Hicks Caitlin W, Wang Dan, Schneider Andrea L C, Johansen Michelle C, Gottesman Rebecca F, Matsushita Kunihiro, Coresh Josef, Windham B Gwen, Selvin Elizabeth
Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA,
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Dement Geriatr Cogn Disord. 2022;51(2):150-158. doi: 10.1159/000523762. Epub 2022 Mar 28.
The aim of this study was to assess the association of peripheral neuropathy (PN) as defined by monofilament insensitivity with mild cognitive impairment (MCI) and dementia in older adults with and without diabetes.
We conducted a cross-sectional analysis of 3,362 Black and White participants in the Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS) who underwent monofilament testing at visit 6 (2016-2017, age 71-94 years). Participants' cognitive status was classified by an adjudication committee as cognitively normal, MCI, or dementia after completing a comprehensive battery of neurocognitive assessments. We used logistic regression to evaluate the association of PN with MCI or dementia overall and stratified by diabetes status after adjusting for traditional dementia risk factors. We also compared age-adjusted brain MRI measures among a subset (N = 1,095) of participants with versus without PN.
Overall, the prevalence of MCI (21.9% vs. 16.7%) and dementia (7.8% vs. 3.9%) were higher among participants with versus without PN (both p < 0.05). After adjustment, PN was positively associated with MCI or dementia in the overall study population (OR 1.45, 95% CI 1.23, 1.73). Results were similar by diabetes status (diabetes: OR 1.38, 95% CI 1.03-1.87; no diabetes: OR 1.48, 95% CI 1.20-1.83; p-for-interaction = 0.46). Age-adjusted total and lobar brain volumes were significantly lower in participants with versus without PN (both, p < 0.05).
DISCUSSION/CONCLUSIONS: PN as defined by monofilament insensitivity was associated with cognitive status independent of vascular risk factors and regardless of diabetes status. Our findings support a connection between PN and cognitive impairment, even in the absence of diabetes.
本研究的目的是评估单丝触觉不敏感所定义的周围神经病变（PN）与患有和未患有糖尿病的老年人的轻度认知障碍（MCI）及痴呆症之间的关联。
我们对社区动脉粥样硬化风险神经认知研究（ARIC-NCS）中的3362名黑人和白人参与者进行了横断面分析，这些参与者在第6次访视（2016 - 2017年，年龄71 - 94岁）时接受了单丝测试。在完成一系列全面的神经认知评估后，参与者的认知状态由一个判定委员会分类为认知正常、MCI或痴呆症。我们使用逻辑回归来评估PN与MCI或痴呆症的总体关联，并在调整传统痴呆风险因素后按糖尿病状态进行分层。我们还比较了一部分（N = 1095）有PN和无PN参与者之间经年龄调整的脑MRI测量值。
总体而言，有PN的参与者中MCI（21.9%对16.7%）和痴呆症（7.8%对3.9%）的患病率高于无PN的参与者（两者p < 0.05）。调整后，在整个研究人群中PN与MCI或痴呆症呈正相关（比值比1.45，95%置信区间1.23，1.73）。按糖尿病状态分析结果相似（糖尿病：比值比1.38，95%置信区间1.03 - 1.87；无糖尿病：比值比1.48，95%置信区间1.20 - 1.83；交互作用p值 = 0.46）。有PN的参与者经年龄调整后的全脑和脑叶体积显著低于无PN的参与者（两者，p < 0.05）。
讨论/结论：单丝触觉不敏感所定义的PN与认知状态相关，独立于血管危险因素且与糖尿病状态无关。我们的研究结果支持PN与认知障碍之间的联系，即使在没有糖尿病的情况下也是如此。
