Loma Linda University Health, Department of Neurology, CA, United States.
College of Medicine, Charles R. Drew University of Medicine and Science, University of California Los Angeles, Los Angeles, CA, United States.
J Neurol Sci. 2018 May 15;388:97-102. doi: 10.1016/j.jns.2017.11.031. Epub 2017 Nov 23.
To examine the relationship between homeostatic model of insulin resistance (HOMA-IR) and cognitive test performance among population≥60years in a national database.
Higher insulin resistance is associated with lower cognitive test performance score in the population≥60years.
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000 and 2001-2002.
Cognitive test performance was measured by the Digit Symbol Substitution (DSS) exercise score. The main independent variable was the homeostasis model assessment of insulin resistance (HOMA-IR). We used bivariate analysis and generalized linear model adjusting for age, gender, race, education, body mass index, and systolic and diastolic blood pressures; total cholesterol, low density lipoprotein (LDL), high density lipoprotein (HDL) and triglyceride levels; and physical activity, diabetes mellitus, stroke, and congestive heart failure. STATA 14 was used to analyze the data taking into consideration the design, strata and weight.
Of the 1028 participants, 44% were male and 85% were white. The mean age was 70.0±0.28 (SE) years. Their average HOMA-IR was 3.6±0.14 and they had a mean of 49.2±0.8 correct DSS score in the cognitive test. Adjusting for the confounding variables, HOMA-IR was associated with decline in DSS score (B=-0.30, 95% confidence interval=-0.54 and -0.05, p=0.01). The model explained 44% of the variability of the DSS score (R=0.44). Significant predictors of decline in DSS score were age, gender, race, and education (p=0.01).
Insulin resistance as measured by HOMA-IR was independently associated with lower cognitive test performance score among elderly participants aged ≥60years. Longitudinal studies are needed to test the mechanism and the causal relationship.
在国家数据库中，研究稳态模型评估的胰岛素抵抗（HOMA-IR）与 60 岁以上人群认知测试表现之间的关系。
较高的胰岛素抵抗与 60 岁以上人群的认知测试表现得分较低相关。
我们分析了 1999-2000 年和 2001-2002 年全国健康和营养检查调查（NHANES）的数据。
认知测试表现通过数字符号替代（DSS）运动得分来衡量。主要的独立变量是胰岛素抵抗的稳态模型评估（HOMA-IR）。我们使用双变量分析和广义线性模型，根据年龄、性别、种族、教育程度、体重指数以及收缩压和舒张压；总胆固醇、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）和甘油三酯水平；以及体力活动、糖尿病、中风和充血性心力衰竭进行调整。考虑到设计、层次和权重，使用 STATA 14 分析数据。
在 1028 名参与者中，44%为男性，85%为白人。平均年龄为 70.0±0.28（SE）岁。他们的平均 HOMA-IR 为 3.6±0.14，认知测试中的 DSS 平均正确得分为 49.2±0.8。在调整混杂变量后，HOMA-IR 与 DSS 评分下降相关（B=-0.30，95%置信区间=-0.54 至 -0.05，p=0.01）。该模型解释了 DSS 评分变化的 44%（R=0.44）。DSS 评分下降的显著预测因素是年龄、性别、种族和教育程度（p=0.01）。
HOMA-IR 衡量的胰岛素抵抗与 60 岁以上老年参与者的认知测试表现得分较低独立相关。需要进行纵向研究以测试机制和因果关系。
