老年人中高胰岛素血症、胰岛素抵抗与认知能力下降。

Hyperinsulinemia, insulin resistance and cognitive decline in older cohort.

机构信息

Department of Geriatrics, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.

出版信息

Biomed Environ Sci. 2012 Feb;25(1):8-14. doi: 10.3967/0895-3988.2012.01.002.

DOI:10.3967/0895-3988.2012.01.002

PMID:22424621

Abstract

OBJECTIVE

Type 2 diabetes has been recently recognized as an important risk factor for cognitive decline of patients with Alzheimer's disease (AD). But the roles of hyperinsulinemia (HI) and insulin resistance (IR) in the development of AD are still controversial. This study was designed to evaluate whether HI or IR influenced the cognitive functions of older cohort.

METHODS

The cognitive functions of 328 consecutive elderly patients were evaluated with a battery of cognitive rating scales. Their fasting blood glucose (FBG) and fasting insulin (FINS) were analyzed and IR was calculated with modified-Homa. The cognitive scores in different groups and the correlation of cognitive functions with HI or IR were analyzed.

RESULTS

In our study, there were 180 participants with HI and 148 without HI, and 192 with IR and 136 without IR. The participants with HI showed worse cognitive functions than those without HI in MMSE, MOCA, CDR, orientation, delayed memory, and attention/calculation domains. Similarly, the elderly with IR had lower cognitive scores than those without IR in MMSE, MOCA, CDR, GDS, orientation, delayed memory, and attention/calculation domains. The insulin levels and Homa IR had negative correlation with the scores of MMSE and delayed memory, not only in the model 1 adjusted for FBG and diabetes history, but also in the model 2 adjusted for all nine demographic characteristics.

CONCLUSION

HI and IR are important risk factors for cognitive decline of the elderly, especially for the dysfunctions in delayed memory domains.

摘要

目的

2 型糖尿病最近被认为是阿尔茨海默病（AD）患者认知能力下降的一个重要危险因素。但是高胰岛素血症（HI）和胰岛素抵抗（IR）在 AD 发展中的作用仍存在争议。本研究旨在评估 HI 或 IR 是否会影响老年患者的认知功能。

方法

对 328 例连续老年患者进行一系列认知评定量表评估。分析其空腹血糖（FBG）和空腹胰岛素（FINS），并用改良的 Homa 计算 IR。分析不同组的认知评分以及认知功能与 HI 或 IR 的相关性。

结果

在本研究中，有 180 名参与者存在 HI，148 名参与者不存在 HI，192 名参与者存在 IR，136 名参与者不存在 IR。与无 HI 者相比，HI 者在 MMSE、MOCA、CDR、定向力、延迟记忆和注意力/计算域的认知功能更差。同样，与无 IR 者相比，IR 者在 MMSE、MOCA、CDR、GDS、定向力、延迟记忆和注意力/计算域的认知评分更低。胰岛素水平和 Homa-IR 与 MMSE 和延迟记忆评分呈负相关，这不仅在调整 FBG 和糖尿病史的模型 1 中，而且在调整所有 9 种人口统计学特征的模型 2 中均如此。