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Clinical and subclinical macrovascular disease as predictors of cognitive decline in older patients with type 2 diabetes: the edinburgh type 2 diabetes study.

机译:临床和亚临床大血管疾病可预测老年2型糖尿病患者认知能力下降:爱丁堡2型糖尿病研究。

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OBJECTIVE Macrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macrovascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes. RESEARCH DESIGN AND METHODS Eight hundred thirty-one men and women (aged 60-75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at baseline and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change. RESULTS Measures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized β, -0.12) and of subclinical markers with actual 4-year decline (standardized β, -0.12, 0.12, and -0.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P < 0.006). Results altered only slightly on adjustment for vascular risk factors. CONCLUSIONS Stroke and subclinical markers of cardiac stress and generalized atherosclerosis are associated with cognitive decline in older patients with type 2 diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted.
机译:目的大血管疾病可能导致2型糖尿病患者加速认知功能下降的风险增加。我们旨在确定认知健康的2型糖尿病老年人群中大血管疾病与认知变化的关系。研究设计与方法831位年龄在60-75岁之间的男性和女性参加了两次前瞻性的爱丁堡2型糖尿病研究(ET2DS)。在基线时,对临床和亚临床大血管疾病进行了测量,包括心血管事件史,颈动脉内膜中层厚度(cIMT),踝臂指数(ABI)和血清N末端前脑钠尿肽(NT-proBNP)。在基线期和4年后进行了7次神经心理学测试。将分数合并为标准化的一般能力因子(g)。调整基线g的随访g评估了4年的认知变化。词汇调整(估计的病前能力)被用来估计一生的认知变化。结果认知能力下降的指标与中风,NT-proBNP,ABI和cIMT显着相关,但与非中风血管事件无关。对于NT-proBNP,ABI和cIMT,卒中与估计的终生认知能力下降(标准β,-0.12)和亚临床标志物与实际4年下降(标准β,-0.12、0.12和-0.15)的相关性)达到经Bonferroni调整的统计学显着性水平(P <0.006)。在调整血管危险因素后,结果仅略有改变。结论中风和亚临床标志物的心脏压力和广泛的动脉粥样硬化与老年2型糖尿病患者的认知能力下降有关。有必要进一步研究亚临床血管疾病标记物在预测认知能力下降中的潜在用途。

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