Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada.
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Clin Endocrinol Metab. 2021 Jan 23;106(2):e891-e898. doi: 10.1210/clinem/dgaa815.
Diabetes is a risk factor for cerebrovascular disease and cognitive impairment. The anatomical basis for this is uncertain.
The Canadian Alliance for Healthy Hearts and Minds collected brain and carotid magnetic resonance imaging (MRI) and 2 cognitive tests (the Digit Symbol Substitution Test and the Montreal Cognitive Assessment test) in a cross-sectional sample of men and women. Brain MRIs identified brain infarcts (BI), lacunar BI, high white matter hyperintensity (WMH), vascular brain injury (VBI; BI or high WMH), and small vessel VBI (lacunar BI or high WMH). Carotid MRIs estimated carotid wall volume, a measure of subclinical atherosclerosis. Cognitive scores were standardized to each site's mean score, and cognitive impairment was identified by 1 or both test scores ≤1 standard deviation below the site's mean score on that test.
The 7733 participants included 495 participants (6.4%) with diabetes, of whom 388 were taking diabetes drugs. After age and sex adjustment, diabetes was independently associated with BI (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.05, 2.24), VBI (OR 1.64, 95% CI 1.26, 2.13), small vessel VBI (OR 1.67, 95% CI 1.28, 2.19), and cognitive impairment (OR 1.47, 95% CI 1.20, 1.80). The association between diabetes and small vessel VBI persisted after adjustment for cerebrovascular disease risk factors and nonlacunar infarcts (OR 1.52, 95% CI 1.15, 2.01), and the association with cognitive impairment persisted after adjustment for small vessel VBI (OR 1.27, 95% CI 1.03, 1.56).
Small vessel disease characterizes much of the relationship between diabetes and VBI. However, additional factors are required to disentangle the relationship between diabetes and cognitive impairment.
糖尿病是脑血管疾病和认知障碍的一个危险因素。其解剖学基础尚不确定。
加拿大健康心脏和大脑联盟（Canadian Alliance for Healthy Hearts and Minds）在一项男性和女性的横断面样本中收集了大脑和颈动脉磁共振成像（MRI）以及 2 项认知测试（数字符号替换测试和蒙特利尔认知评估测试）。脑 MRI 确定了脑梗死（BI）、腔隙性 BI、高白质高信号（WMH）、血管性脑损伤（VBI；BI 或高 WMH）和小血管 VBI（腔隙性 BI 或高 WMH）。颈动脉 MRI 估计了颈动脉壁体积，这是亚临床动脉粥样硬化的一个衡量指标。认知评分标准化为每个部位的平均评分，认知障碍的定义是 1 项或 2 项测试的评分均低于该部位该测试的平均评分 1 个标准差。
7733 名参与者中包括 495 名（6.4%）患有糖尿病的患者，其中 388 名正在服用糖尿病药物。在年龄和性别调整后，糖尿病与 BI（比值比 [OR] 1.53，95%置信区间 [CI] 1.05，2.24）、VBI（OR 1.64，95% CI 1.26，2.13）、小血管 VBI（OR 1.67，95% CI 1.28，2.19）和认知障碍（OR 1.47，95% CI 1.20，1.80）独立相关。在调整了脑血管疾病危险因素和非腔隙性梗死后，糖尿病与小血管 VBI 的关联仍然存在（OR 1.52，95% CI 1.15，2.01），而在调整了小血管 VBI 后，糖尿病与认知障碍的关联仍然存在（OR 1.27，95% CI 1.03，1.56）。
小血管疾病是糖尿病与 VBI 之间关系的主要特征。然而，需要其他因素来理清糖尿病与认知障碍之间的关系。
