| Autor: |
Chaytor NS; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA., Trapani VR; Biostatistics Center, George Washington University, Rockville, MD, USA., Braffett BH; Biostatistics Center, George Washington University, Rockville, MD, USA., Fonseca LM; Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA., Lorenzi GM; Medicine, University of California San Diego, La Jolla, CA, USA., Gubitosi-Klug RA; Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA., Hitt S; Ophthalmology, University of Missouri, Columbia, MO, USA., Farrell K; Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA., Jacobson AM; NYU Langone Long Island Hospital, NYU Long Island School of Medicine, Mineola, NY, USA., Ryan CM; Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. |
| Abstrakt: |
Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43-74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations ( r = 0.36-0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed. |
