Department of Neurology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Neuroepidemiology. 2020;54(5):419-426. doi: 10.1159/000509754. Epub 2020 Aug 25.
A hyperglycemic crisis episode (HCE) signifies poor control of diabetes and may increase the risk of dementia via microvascular and macrovascular injuries.
We conducted this study to clarify this issue, which remains unclear.
Using the Taiwan National Health Insurance Database, we identified 9,466 diabetic patients with HCE and the identical number of diabetic patients without HCE who were matched by age and sex for this nationwide population-based cohort study. The risk of dementia was compared between the 2 cohorts by following up until 2014. Investigation of independent predictors of dementia was also done.
In the overall analysis, the risk of dementia between the 2 cohorts was not different. However, stratified analyses showed that patients with HCE had a higher risk of subsequent dementia in the age subgroup of 45-54 and 55-64 years (adjusted odds ratio [AOR]: 2.4, 95% confidence interval [CI]: 1.6-3.6, and AOR: 1.2, 95% CI: 1.0-1.5, respectively). In the overall analysis, older age, female sex, ≥3 HCEs, hypertension, hyperlipidemia, depression, cerebrovascular disease, Parkinson's disease, and head injury were independent predictors.
HCE increased the risk of dementia in diabetic patients aged 45-64 years. Dementia was predicted by ≥3 HCEs. Prevention of recurrent HCE, control of comorbidities, and close follow-up of cognitive decline and dementia are suggested in patients with HCE.
高血糖危象（HCE）表明糖尿病控制不佳，可能通过微血管和大血管损伤增加痴呆的风险。
我们进行这项研究是为了阐明这一仍不清楚的问题。
我们使用台湾全民健康保险数据库，在这项全国性基于人群的队列研究中，确定了 9466 例患有 HCE 的糖尿病患者和年龄与性别相匹配的 9466 例无 HCE 的糖尿病患者。通过随访至 2014 年，比较了两组患者的痴呆风险。还进行了痴呆独立预测因素的调查。
在总体分析中，两组患者痴呆的风险没有差异。然而，分层分析显示，45-54 岁和 55-64 岁年龄亚组的 HCE 患者发生后续痴呆的风险更高（调整后的优势比 [AOR]：2.4，95%置信区间 [CI]：1.6-3.6，AOR：1.2，95% CI：1.0-1.5）。在总体分析中，年龄较大、女性、≥3 次 HCE、高血压、高血脂、抑郁、脑血管疾病、帕金森病和头部受伤是独立的预测因素。
HCE 增加了 45-64 岁糖尿病患者发生痴呆的风险。≥3 次 HCE 预测痴呆。建议 HCE 患者预防反复发作的 HCE、控制合并症，并密切随访认知能力下降和痴呆。
