Jiangwan Hospital of Hongkou District, Shanghai University of Medicine and Health Science Affiliated First Rehabilitation Hospital, Shanghai, China.
Department of Rehabilitation Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China.
Front Endocrinol (Lausanne). 2022 Sep 9;13:897728. doi: 10.3389/fendo.2022.897728. eCollection 2022.
The purpose of this study was to observe the relationship between physical performance and mild cognitive impairment (MCI) in the presence or absence of type 2 diabetes in elderly hemodialysis patients.
In this multicenter cross-sectional study, 396 clinically stable and aged ≥60 years hemodialysis patients (255 men; mean age: 68.3 ± 5.9 years) were included from seven dialysis units in Shanghai, China. The Chinese version of the Modified Mini-Mental State Examination (MMSE) and the Instrumental Activities of Daily Living (IADL) scale were utilized to assess MCI. The performance-based assessments consisted of three physical tests, grip strength (GS), Timed Up and Go Test (TUGT), and 4-m walking test, which respectively represent muscle strength, mobility, and walking speed (WS). Logistic regression and multivariate linear regression were used for analysis.
Hemodialysis patients with diabetes had a high prevalence of MCI (20.6%). The odds ratio (OR) of MCI for the interacted items [(TUGT) * (diabetes) and (WS) * (diabetes)] was significant (p < 0.05). In diabetes patients, TUGT was positively associated with MCI, and WS was negatively associated with MCI after adjusting covariates [OR = 0.129; 95% confidence interval (CI) = 0.028-0.704, p = 0.021]. However, no significant association was found between physical performance and MCI in the non-diabetes hemodialysis patients (p > 0.05). Further analysis showed that TUGT was negatively associated with attention and calculation and language. WS was positively associated with recall and language in diabetic hemodialysis patients.
Physical performance was associated with MCI in diabetic hemodialysis patients rather than the non-diabetes group. Whether increasing mobility or WS can positively influence MCI in individuals with type 2 diabetes requires further study.
本研究旨在观察在存在或不存在 2 型糖尿病的情况下，老年血液透析患者的身体机能与轻度认知障碍（MCI）之间的关系。
在这项多中心横断面研究中，纳入了来自中国上海 7 个透析单位的 396 名临床稳定且年龄≥60 岁的血液透析患者（255 名男性；平均年龄：68.3±5.9 岁）。采用中文版简易精神状态检查（MMSE）和工具性日常生活活动（IADL）量表评估 MCI。基于表现的评估包括 3 项身体测试，即握力（GS）、计时起立行走测试（TUGT）和 4 米步行测试，分别代表肌肉力量、移动能力和步行速度（WS）。采用 logistic 回归和多元线性回归进行分析。
患有糖尿病的血液透析患者 MCI 患病率较高（20.6%）。交互项[TUGT*（糖尿病）和（WS）*（糖尿病）]的 MCI 比值比（OR）有统计学意义（p<0.05）。在糖尿病患者中，校正混杂因素后，TUGT 与 MCI 呈正相关，WS 与 MCI 呈负相关[OR=0.129；95%置信区间（CI）=0.028-0.704，p=0.021]。然而，在非糖尿病血液透析患者中，身体机能与 MCI 之间无显著相关性（p>0.05）。进一步分析显示，TUGT 与注意力和计算力以及语言呈负相关，WS 与糖尿病血液透析患者的记忆力和语言呈正相关。
身体机能与糖尿病血液透析患者的 MCI 相关，而非非糖尿病组。增加移动能力或 WS 是否能对 2 型糖尿病患者的 MCI 产生积极影响，还需要进一步研究。
