一项为期两年的多领域生活方式随机对照试验中，糖尿病前期、糖尿病及血糖相关标志物与认知及神经影像学的关联
Associations of Prediabetes, Diabetes and Glucose-Related Markers With Cognition and Neuroimaging in a 2-Year Multidomain Lifestyle Randomised Controlled Trial.
作者信息
Lorenzo Thais, Ngandu Tiia, Lehtisalo Jenni, Antikainen Riitta, Gispert Juan Domingo, Kemppainen Nina, Laatikainen Tiina, Lindström Jaana, Rinne Juha, Soininen Hilkka, Strandberg Timo, Torre Rafael de la, Tuomilehto Jaakko, Solomon Alina, Kivipelto Miia
机构信息
Neuroimaging Research Group, BarcelonaBeta Brain Research Centre, Barcelona, Spain.
Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.
出版信息
Diabetes Metab Res Rev. 2025 Jul;41(5):e70053. doi: 10.1002/dmrr.70053.
AIMS
Few longitudinal studies have explored Oral Glucose Tolerance Test markers (OGTT) and both cognitive and brain changes. We investigated OGTT and other glycaemia and insulin resistance markers, and cognitive and neuroimaging changes in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER).
MATERIALS AND METHODS
At-risk individuals aged 60-77 years without dementia (N = 1259) were randomly enrolled in a 2-year multidomain lifestyle intervention or regular health advice program. 1025 participants without previously diagnosed diabetes underwent OGTT. Brain MRI scans were available for 132 participants and amyloid (PiB)-PET and FDG-PET scans for 47. Cognition was assessed using the modified Neuropsychological Test Battery (mNTB).
RESULTS
Higher baseline dysglycaemia measures, particularly those from the OGTT, were connected to less favourable changes in multiple cognitive measures and hippocampal volume. Higher baseline triglyceride-glucose (TyG) index was associated with higher amyloid accumulation and decline in brain glucose metabolism. Higher baseline glycated haemoglobin (HbA1c) was related to favourable changes in processing speed and cortical thickness. There were no significant intervention-control differences in the change in glycaemia markers. Baseline dysglycaemia and glycaemia-related markers did not modify the previously reported intervention benefits on cognition.
CONCLUSIONS
Higher baseline dysglycaemia measures are linked to more deleterious changes in cognition. Specifically, OGTT measures may be the most sensitive for detecting subtle glycaemic abnormalities associated with both unfavourable cognitive and neuroimaging changes. However, HbA1c shows mixed associations with cognition and neuroimaging in people at risk of dementia without previously diagnosed diabetes. This study emphasises the importance of more accurate glucose-related markers when investigating early stages of glucose metabolism abnormalities and their relationship to subtle cognitive impairment and its structural brain correlates.
TRIAL REGISTRATION
ID NCT01041989 https://clinicaltrials.gov.
目的
很少有纵向研究探讨口服葡萄糖耐量试验指标（OGTT）以及认知和大脑变化。我们在芬兰预防认知障碍和残疾老年干预研究（FINGER）中调查了OGTT以及其他血糖和胰岛素抵抗指标，以及认知和神经影像学变化。
材料与方法
年龄在60 - 77岁且无痴呆的高危个体（N = 1259）被随机纳入为期2年的多领域生活方式干预或常规健康建议项目。1025名既往未诊断糖尿病的参与者接受了OGTT。132名参与者可进行脑部MRI扫描，47名可进行淀粉样蛋白（PiB）-PET和氟代脱氧葡萄糖（FDG）-PET扫描。使用改良神经心理测试组合（mNTB）评估认知。
结果
更高的基线血糖异常指标，尤其是来自OGTT的指标，与多种认知指标和海马体积的更不利变化相关。更高的基线甘油三酯-葡萄糖（TyG）指数与更高的淀粉样蛋白积累和脑葡萄糖代谢下降相关。更高的基线糖化血红蛋白（HbA1c）与处理速度和皮质厚度的有利变化相关。血糖指标变化在干预组和对照组之间无显著差异。基线血糖异常和血糖相关指标并未改变先前报道的干预对认知的益处。
结论
更高的基线血糖异常指标与认知方面更有害的变化相关。具体而言，OGTT指标可能对检测与不利的认知和神经影像学变化相关的细微血糖异常最为敏感。然而，在既往未诊断糖尿病的痴呆高危人群中，HbA1c与认知和神经影像学表现出混合关联。本研究强调了在研究葡萄糖代谢异常早期阶段及其与细微认知障碍及其脑结构相关性时，更准确的血糖相关指标的重要性。
试验注册
ID NCT01041989 https://clinicaltrials.gov
Zotero 插件