From the Institute and Department of Endocrinology and Metabolism (B.W., Y.S., N.W., Y.L.), Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, China; Department of Neuroscience (X.T.), Uppsala University, Sweden; Department of Clinical Neuroscience (X.T.), Karolinska Institutet, Sweden; and Guangdong Mental Health Center (J.Z.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Neurology. 2022 Nov 22;99(21):e2336-e2345. doi: 10.1212/WNL.0000000000201231. Epub 2022 Sep 14.
Type 2 diabetes and lifestyle factors have been associated with dementia risk, but the effect of a healthy lifestyle on diabetes-related dementia remains largely unknown. We aimed to investigate whether the increased risk of dementia among individuals with diabetes can be offset by a broad combination of healthy lifestyle factors.
This prospective study used data from the UK Biobank cohort. An overall lifestyle score ranging from 0 to 7 was created, with 1 point for each of the 7 healthy lifestyle factors: no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, adequate sleep duration, less sedentary behavior, and frequent social contact. Incident dementia was ascertained using linkage with electronic health records. Cox proportional hazards models were used to examine the associations between diabetes, healthy lifestyle score, and dementia incidence.
We included 167,946 participants aged 60 years or older without dementia at baseline (mean age 64.1 [SD 2.8] years, 51.7% female). During a median follow-up of 12.3 years, 4,351 developed all-cause dementia. Participants with diabetes, but not those with prediabetes, showed a higher risk of dementia than those with normoglycemia. Compared with diabetes-free participants who had a lifestyle score of 7, the hazard ratios (HRs) for dementia were 4.01 (95% CI 3.06-5.25) and 1.74 (95% CI 1.11-2.72) for those with diabetes who had a lifestyle score of 0-2 and 7, respectively. Among participants with diabetes, the HR for dementia comparing a lifestyle score of 7 vs 0-2 was 0.46 (95% CI 0.28-0.75). This finding corresponded to a reduction in the 10-year absolute risk of dementia from 5.22% (95% CI 3.94%-6.73%) to 1.72% (95% CI 0.92%-2.97%). The association between higher lifestyle score and lower dementia risk was independent of glycemic control and diabetes medication.
Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of dementia among participants with diabetes. Behavioral lifestyle modification through multifactorial approaches should be a priority for prevention and delayed onset of dementia in patients with diabetes.
2 型糖尿病和生活方式因素与痴呆风险相关，但健康生活方式对糖尿病相关痴呆的影响在很大程度上仍不清楚。我们旨在研究糖尿病患者的痴呆风险是否可以通过广泛的健康生活方式因素组合来降低。
本前瞻性研究使用了英国生物库队列的数据。创建了一个总分范围为 0 至 7 的整体生活方式评分，每个健康生活方式因素得 1 分：不吸烟、适量饮酒、定期体育锻炼、健康饮食、充足的睡眠时间、减少久坐行为和经常社交。使用电子健康记录进行关联来确定痴呆的发病情况。使用 Cox 比例风险模型来检查糖尿病、健康生活方式评分和痴呆发病之间的关联。
我们纳入了 167946 名年龄在 60 岁或以上且基线时无痴呆（平均年龄 64.1[2.8]岁，51.7%为女性）的参与者。在中位随访 12.3 年后，有 4351 名参与者发生了全因痴呆。与无糖尿病的参与者相比，患有糖尿病但无糖尿病前期的参与者发生痴呆的风险更高。与无糖尿病且生活方式评分为 7 的参与者相比，生活方式评分为 0-2 和 7 的糖尿病患者发生痴呆的风险比分别为 4.01（95%CI 3.06-5.25）和 1.74（95%CI 1.11-2.72）。在患有糖尿病的参与者中，生活方式评分为 7 与 0-2 相比，痴呆的风险比为 0.46（95%CI 0.28-0.75）。这一发现对应于痴呆的 10 年绝对风险从 5.22%（95%CI 3.94%-6.73%）降至 1.72%（95%CI 0.92%-2.97%）。较高的生活方式评分与较低的痴呆风险之间的关联独立于血糖控制和糖尿病药物治疗。
在患有糖尿病的参与者中，坚持广泛的健康生活方式因素与痴呆风险显著降低相关。通过多因素方法进行行为生活方式改变应该是预防和延迟糖尿病患者痴呆发病的优先事项。
