<span>研究者們發(fā)現(xiàn)糖尿病或加速老年人認(rèn)知功能障礙。</span><span>Kristine Yaffe, MD</span><span>（</span><span>University of California San Francisco</span><span>）和其同事在</span><span>Archives of Neurology</span><span>上報(bào)道，在</span><span>9</span><span>年里，那些患有糖尿病的個(gè)體在兩項(xiàng)單獨(dú)認(rèn)知測(cè)試上的表現(xiàn)要遠(yuǎn)差于那些沒(méi)有糖尿病的人</span><span>(P=0.008 and P=0.001)</span><span>。</span>

<span>該發(fā)現(xiàn)提示預(yù)防糖尿病能幫助維持老年人的認(rèn)知功能。</span>

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<span>Yaffe</span><span>和他的同事為了評(píng)價(jià)糖尿病是否會(huì)加速認(rèn)知功能減退以及血糖控制不佳是否與會(huì)在老年人中造成認(rèn)知功能變差，而在兩個(gè)社區(qū)里進(jìn)行了前瞻性</span><span>Health, Aging, and Body Composition (Health ABC)</span><span>研究，總共納入了</span><span>3069</span><span>名平均年齡為</span><span>74.2</span><span>歲的患者。患者在入組時(shí)首先完成兩個(gè)測(cè)試——改良簡(jiǎn)易精神狀態(tài)檢查（</span><span>3MS</span><span>）和數(shù)字符號(hào)替換測(cè)試（</span><span>DSST</span><span>），并在隨訪的十年中定期進(jìn)行復(fù)測(cè)。他們也在入組時(shí)、第四年、第六年和第十年時(shí)進(jìn)行糖化血紅蛋白測(cè)定。在入組時(shí)，</span><span>23.4%</span><span>的患者診斷為糖尿病，有</span><span>159</span><span>名患者或</span><span>5.2%</span><span>在研究過(guò)程中發(fā)展為糖尿病。研究者們發(fā)現(xiàn)在入組時(shí)，那些確診為糖尿病的患者兩項(xiàng)認(rèn)知功能測(cè)試的分?jǐn)?shù)較沒(méi)有糖尿病的受試者而言顯著降低</span><span>(</span><span>兩項(xiàng)測(cè)試</span><span>P=0.001)</span><span>，并且在調(diào)整了年齡、種族、性別和受教育程度等因素后，結(jié)果未發(fā)生任何變化。在</span><span>9</span><span>年后，</span><span>Yaffe</span><span>和其同事發(fā)現(xiàn)比起那些入組時(shí)沒(méi)有糖尿病的患者，患有糖尿病的受試者認(rèn)知功能減退更明顯</span><span>(3MS </span><span>：</span><span>P=0.008 </span><span>，</span><span>DSST</span><span>：</span><span> P=0.001)</span><span>，在混合效應(yīng)模型中得到類似的結(jié)果。</span>

<span>研究過(guò)程中發(fā)展成糖尿病的受試者的得分界于兩組間，但是與沒(méi)有糖尿病的受試者組相比不存在統(tǒng)計(jì)學(xué)差異。研究者們同時(shí)發(fā)現(xiàn)在入組時(shí)即患有糖尿病的受試者中，高糖化血紅蛋白水平與低認(rèn)知評(píng)分相關(guān)。在大約</span><span>3.5</span><span>年時(shí)，糖化血紅蛋白水平中度（</span><span>7%</span><span>至</span><span>8%</span><span>）或高度（大于等于</span><span>8%</span><span>）升高的患者的平均認(rèn)知評(píng)分要低于輕度（小于等于</span><span>7%</span><span>）升高的受試者</span><span>(3MS </span><span>：</span><span>P=0.003 , DSST </span><span>：</span><span>P=0.04 )</span><span>。在經(jīng)過(guò)調(diào)整后，</span><span>3Ms</span><span>評(píng)分還是存在顯著差異但是</span><span>DSST</span><span>評(píng)分不存在顯著性差異。</span>
<span>Yaffe</span><span>和其同事指出他們的研究發(fā)現(xiàn)和既往研究結(jié)果一致，提示糖尿病的嚴(yán)重程度會(huì)加速認(rèn)知功能的減退。糖尿病導(dǎo)致認(rèn)知減退的機(jī)制包括炎癥和微血管病變，也包括糖尿病患者易患腎臟病變、抑郁、卒中、高血壓、高脂血癥和心血管疾病，所有這些都會(huì)導(dǎo)致認(rèn)知功能受損。延遲或預(yù)防糖尿病的發(fā)生有益于保持老年人的認(rèn)知功能。</span>

