Kowall Bernd, Rathmann Wolfgang
Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.
Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Gerontology. 2023;69(2):172-180. doi: 10.1159/000524571. Epub 2022 May 13.
Diabetes management requires cognitive abilities. Unfortunately, diabetes is a risk factor for cognitive decline. However, the effects of diabetes in persons with reduced cognitive reserves are unclear. We aimed to examine whether the effects of diabetes and education on cognitive skills simply add up or deviate from simple additivity.
We used data from waves 1 to 7 (except wave 3) of the Survey of Health, Ageing, and Retirement in Europe (SHARE) collected between 2004 and 2017. SHARE includes 140,000 persons aged ≥50 years from 28 European countries and Israel. Diabetes was assessed by self-report and education was coded according to the International Standard Classification of Education levels. Verbal fluency, immediate, and delayed memory were assessed using standard tests. Interaction between diabetes and education was estimated from interaction contrasts and from interaction terms in adjusted regression models.
At baseline, cognitive performance declined in the order "no diabetes/high education" > "diabetes/high education" > "no diabetes/low education" > "diabetes/low education" for all three tests - e.g., the first group named 21.4 ± 7.2, the fourth group 14.6 ± 6.1 animals in a minute in the test of verbal fluency. Interaction contrasts and regression coefficients of interaction terms were close to zero, showing that the effects of diabetes and education on cognitive performance added up without interaction both in cross-sectional and longitudinal analyses.
We have observed no interaction between education and diabetes on cognitive skills. Yet, people with diabetes and low education showed poor cognitive performance and should receive particular support in managing diabetes.
糖尿病管理需要认知能力。不幸的是，糖尿病是认知功能衰退的一个风险因素。然而，糖尿病对认知储备减少的人的影响尚不清楚。我们旨在研究糖尿病和教育程度对认知技能的影响是简单相加还是偏离简单相加。
我们使用了2004年至2017年间收集的欧洲健康、老龄化和退休调查（SHARE）第1至7轮（第3轮除外）的数据。SHARE包括来自28个欧洲国家和以色列的140,000名年龄≥50岁的人。糖尿病通过自我报告进行评估，教育程度根据国际教育水平标准分类进行编码。使用标准测试评估语言流畅性、即时记忆和延迟记忆。糖尿病和教育程度之间的相互作用通过相互作用对比和调整后的回归模型中的相互作用项进行估计。
在基线时，对于所有三项测试，认知表现按“无糖尿病/高教育程度”>“糖尿病/高教育程度”>“无糖尿病/低教育程度”>“糖尿病/低教育程度”的顺序下降——例如，在语言流畅性测试中，第一组每分钟说出21.4±7.2个动物，第四组每分钟说出14.6±6.1个动物。相互作用对比和相互作用项的回归系数接近零，表明在横断面和纵向分析中，糖尿病和教育程度对认知表现的影响是相加的，没有相互作用。
我们观察到教育程度和糖尿病在认知技能方面没有相互作用。然而，糖尿病患者和低教育程度者的认知表现较差，在糖尿病管理方面应得到特别支持。
