Division of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, IN, USA.
Alzheimers Dement. 2011 Jul;7(4):418-24. doi: 10.1016/j.jalz.2010.07.003.
Diabetes mellitus is associated with an increased risk for cognitive impairment and vascular factors seem to play a role in this relationship. In a sample involving elderly African Americans, we tested the hypothesis that diabetes accelerates cognitive decline and explored possible mediating mechanisms within a follow-up period of 15 years.
A total of 1,702 subjects, of whom 441 had diabetes, were given the community screening interview for dementia to measure cognitive functioning at six different time points spread over a 15-year follow-up period. Mixed effects models with repeated measures were used to examine the association of diabetes and vascular risk factors with cognitive scores over time.
African American subjects with diabetes reported having a significant accelerated cognitive decline as compared with those without diabetes (P = .046), when controlling for basic demographics and baseline comorbid conditions (heart disease, hypertension, stroke, and depression). Adjusting for incident heart disease, and especially stroke, weakened this association (P = .098), thereby indicating a mediating effect of stroke on the association between diabetes and cognitive decline. However, when incident stroke was incorporated into the model, the effect for participants with diabetes increased greatly (P = .007).
Diabetes, mediated by cerebrovascular pathology, accelerates cognitive decline within a follow-up period of 15 years in a sample comprising African Americans.
糖尿病与认知障碍风险增加有关，血管因素似乎在这种关系中起作用。在一项涉及老年非裔美国人的样本中，我们检验了糖尿病加速认知衰退的假设，并在 15 年的随访期内探讨了可能的中介机制。
共有 1702 名受试者，其中 441 名患有糖尿病，他们接受了社区痴呆症筛查访谈，以在 15 年的随访期间的六个不同时间点测量认知功能。使用具有重复测量的混合效应模型来检查糖尿病和血管危险因素与随时间变化的认知评分之间的关联。
与没有糖尿病的受试者相比，患有糖尿病的非裔美国受试者报告认知衰退明显加速（P =.046），在控制基本人口统计学和基线合并症（心脏病、高血压、中风和抑郁症）后。调整新发心脏病，特别是中风，削弱了这种关联（P =.098），表明中风对糖尿病与认知衰退之间的关联具有中介作用。然而，当将新发中风纳入模型时，糖尿病患者的效果大大增加（P =.007）。
在一个由非裔美国人组成的样本中，糖尿病通过脑血管病理介导，在 15 年的随访期内加速认知衰退。
