Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
J Diabetes Investig. 2022 Nov;13(11):1873-1880. doi: 10.1111/jdi.13875. Epub 2022 Jul 28.
AIMS/INTRODUCTION: To examine the association between cholesterol efflux capacity (CEC) of serum high-density lipoprotein (HDL) and cognitive function and brain structures in older people with diabetes mellitus.
Participants of a randomized placebo-controlled trial of 27-month vitamin B supplementation in older people with diabetes mellitus, which showed no effect on cognition, were further followed up at month 72. Cognitive tests included the Clinical Dementia Rating scale, Neuropsychological Test Battery in memory, executive function and psychomotor speed. Brain magnetic resonance imaging scans were carried out in a subset at baseline, month 27 and month 45. Fasting serum at baseline, month 9, month 27 and month 72 were analyzed for adenosine triphosphate-binding cassette transporter A1-mediated CEC of HDL and apolipoprotein A1 (ApoA1).
Serum HDL cholesterol at baseline was associated with better executive and memory function at follow up. Serum ApoA1 was associated with a better memory Z-score at month 18. Serum CEC and ApoA1 were not associated with Clinical Dementia Rating scale, Neuropsychological Test Battery, hippocampal volume and white matter disease on magnetic resonance imaging at baseline and whole brain atrophy rates. They were also not associated with cognitive function at month 27 and 72 on multilevel modeling. CEC and ApoA1 decreased significantly from baseline to month 27. Faster decliners in CEC had a greater increase in brain peak width of skeletonized mean diffusivity.
Higher serum HDL cholesterol was associated with more favorable changes in memory and executive function in older people with diabetes mellitus. However, this was not due to CEC or ApoA1. A decline in CEC was associated with small vessel disease in the brain.
目的/引言：本研究旨在探讨血清高密度脂蛋白（HDL）胆固醇外排能力（CEC）与糖尿病老年人认知功能和大脑结构之间的关系。
本研究对一项为期 27 个月的维生素 B 补充剂随机安慰剂对照试验的参与者进行了进一步随访，该试验在糖尿病老年人中未显示出对认知功能的影响，随访时间为 72 个月。认知测试包括临床痴呆评定量表、记忆、执行功能和精神运动速度神经心理测试电池。在基线、27 个月和 45 个月时，对部分参与者进行了脑磁共振成像扫描。在基线、9 个月、27 个月和 72 个月时，分析了空腹血清中的三磷酸腺苷结合盒转运蛋白 A1 介导的 HDL CEC 和载脂蛋白 A1（ApoA1）。
基线时血清 HDL 胆固醇与随访时的执行功能和记忆功能更好相关。基线时血清 ApoA1 与 18 个月时更好的记忆 Z 评分相关。CEC 和 ApoA1 与基线时的临床痴呆评定量表、神经心理测试电池、海马体积和磁共振成像上的白质病变以及全脑萎缩率均无相关性。它们也与 27 个月和 72 个月时的多水平模型认知功能无关。CEC 和 ApoA1 从基线到 27 个月显著下降。CEC 下降速度较快的患者，大脑峰值宽度的骨架平均弥散度增加幅度更大。
较高的血清 HDL 胆固醇与糖尿病老年人记忆和执行功能的更有利变化相关。然而，这不是由于 CEC 或 ApoA1 所致。CEC 的下降与大脑小血管疾病有关。
