2 型糖尿病患者中非洲裔美国人和欧洲裔美国人的大脑结构与认知表现。
Cerebral Structure and Cognitive Performance in African Americans and European Americans With Type 2 Diabetes.
机构信息
Division of Public Health Sciences, Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, North Carolina.
出版信息
J Gerontol A Biol Sci Med Sci. 2018 Mar 2;73(3):407-414. doi: 10.1093/gerona/glx255.
BACKGROUND
African Americans typically perform worse than European Americans on cognitive testing. Contributions of cardiovascular disease (CVD) risk factors and educational quality to cognitive performance and brain volumes were compared in European Americans and African Americans with type 2 diabetes.
METHODS
Association between magnetic resonance imaging-determined cerebral volumes of white matter (WMV), gray matter (GMV), white matter lesions (WMLV), hippocampal GMV, and modified mini-mental state exam (3MSE), digit symbol coding (DSC), Rey Auditory Verbal Learning Test (RAVLT), Stroop, and verbal fluency performance were assessed in Diabetes Heart Study Memory in Diabetes (MIND) participants. Marginal models incorporating generalized estimating equations were employed with serial adjustment for risk factors.
RESULTS
The sample included 520 African Americans and 684 European Americans; 56 per cent female with mean ± SD age 62.8 ± 10.3 years and diabetes duration 14.3 ± 7.8 years. Adjusting for age, sex, diabetes duration, BMI, HbA1c, total intracranial volume, scanner, statins, CVD, smoking, and hypertension, WMV (p = .001) was lower and WMLV higher in African Americans than European Americans (p = .001), with similar GMV (p = .30). Adjusting for age, sex, education, HbA1c, diabetes duration, hypertension, BMI, statins, CVD, smoking, and depression, poorer performance on 3MSE, RAVLT, and DSC were seen in African Americans (p = 6 × 10-23-7 × 10-62). Racial differences in cognitive performance were attenuated after additional adjustment for WMLV and nearly fully resolved after adjustment for wide-range achievement test (WRAT) performance (p = .0009-.65).
CONCLUSIONS
African Americans with type 2 diabetes had higher WMLV and poorer cognitive performance than European Americans. Differences in cognitive performance were attenuated after considering WMLV and apparent poorer educational quality based on WRAT.
背景
非洲裔美国人在认知测试中的表现通常不如欧洲裔美国人。本研究比较了 2 型糖尿病患者中，心血管疾病（CVD）风险因素和教育质量对认知表现和脑容量的影响。
方法
在糖尿病心脏研究记忆中的糖尿病（MIND）参与者中，评估磁共振成像（MRI）确定的脑白质体积（WMV）、脑灰质体积（GMV）、脑白质病变（WMLV）、海马 GMV 和改良简易精神状态检查（3MSE）、数字符号编码（DSC）、 Rey 听觉言语学习测验（RAVLT）、Stroop 和言语流畅性的关联。采用包含广义估计方程的边缘模型，对危险因素进行连续调整。
结果
样本包括 520 名非洲裔美国人和 684 名欧洲裔美国人，56%为女性，平均年龄为 62.8 ± 10.3 岁，糖尿病病程为 14.3 ± 7.8 年。在调整年龄、性别、糖尿病病程、体重指数、糖化血红蛋白、总颅内体积、扫描、他汀类药物、CVD、吸烟和高血压后，非洲裔美国人的 WMV（p=0.001）更低，WMLV（p=0.001）更高，GMV 相似（p=0.30）。在调整年龄、性别、教育程度、糖化血红蛋白、糖尿病病程、高血压、体重指数、他汀类药物、CVD、吸烟和抑郁后，非洲裔美国人在 3MSE、RAVLT 和 DSC 上的表现更差（p=6×10-23-7×10-62）。在考虑 WMLV 后，认知表现的种族差异减弱，在考虑广泛成就测验（WRAT）表现后，差异几乎完全解决（p=0.0009-0.65）。
结论
与欧洲裔美国人相比，患有 2 型糖尿病的非洲裔美国人的 WMLV 更高，认知表现更差。在考虑 WMLV 后，差异减弱，并且根据 WRAT，教育质量似乎更差。
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