Fava Antonietta, Colica Carmen, Plastino Massimiliano, Messina Demetrio, Cristiano Dario, Opipari Carlo, Vaccaro Antonio, Gorgone Gaetano, Bosco Francesca, Fratto Alessandra, De Bartolo Matteo, Bosco Domenico
Department of Clinical and Experimental Medicine, University of Catanzaro, 88100, Catanzaro, Italy.
Institute of Neurological Science - National Research Council, Roccelletta di Borgia, 88100, Catanzaro, Italy.
Metab Brain Dis. 2017 Jun;32(3):799-810. doi: 10.1007/s11011-017-9977-4. Epub 2017 Feb 23.
Several epidemiological studies have shown that Diabetes Mellitus (DM) or Insulin Resistance (IR) increases the risk of dementia. Besides, some authors suggested that poor glucose control to be associated with worse cognitive function. We aimed to assess cognitive functions and IR-degree over time in diabetic. We also evaluated whether a greater magnitude of cognitive decline could be related with their IR degree. We enrolled 335 diabetic patients and 142 non-diabetic subjects; participants were subdivided into three groups in accordance with their IRdegree assessed by Homa-Index (HI): Normal-HI (non-diabetic NHI < 2,6), Moderate-HI (MHI > 2,6 < 10) and High-HI (HHI > 10). Metabolic status and a comprehensive neuropsycological test battery (MMSE, ADAS-Cog, ACDS-ADL) were assessed at baseline and every 12-months during the follow-up (6,8 years). At the end of the study, the average MMSE decreased significantly in patients of HHI group (P = .001) compared to baseline. MMSE scores were also reduced both in MHI group and in controls, but the difference between two groups was not significant. In HHI group, similar effects were observed for the ADAS-Cog score compared to baseline (P = 0.001); instead, when ACDS-ADL was evaluated, no differences was observed among the three groups. These results remained unchanged also after adjustment for confounding variables (i.e. APOε-status, sex, BMI, education level, heart diseases and HbA1c). We suggest that higher IR-degree is associated with greater cognitive decline in diabetic patients; so we hypothesize that IR degree, more than IR status itself, could be related to the severity of cognitive impairment.
多项流行病学研究表明，糖尿病（DM）或胰岛素抵抗（IR）会增加患痴呆症的风险。此外，一些作者认为血糖控制不佳与较差的认知功能有关。我们旨在评估糖尿病患者随时间推移的认知功能和IR程度。我们还评估了更大程度的认知衰退是否与其IR程度有关。我们招募了335名糖尿病患者和142名非糖尿病受试者；根据通过稳态模型评估法（Homa-Index，HI）评估的IR程度，将参与者分为三组：正常HI组（非糖尿病患者，NHI<2.6）、中度HI组（MHI>2.6<10）和高度HI组（HHI>10）。在基线时以及随访期间（6.8年）每12个月评估一次代谢状况和一套全面的神经心理学测试（简易精神状态检查表（MMSE）、阿尔茨海默病评估量表认知部分（ADAS-Cog）、日常生活能力量表（ACDS-ADL））。在研究结束时，与基线相比，HHI组患者的平均MMSE显著下降（P = 0.001）。MHI组和对照组的MMSE评分也有所降低，但两组之间的差异不显著。在HHI组中，与基线相比，ADAS-Cog评分也有类似变化（P = 0.001）；相反，在评估ACDS-ADL时，三组之间未观察到差异。在对混杂变量（即APOε状态、性别、体重指数、教育水平、心脏病和糖化血红蛋白（HbA1c））进行调整后这些结果也保持不变。我们认为，较高的IR程度与糖尿病患者更大程度的认知衰退有关；因此我们推测，IR程度而非IR状态本身，可能与认知障碍的严重程度有关。
