Feinkohl Insa, Keller Markéta, Robertson Christine M, Morling Joanne R, McLachlan Stela, Frier Brian M, Deary Ian J, Strachan Mark W J, Price Jackie F
Centre for Population Health Sciences, Medical School, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK,
Diabetologia. 2015 Jul;58(7):1637-45. doi: 10.1007/s00125-015-3581-0. Epub 2015 Apr 7.
AIMS/HYPOTHESIS: The aim of this work was to assess the role of well-established cardiovascular risk factors in the late-life cognitive decline of patients with type 2 diabetes.
Data from 831 participants (aged 60-75 years) attending the 4 year follow-up of the Edinburgh Type 2 Diabetes Study (ET2DS) were used. Smoking history (pack-years), BP, HbA1c, plasma glucose and cholesterol were determined at baseline clinics (single time measurements) and/or from serial data recorded on a clinical management database from diagnosis until recruitment ('historical' data). Principal component analysis derived a factor, g, of general ability from seven cognitive tests. Linear regression models of follow-up g were adjusted for baseline g to represent 4 year cognitive change. 'Accelerated late-life cognitive decline' was defined as scoring in the lowest tertile of '4 year cognitive change' regression scores. Analyses controlled for age and sex.
A baseline history of moderate/heavy smoking (≥ 10 pack-years) and a 1% increased historical HbA1c (equivalent to an increase by 11 mmol/mol) predicted a 64% (OR 1.64; 95% CI 1.14, 2.34; p = 0.007) and 21% (OR 1.21; 95% CI 1.00, 1.45; p = 0.046) increased risk of accelerated cognitive decline, respectively. When treated as continuous measures, higher pack-years, historical HbA1c and historical BP emerged as significant independent predictors of 4 year decline in g (standardised β range -0.07 to -0.14; all p ≤ 0.05).
CONCLUSIONS/INTERPRETATION: Increased smoking and poorer glycaemic control (with relatively weaker findings for BP) during the life-course were independently associated with accelerated late-life cognitive decline. Where possible, evaluation is warranted of these risk factors as targets for intervention to reduce the burden of cognitive impairment in diabetes.
目的/假设：本研究旨在评估公认的心血管危险因素在2型糖尿病患者晚年认知功能衰退中的作用。
使用了来自爱丁堡2型糖尿病研究（ET2DS）4年随访的831名参与者（年龄60 - 75岁）的数据。吸烟史（包年数）、血压、糖化血红蛋白（HbA1c）、血糖和胆固醇在基线诊所（单次测量）和/或从诊断到招募期间临床管理数据库记录的系列数据（“历史”数据）中进行测定。主成分分析从七项认知测试中得出一般能力因子g。随访g的线性回归模型针对基线g进行调整，以代表4年的认知变化。“加速的晚年认知衰退”定义为在“4年认知变化”回归分数的最低三分位数中得分。分析对年龄和性别进行了控制。
中度/重度吸烟（≥10包年）的基线病史以及历史糖化血红蛋白增加1%（相当于增加11 mmol/mol）分别预测加速认知衰退的风险增加64%（比值比1.64；95%置信区间1.14, 2.34；p = 0.007）和21%（比值比1.21；95%置信区间1.00, 1.45；p = 0.046）。当作为连续测量指标时，更高的包年数、历史糖化血红蛋白和历史血压成为g在4年下降的显著独立预测因素（标准化β范围为 - 0.07至 - 0.14；所有p≤0.05）。
结论/解读：在生命过程中吸烟增加和血糖控制较差（血压的相关结果相对较弱）与加速的晚年认知衰退独立相关。在可能的情况下，有必要评估这些危险因素作为干预靶点，以减轻糖尿病患者认知障碍的负担。