<span>本研究的不足之處在于在研究過(guò)程中發(fā)展成為糖尿病患者的受試者人數(shù)較少，并且缺乏在研究開(kāi)始時(shí)糖尿病患者的病程和嚴(yán)重程度的相關(guān)數(shù)據(jù)。其他的不足之處包括僅使用兩種方法評(píng)價(jià)認(rèn)知功能，組間認(rèn)知功能差異小以及由于在不同時(shí)間使用不同的方法評(píng)價(jià)糖化血紅蛋白。</span>

<span>研究者們指出需要進(jìn)行進(jìn)一步的研究來(lái)確定對(duì)糖尿病的早期診斷和治療能否降低其對(duì)認(rèn)知功能的損害。</span>
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<h2>相關(guān)文獻(xiàn)</h2>
<h3>Diabetes, Glucose Control, and 9-Year Cognitive Decline Among Older Adults Without DementiaDiabetes and Risk of Cognitive Decline.</h3>
Yaffe K Falvey C Hamilton N Schwartz AV Simonsick EM Satterfield S Cauley JA Rosano C Launer LJ Strotmeyer ES Harris TB

<br/><strong>Abstract</strong><br/>

OBJECTIVES To determine if prevalent and incident diabetes mellitus (DM) increase risk of cognitive decline and if, among elderly adults with DM, poor glucose control is related to worse cognitive performance. DESIGN Prospective cohort study. SETTING Health, Aging, and Body Composition Study at 2 community clinics. PARTICIPANTS A total of 3069 elderly adults (mean age, 74.2 years; 42% black; 52% female). MAIN OUTCOME MEASURES Participants completed the Modified Mini-Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) at baseline and selected intervals over 10 years. Diabetes mellitus status was determined at baseline and during follow-up visits. Glycosylated hemoglobin A1c level was measured at years 1 (baseline), 4, 6, and 10 from fasting whole blood. RESULTS At baseline, 717 participants (23.4%) had prevalent DM and 2352 (76.6%) were without DM, 159 of whom developed incident DM during follow-up. Participants with prevalent DM had lower baseline test scores than participants without DM (3MS: 88.8 vs 90.9; DSST: 32.5 vs 36.3, respectively; t = 6.09; P = .001 for both tests). Results from mixed-effects models showed a similar pattern for 9-year decline (3MS: -6.0- vs -4.5-point decline; t = 2.66; P = .008; DSST: -7.9- vs -5.7-point decline; t = 3.69; P = .001, respectively). Participants with incident DM tended to have baseline and 9-year decline scores between the other 2 groups but were not statistically different from the group without DM. Multivariate adjustment for demographics and medical comorbidities produced similar results. Among participants with prevalent DM, glycosylated hemoglobin A1c level was associated with lower average mean cognitive scores (3MS: F = 8.2; P for overall = .003; DSST: F = 3.4; P for overall = .04), even after multivariate adjustment. CONCLUSION Among well-functioning older adults, DM and poor glucose control among those with DM are associated with worse cognitive function and greater decline. This suggests that severity of DM may contribute to accelerated cognitive aging.

<br/>來(lái)源：丁香園

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