Okereke Olivia I, Kang Jae H, Cook Nancy R, Gaziano J Michael, Manson JoAnn E, Buring Julie E, Grodstein Francine
Division of Aging and Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA.
J Am Geriatr Soc. 2008 Jun;56(6):1028-36. doi: 10.1111/j.1532-5415.2008.01686.x. Epub 2008 Apr 1.
To relate diabetes mellitus (DM) status and duration to late-life cognitive impairment and decline in men and women.
Prospective cohort.
Community.
Five thousand nine hundred seven men in the Physicians' Health Study II and 6,326 women in the Women's Health Study (mean age 74.1 and 71.9, respectively, at baseline cognitive assessment); 553 men and 405 women had DM.
Primary outcomes were general cognition (the Telephone Interview for Cognitive Status (TICS) and a global score averaging five tests) and verbal memory. All participants had second assessments approximately 2 years later; women had third assessments an average of 4 years later.
In adjusted linear regression models, participants with DM had significantly lower baseline scores for all outcomes, and longer duration of DM was associated with lower scores (P-trends < .001). Men with DM had significantly greater 2-year cognitive decline than men without DM, and longer duration of DM was associated with worse decline (P-trends < or = .01). In repeated-measures analyses of response profiles, women with DM had significantly greater 4-year cognitive decline in all outcomes than women without DM. In women, as in men, there was generally greater cognitive decline with longer duration of DM (e.g., the adjusted mean difference in decline on the TICS associated with duration of > or = 5 years was -0.74 (95% confidence interval = -1.05 to -0.43) points (P-trend < .001). There were no significant sex-DM interactions.
Type 2 DM and longer duration of DM are similarly related to cognitive impairment and decline in men and women.
探讨糖尿病（DM）状态及病程与老年人认知功能损害及衰退在男性和女性中的关系。
前瞻性队列研究。
社区。
医师健康研究II中的5907名男性以及女性健康研究中的6326名女性（基线认知评估时平均年龄分别为74.1岁和71.9岁）；553名男性和405名女性患有DM。
主要结局指标为总体认知（认知状态电话访谈（TICS）以及五项测试平均后的综合得分）和言语记忆。所有参与者约2年后进行第二次评估；女性平均4年后进行第三次评估。
在调整后的线性回归模型中，患有DM的参与者所有结局指标的基线得分均显著较低，且DM病程越长得分越低（P趋势<0.001）。患有DM的男性2年认知衰退显著大于未患DM的男性，且DM病程越长衰退越严重（P趋势≤0.01）。在反应曲线的重复测量分析中，患有DM的女性所有结局指标的4年认知衰退均显著大于未患DM的女性。与男性一样，女性中DM病程越长通常认知衰退越大（例如，TICS评分中与病程≥5年相关的衰退调整后平均差异为-0.74（95%置信区间=-1.05至-0.43）分（P趋势<0.001）。不存在显著的性别-DM交互作用。
2型DM及较长的DM病程与男性和女性的认知损害及衰退的关系相似。
