Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
Division of Geriatrics, University of São Paulo Medical School, São Paulo, Brazil.
J Alzheimers Dis. 2017;60(3):1035-1043. doi: 10.3233/JAD-170179.
Previous evidence linking diabetes to Alzheimer's disease (AD) neuropathology is mixed and scant data are available from low- and middle-income countries.
To investigate the association between diabetes and AD neuropathology in a large autopsy study of older Brazilian adults.
In this cross-sectional study, diabetes was defined by diagnosis during life or use of antidiabetic medication. A standardized neuropathological examination was performed using immunohistochemistry. The associations of diabetes with Consortium to Establish and Registry for Alzheimer Disease (CERAD) scores for neuritic plaques and Braak-Braak (BB) scores for neurofibrillary tangles were investigated using multivariable ordinal logistic regression. We investigated effect modification of education, race, and APOE on these associations.
Among 1,037 subjects (mean age = 74.4±11.5 y; mean education = 4.0±3.7 y; 48% male, 61% White), diabetes was present in 279 subjects. Diabetes was not associated with BB (OR = 1.12, 95% CI = 0.81-1.54, p = 0.48) or with CERAD (OR = 0.97, 95% CI = 0.68-1.38, p = 0.86) scores on analyses adjusted for sociodemographic and clinical variables. We observed effect modification by the APOE allele ɛ4 on the association between diabetes mellitus and BB scores.
No evidence of an association between diabetes and AD neuropathology was found in a large sample of Brazilians; however, certain subgroups, such as APOE allele ɛ4 carriers, had higher odds of accumulation of neurofibrillary tangles.
先前将糖尿病与阿尔茨海默病（AD）神经病理学联系起来的证据相互矛盾，且来自中低收入国家的数据十分有限。
在一项对巴西老年人进行的大型尸检研究中，调查糖尿病与 AD 神经病理学之间的关联。
在这项横断面研究中，通过生前诊断或使用抗糖尿病药物来定义糖尿病。使用免疫组织化学方法进行标准化神经病理学检查。使用多变量有序逻辑回归调查糖尿病与 Consortium to Establish and Registry for Alzheimer Disease（CERAD）神经原纤维缠结评分和 Braak-Braak（BB）评分之间的关联。我们还调查了教育、种族和 APOE 对这些关联的修饰作用。
在 1037 名受试者（平均年龄 74.4±11.5 岁；平均受教育年限 4.0±3.7 年；48%为男性，61%为白人）中，有 279 名患有糖尿病。糖尿病与 BB（OR=1.12，95%CI=0.81-1.54，p=0.48）或 CERAD（OR=0.97，95%CI=0.68-1.38，p=0.86）评分均无关联，这些分析调整了社会人口统计学和临床变量。我们观察到 APOE 等位基因 ɛ4 对糖尿病与 BB 评分之间的关联存在修饰作用。
在一项大型巴西人群样本中，未发现糖尿病与 AD 神经病理学之间存在关联；然而，某些亚组，如 APOE 等位基因 ɛ4 携带者，神经原纤维缠结的累积可能性更高。
