糖尿病对老年人总体认知功能水平及各认知领域的影响

The Impact of Diabetes on Global and Domain-specific Cognition among Older Adults Residing in An Urban Community

目的研究糖尿病(DM)对社区老年人总体认知功能水平及各认知功能领域的影响。方法根据街道人口登记册确定符合条件的调查对象名单,根据入组和排除标准纳入3 745例社区居民(包括有糖尿病史的居民),分为3组:DM病程>6年组,DM病程≤6年组和非DM组。应用全套认知功能量表(华山版)评估研究对象的认知功能,并用Z评分标准化不同认知领域评分。依据美国精神病协会精神障碍与统计手册Ⅳ(DSM-Ⅳ)和Peterson标准确立痴呆和轻度认知功能障碍(MCI)诊断。比较3组不同认知领域评分差异,以广义线性模型分析不同病程DM患者各认知领域受损的特点。结果 3组研究对象的痴呆患病率分别为4. 1%、4. 2%和5. 9%; MCI患病率分别为17. 7%、18. 6%和27. 2%,且3组认知状况(痴呆、MCI和正常)差异有统计学意义(均P <0. 05)。3组简易智力状态检查量表(MMSE)、搭火柴测验、物品分类测验、听觉词语学习测验以及连线测验A和B量表评分比较,差异有统计学意义(P <0. 05)。校正血糖、年龄、性别、受教育年限、吸烟、饮酒、心脏病、高血压病、DM、脑卒中、APOE-ε4水平、肥胖、抑郁、焦虑等因素后,广义线性模型结果表明DM病程>6年组与非DM组比较,连线测验A、连线测验B、连线耗时、搭火柴和物品分类(类别)等分项测验,差异有统计学意义(均P <0. 05)。DM病程≤6年组各分项测验得分与非DM组比较,差异无显著性。结论长病程DM患者的痴呆和MCI患病率显著高于短病程DM患者和非DM者;长病程DM患者的执行功能、语言和视觉空间能力损害显著,短病程DM患者各认知领域未见受损;尽早发现和治疗DM对老年人认知功能保护具有重要意义。

Aim To study the impact of diabetes mellitus( DM) on global and domain-specific cognition among older adults residing in an urban community. Methods Study subjects were identified using the government maintained "residents list". 3754 people who met inclusion and exclusion criteria and were willing to participate were enrolled. They are divided into three groups: a DM group with more than 6-year duration,a DM group with than less 6-year duration,and a non-DM group. The Scale of Cognitive Function( Huashan version) was used to assess the cognitive function of the participants,and Z-scores were used to standardize the scores of domain-specific cognition. Diagnostic and Statistical Manual of Mental Disorders Ⅳ version( DSM-Ⅳ) criteria and Peterson ’s criteria were used to diagnose dementia and mild cognitive impairment( MCI). The variance analysis were used to compare the difference of Z-scores of cognitive-domains among the three groups and generalized linear model( GLM) was used to analyze the characteristics of impairment in domain-specific cognition between the DM groups with different disease duration. Results The prevalence of dementia( 4. 1%,4. 2% and 5. 9%) and MCI( 17. 7%,18. 6% and27. 2%) of the three groups was significant( P < 0. 05). The same trend was found in MMSE,Stick test,Common Object Sort test,Auditory Verbal Learning Test( AVLT) and Trial Making A and B Test( P <0. 05). GLM showed that DM participants with more than 6-year duration in Trial Making A,Trial Making B,taking time doing Trial Making test,Stick test and Common Object Sort test performance was worse than those without DM,after adjusting for fasting blood glucose,age,sex,years of education,drinking,smoking,heart disease,hypertension,stroke,APOE-ε4 level,obesity,depression and anxiety( P < 0. 05).However,the significance was not found between DM group with less than 6-year duration and non-DM group. Conclusion The prevalence of dementia and MCI in DM participants with longer duration was higher than DM participants with shorter duration and non-DM participants. The performance of execution function,language function and visual spatial ability was poorer in DM participants with longer duration. However,the domain-specific cognition of DM participants with shorter duration was not significantly impaired. The results suggested the importance of early-detection and treatment of diabetes to protect cognitive function in the community elderly.