撰文 | 宋文法

2型糖尿病是一种慢性疾病，影响全球超过5.4亿人。随着生活和饮食习惯的改变，糖尿病已经成为影响人类健康的第三大因素。在中国，成年人有超过1.14亿糖尿病患者，占全世界糖尿病患者四分之一，在全球范围内居首位。

糖尿病是痴呆症的一个关键的可改变危险因素。早期研究显示，患有糖尿病的人患痴呆症的风险较高，认知功能较低。然而，尚不清楚糖尿病前和新发糖尿病后短期内认知功能发展趋势。

近日，苏州大学附属第一医院的研究人员在《神经病学》"

Neurology "期刊上发表了一篇题为"

Trends in Cognitive Function Before and After Diabetes Onset：The China Health and Retirement Longitudinal Study

"的研究论文。

该研究发现，糖尿病加速大脑衰老，加快认知能力下降，与糖尿病前期相比，新发糖尿病与发病后约4年内的认知能力下降速度加快了68%。

在这项研究中，研究人员分析了中国健康与退休纵向调查（CHARLS）中12422名来自中国28个省份的参与者，平均在45岁或以上，基线时没有糖尿病，也没有认知能力相关问题，分析了糖尿病发病前后认知功能的变化。

在研究期间，参与者通过整体认知评分来评估认知功能，包括4项认知测试，情景记忆、视觉空间能力、定向能力、注意力和计算能力。糖尿病的定义是，诊断为糖尿病、正在使用降糖药、HbA1c≥6.5%。

在为期7年的随访期间，共有1207名参与者患上了糖尿病。

研究发现，非糖尿病组和糖尿病组的认知功能均逐年下降，糖尿病组在糖尿病组发病前的认知功能下降速度与非糖尿病组相似。但是，糖尿病发病后的认知功能加速下降。

整体认知分数变化（红色实线：

糖尿病发病后）

具体来说，非糖尿病组整体认知功能评分平均每年下降0.035，而糖尿病发病后整体认知评分平均每年下降0.043，速度加快了68%。

此外，视觉空间能力下降速度更快，非糖尿病组视觉空间能力平均每年下降0.036，糖尿病组视觉空间能力平均每年下降0.061，速度加快了96%。

然而，与非糖尿病组相比，糖尿病组在情景记忆、定向能力、注意力和计算能力上，没有显示出统计学上显著的加速下降。

四项认知测试分数变化

最后，研究人员了糖尿病发生的年龄是否会影响认知下降的速度，有275人在45-54岁患上糖尿病，有478人在55-64岁患上糖尿病，有352人在65-74岁患上糖尿病，与45-54岁之间患糖尿病的人相比，患上糖尿病时年龄较大的人，并没有表现出总体认知能力下降率的不同。

这意味着，年龄并没有改变糖尿病后认知能力下降的影响，无论年龄，糖尿病发病后，均会加速整体认知能力下降。

研究人员表示，根据研究结果，在糖尿病诊断后的短时间内，密切监测糖尿病患者的认知功能障碍至关重要。

对于糖尿病导致认知下降加速的潜在机制，研究指出，胰岛素抵抗可能是一个关键因素，大脑胰岛素抵抗可能导致代谢、免疫功能受损，从而损害认知功能。此外，糖尿病还会诱发阿尔茨海默病相关病理。多种机制共同导致脑损伤，最终导致糖尿病后认知功能下降。

总之，结果表明，新发糖尿病与未来认知能力下降的速度更快有关，发病前则不然，年龄并没有改变糖尿病对糖尿病后认知能力下降的影响。

论文链接：

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