Diabetes Care：亚临床大血管病变与认知功能下降有关

　　近期公布的Edinburgh 2型糖尿病研究结果提示，对于老年2型糖尿病患者， 脑卒中、亚临床心脏病和动脉粥样硬化均与认知功能下降有关。（Diabetes Care. 2013年4月11日在线版） |

　　该研究入选831例基线无认知功能障碍的老年2型糖尿病患者，评估大血管病变标志物与认知功能之间的关系。结果显示，认知功能下降与脑卒中、N末端B型脑钠肽前体、踝臂指数和颈动脉内膜中层厚度均显著相关，但与非卒中性血管事件无关。研究者报告，脑卒中与估算认知功能下降、亚临床标志物和4年实际认知功能下降之间均有显著关联。校正血管危险因素后，上述结果无明显变化。

与糖尿病相关的拓展阅读：

• Diabetes Care：良好的血糖和血压控制有益于延长糖尿病患者生存期
• 第一时相胰岛素分泌减少是我国2型糖尿病关键诱因
• Diabetic Med：高血压患者治疗时HDL低预示新发糖尿病风险更高
• AACE2013糖尿病治疗方案
• 美国糖尿病防治十年进展回顾
• NEJM：糖尿病治疗有进展但仍存不足
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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
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.