ACCORD-MIND 试验中 2 型糖尿病患者抑郁与认知加速衰退的相关性。
Association of depression with accelerated cognitive decline among patients with type 2 diabetes in the ACCORD-MIND trial.
机构信息
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington.
出版信息
JAMA Psychiatry. 2013 Oct;70(10):1041-7. doi: 10.1001/jamapsychiatry.2013.1965.
IMPORTANCE
Depression has been identified as a risk factor for dementia among patients with type 2 diabetes mellitus but the cognitive domains and patient groups most affected have not been identified.
OBJECTIVE
To determine whether comorbid depression in patients with type 2 diabetes accelerates cognitive decline.
DESIGN
A 40-month cohort study of participants in the Action to Control Cardiovascular Risk in Diabetes-Memory in Diabetes (ACCORD-MIND) trial.
SETTING
Fifty-two clinics organized into 6 clinical networks across the United States and Canada.
PARTICIPANTS
Two thousand nine hundred seventy-seven participants with type 2 diabetes at high risk for cardiovascular events.
INTERVENTION
The Digit Symbol Substitution Test, Rey Auditory Verbal Learning Test, and the modified Stroop test were used to assess cognition. The 9-item Patient Health Questionnaire was used to assess depression.
MAIN OUTCOMES AND MEASURES
Mixed-effects statistical models were used to analyze cognitive test outcomes incorporating depression as a time-dependent covariate.
RESULTS
Participants with scores indicative of depression (9-item Patient Health Questionnaire, ≥10) showed greater cognitive decline during 40-month follow-up on all tests, with the following differences in estimated least squares means: Digit Symbol Substitution Test, 0.72 (95% CI, 0.25 to 1.19; P = .003), Rey Auditory Verbal Learning Test, 0.18 (95% CI, 0.07 to 0.29; P = .001), and Stroop interference, -1.06 (95% CI, -1.93 to -0.18; P = .02). This effect of depression on risk of cognitive decline did not differ according to previous cardiovascular disease; baseline cognition or age; or intensive vs standard glucose-lowering treatment, blood pressure treatment, lipid treatment, or insulin treatment. Addition of demographic and clinical covariates to models did not significantly change the cognitive decline associated with depression.
CONCLUSIONS AND RELEVANCE
Depression in patients with type 2 diabetes was associated with greater cognitive decline in all domains, across all treatment arms, and in all participant subgroups assessed. Future randomized trials will be necessary to determine if depression treatment can lower the risk of cognitive decline in patients with diabetes.
重要性
抑郁已被确定为 2 型糖尿病患者发生痴呆的一个风险因素，但尚未确定受影响的认知领域和患者群体。
目的
确定 2 型糖尿病合并抑郁是否会加速认知能力下降。
设计
这是一项为期 40 个月的队列研究，参与者来自心血管风险控制行动中的糖尿病-糖尿病认知研究（ACCORD-MIND）试验。
设置
美国和加拿大的 6 个临床网络中的 52 个诊所。
参与者
2977 名患有心血管事件高危 2 型糖尿病的患者。
干预措施
采用数字符号替代测试、 Rey 听觉词语学习测试和改良 Stroop 测试评估认知能力。使用 9 项患者健康问卷评估抑郁。
主要结果和测量
采用混合效应统计模型分析认知测试结果，将抑郁作为时间依赖性协变量。
结果
在 40 个月的随访中，有抑郁评分（9 项患者健康问卷，≥10）的患者在所有测试中认知能力下降更为明显，估计最小二乘均值的差异如下：数字符号替代测试，0.72（95%CI，0.25 至 1.19；P=.003）， Rey 听觉词语学习测试，0.18（95%CI，0.07 至 0.29；P=.001），和 Stroop 干扰测试，-1.06（95%CI，-1.93 至-0.18；P=.02）。这种抑郁对认知衰退风险的影响与既往心血管疾病、基线认知或年龄、强化或标准降糖治疗、降压治疗、降脂治疗或胰岛素治疗无关。将人口统计学和临床协变量添加到模型中并没有显著改变与抑郁相关的认知衰退。
结论和相关性
2 型糖尿病患者的抑郁与所有领域的认知衰退相关，跨越所有治疗组和所有评估的患者亚组。未来需要进行随机试验来确定抑郁治疗是否可以降低糖尿病患者的认知衰退风险。
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