INSERM U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France; Université Paris Sud 11, Paris, France.
INSERM U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France; Université de Versailles St-Quentin-en-Yvelines, Versailles, France.
Lancet Diabetes Endocrinol. 2014 Mar;2(3):228-35. doi: 10.1016/S2213-8587(13)70192-X. Epub 2013 Dec 19.
Type 2 diabetes increases the risk for dementia, but whether it affects cognition before old age is unclear. We investigated whether duration of diabetes in late midlife and poor glycaemic control were associated with accelerated cognitive decline.
5653 participants from the Whitehall II cohort study (median age 54.4 years [IQR 50.3-60.3] at first cognitive assessment), were classified into four groups: normoglycaemia, prediabetes, newly diagnosed diabetes, and known diabetes. Tests of memory, reasoning, phonemic and semantic fluency, and a global score that combined all cognitive tests, were assessed three times over 10 years (1997-99, 2002-04, and 2007-09). Mean HbA1c was used to assess glycaemic control during follow-up. Analyses were adjusted for sociodemographic characteristics, health-related behaviours, and chronic diseases.
Compared with normoglycaemic participants, those with known diabetes had a 45% faster decline in memory (10 year difference in decline -0.13 SD, 95% CI -0.26 to -0.00; p=0.046), a 29% faster decline in reasoning (-0.10 SD, -0.19 to -0.01; p=0.026), and a 24% faster decline in the global cognitive score (-0.11 SD, -0.21 to -0.02; p=0.014). Participants with prediabetes or newly diagnosed diabetes had similar rates of decline to those with normoglycaemia. Poorer glycaemic control in participants with known diabetes was associated with a significantly faster decline in memory (-0.12 [-0.22 to -0.01]; p=0.034) and a decline in reasoning that approached significance (-0.07 [-0.15 to 0.00]; p=0.052).
The risk of accelerated cognitive decline in middle-aged patients with type 2 diabetes is dependent on both disease duration and glycaemic control.
US National Institutes of Health, UK Medical Research Council.
2 型糖尿病会增加痴呆的风险，但它是否会影响老年前的认知能力尚不清楚。我们研究了中年后期糖尿病的持续时间和血糖控制不佳是否与认知能力加速下降有关。
来自 Whitehall II 队列研究的 5653 名参与者（首次认知评估时的中位年龄为 54.4 岁[IQR 50.3-60.3]）分为四组：正常血糖、糖尿病前期、新诊断的糖尿病和已知的糖尿病。在 10 年内进行了 3 次记忆、推理、语音和语义流畅性以及综合所有认知测试的全球评分测试（1997-99 年、2002-04 年和 2007-09 年）。平均 HbA1c 用于评估随访期间的血糖控制情况。分析调整了社会人口特征、健康相关行为和慢性疾病。
与正常血糖参与者相比，已知糖尿病患者的记忆下降速度快 45%（10 年下降差异-0.13 SD，95%CI-0.26 至-0.00；p=0.046），推理下降速度快 29%（-0.10 SD，-0.19 至-0.01；p=0.026），整体认知评分下降速度快 24%（-0.11 SD，-0.21 至-0.02；p=0.014）。患有糖尿病前期或新诊断糖尿病的患者与正常血糖者的下降速度相似。已知糖尿病患者的血糖控制较差与记忆下降速度显著加快有关（-0.12 [-0.22 至-0.01]；p=0.034），推理也有下降的趋势（-0.07 [-0.15 至 0.00]；p=0.052）。
中年 2 型糖尿病患者认知能力加速下降的风险取决于疾病持续时间和血糖控制。
美国国立卫生研究院，英国医学研究理事会。
