Accelerated Progression From Mild Cognitive Impairment to Dementia in People With Diabetes

作者：Xu, Weili^*; Caracciolo, Barbara; Wang, Hui-Xin; Winblad, Bengt; Backman, Lars; Qiu, Chengxuan; Fratiglioni, Laura

来源：Diabetes, 2010, 59(11): 2928-2935.

DOI：10.2337/db10-0539

• VASCULAR RISK-FACTORS
• ALZHEIMERS-DISEASE
• KUNGSHOLMEN-PROJECT
• CLINICAL-DIAGNOSIS
• FASTING GLUCOSE
• POPULATION
• COMMUNITY
• MELLITUS
• OLD
• AGE

OBJECTIVE-The effect of diabetes on mild cognitive impairment (MCI) and its conversion to dementia remains controversial. We sought to examine whether diabetes and pre-diabetes are associated with MCI and accelerate the progression from MCI to dementia
RESEARCH DESIGN AND METHODS-In the Kungsholmen Project, 963 cognitively intact participants and 302 subjects with MCI (120 with amnestic MCI [aMCI] and 182 with other cognitive impairment no dementia [oCIND]) age >= 75 years were identified at baseline. The two cohorts were followed for 9 years to detect the incident MCI and dementia following international criteria. Diabetes was ascertained based on a medical examination, hypoglycemic medication use, and random blood glucose level >= 11.0 mmol/l. Pre-diabetes was defined as random blood glucose level of 7.8-11.0 mmol/l in diabetes-free participants. Data were analyzed using standard and time-dependent Cox proportional-hazards models.
RESULTS-During the follow-up period, in the cognitively intact cohort, 182 people developed MCI (42 aMCI and 140 oCIND), and 212 developed dementia. In the MCI cohort, 155 subjects progressed to dementia, the multi-adjusted hazard ratio (95% CI) of dementia was 2.87 (1.30-6.34) for diabetes, and 4.96 (2.27-10.84) for pre-diabetes. In a Kaplan-Meier survival analysis, diabetes and pre-diabetes accelerated the progression from MCI to dementia by 3.18 years. Diabetes and pre-diabetes were neither cross-sectionally nor longitudinally associated with MCI.
CONCLUSIONS-Diabetes and pre-diabetes substantially accelerate the progression from MCI to dementia, and anticipate dementia occurrence by more than 3 years in people with MCI. The association of diabetes with the development of MCI is less evident in old people. Diabetes 59:2928-2935, 2010

• 出版日期2010-11
• 单位天津医科大学