Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, USA; Programa Terceira Idade (PROTER, Old Age Research Group), Department and Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil.
Jaeb Center for Health Research, Tampa, FL, USA.
J Diabetes Complications. 2024 May;38(5):108739. doi: 10.1016/j.jdiacomp.2024.108739. Epub 2024 Mar 26.
Adults with type 1 diabetes (T1D) are considered at increased risk for cognitive impairment and accelerated brain aging. However, longitudinal data on cognitive impairment and dementia in this population are scarce.
To identify risk factors associated with cognitive performance and cognitive impairment in a longitudinal sample of older adults with T1D.
We analyzed data collected as part of the Wireless Innovation for Seniors with Diabetes Mellitus (WISDM) Study, in which 22 endocrinology practices participated. Randomized participants with T1D ≥60 years of age who completed at least one cognitive assessment were included in this study (n = 203). Cognitive impairment was classified using published recommendations.
Older age, male sex, non-private health insurance, worse daily functioning, diagnosis of neuropathy, and longer duration of diabetes were associated with worse cognitive performance, but not cognitive impairment. 49 % and 39 % of the sample met criteria for cognitive impairment at baseline and 52 weeks respectively. Of the participants that had data at both time points, 10 % were normal at baseline and impaired at 52 weeks and 22 % of participants (44 % of those classified with cognitive impairment at baseline) reverted to normal over 52 weeks.
This study indicated that several demographic and clinical characteristics are associated with worse cognitive performance in older adults with T1D, but there were no associations between these characteristics and cognitive impairment defined by NIH Toolbox cognitive impairment criteria. Caution is warranted when assessing cognition in older adults with T1D, as a large percentage of those identified as having cognitive impairment at baseline reverted to normal after 52 weeks. There is need for future studies on the interrelationship of cognition and aging to better understand the effects of T1D on cognitive health, to improve clinical monitoring and help mitigate the risk of dementia in this population.
患有 1 型糖尿病（T1D）的成年人被认为认知障碍和大脑老化加速的风险增加。然而，关于该人群认知障碍和痴呆的纵向数据却很少。
确定与 T1D 老年患者纵向样本中认知表现和认知障碍相关的风险因素。
我们分析了作为糖尿病患者的无线创新研究（WISDM）的一部分所收集的数据，其中有 22 个内分泌科参与了这项研究。本研究纳入了至少完成一次认知评估的≥60 岁、患有 T1D 的随机参与者（n=203）。使用已发表的建议对认知障碍进行分类。
年龄较大、男性、非私人医疗保险、日常功能较差、诊断为神经病和糖尿病病程较长与认知表现较差相关，但与认知障碍无关。基线和 52 周时分别有 49%和 39%的样本符合认知障碍的标准。在有两个时间点数据的参与者中，基线正常而 52 周时受损的占 10%，22%的参与者（基线时被归类为认知障碍的参与者中有 44%）在 52 周时恢复正常。
本研究表明，一些人口统计学和临床特征与 T1D 老年患者的认知表现较差有关，但这些特征与 NIH 工具包认知障碍标准定义的认知障碍之间没有关联。在评估 T1D 老年患者的认知时需要谨慎，因为在基线时被确定为有认知障碍的患者中有很大一部分在 52 周后恢复正常。需要进一步研究认知和衰老之间的相互关系，以更好地了解 T1D 对认知健康的影响，从而改善临床监测并帮助降低该人群患痴呆症的风险。
