The Irish Longitudinal Study on Ageing, Department of Medical Gerontology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
Discipline of Medical Gerontology, School of Medicine, Trinity College, Dublin, Ireland.
J Gerontol A Biol Sci Med Sci. 2024 May 1;79(5). doi: 10.1093/gerona/glae073.
Although type 2 diabetes mellitus (T2DM) is an established risk factor for cognitive impairment, the underlying mechanisms remain poorly explored. One potential mechanism may be through effects of T2DM on cerebral perfusion. The current study hypothesized that T2DM is associated with altered peripheral and central hemodynamic responses to orthostasis, which may in turn be associated with cognitive impairment in T2DM.
A novel use of function-on-scalar regression, which allows the entire hemodynamic response curve to be modeled, was employed to assess the association between T2DM and hemodynamic responses to orthostasis. Logistic regression was used to assess the relationship between tissue saturation index (TSI), T2DM, and cognitive impairment. All analyses used cross-sectional data from Wave 3 of The Irish Longitudinal Study on Ageing (TILDA).
Of 2 984 older adults (aged 64.3 ± 8.0; 55% female), 189 (6.3%) had T2DM. T2DM was associated with many features that are indicative of autonomic dysfunction including a blunted peak heart rate and lower diastolic blood pressure. T2DM was associated with reduced TSI and also with greater odds of impaired performance on the Montreal Cognitive Assessment (odds ratio [OR]: 1.62; confidence interval [CI: 1.07, 2.56]; p = .019). Greater TSI was associated with lower odds of impaired performance (OR: 0.90, CI [0.81-0.99]; p = .047).
T2DM was associated with impaired peripheral and cerebral hemodynamic responses to active stand. Both T2DM and reduced cerebral perfusion were associated with impaired cognitive performance. Altered cerebral perfusion may represent an important mechanism linking T2DM and adverse brain health outcomes in older adults.
尽管 2 型糖尿病（T2DM）是认知障碍的既定危险因素，但潜在机制仍未得到充分探索。一种潜在的机制可能是 T2DM 对脑灌注的影响。本研究假设 T2DM 与体位变化时外周和中枢血液动力学反应的改变有关，而这反过来又可能与 T2DM 患者的认知障碍有关。
采用功能标量回归的新方法，该方法允许对整个血液动力学反应曲线进行建模，以评估 T2DM 与体位变化时血液动力学反应之间的关系。采用逻辑回归评估组织饱和度指数（TSI）、T2DM 和认知障碍之间的关系。所有分析均使用爱尔兰老龄化纵向研究（TILDA）第 3 波的横断面数据。
在 2984 名年龄在 64.3±8.0 岁（55%为女性）的老年人中，有 189 人（6.3%）患有 T2DM。T2DM 与许多表明自主神经功能障碍的特征有关，包括峰值心率降低和舒张压降低。T2DM 与 TSI 降低以及蒙特利尔认知评估（Montreal Cognitive Assessment，MoCA）表现受损的几率增加有关（比值比[OR]：1.62；95%置信区间[CI]：1.07，2.56；p=0.019）。较高的 TSI 与较低的 MoCA 表现受损几率呈负相关（OR：0.90，CI [0.81-0.99]；p=0.047）。
T2DM 与主动站立时外周和脑血液动力学反应受损有关。T2DM 和脑灌注减少都与认知功能障碍有关。脑灌注改变可能是将 T2DM 与老年人不良脑健康结局联系起来的一个重要机制。
