可能从预防或尽量减少进一步残疾和认知功能衰退的干预措施中获益的患者。
