老年糖尿病患者认知衰弱研究进展

老年糖尿病患者认知障碍与躯体衰弱共存被称为认知衰弱,其已成为老年糖尿病的新型并发症,并增加了跌倒、失能、住院、死亡等不良结局的风险。及时采取干预措施可延缓甚至阻止认知衰弱向痴呆的发展,降低不良结局的发生风险,但目前老年糖尿病患者认知衰弱的诊断标准及评估方法尚未达成共识,因此本文就老年糖尿病患者认知衰弱的概念、现状、评估及干预展开综述,为未来的研究提供参考。     

老年2型糖尿病住院患者衰弱、认知功能与跌倒恐惧的相关性

目的 探讨老年2型糖尿病住院患者衰弱、认知功能与跌倒恐惧的相关性.方法 选取2019年12月至2020年8月大连医科大学附属第一医院内分泌科及老年医学科收治的199例老年2型糖尿病住院患者为研究对象,采用一般资料调查表、衰弱筛查表、修订版跌倒效能量表、简易认知状态量表进行调查.采用SPSS 22.0统计软件进行数据分析...     

老年糖尿病患者衰弱现状及其影响因素

目的 探讨老年糖尿病(DM)患者衰弱现状并分析其影响因素,为衰弱的干预提供指导。方法 采用便利抽样法选取2022年12月至2023年4月中国人民解放军总医院8个医学中心内分泌科及北京瑞京糖尿病医院住院治疗的301例老年DM患者为研究对象,通过面对面调查采集患者一般资料及衰弱相关资料。根据是否发生衰弱,将患者分为衰弱组(71例)和非衰弱组(230例)。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用Mann-Whitney U检验、χ²检验或Fisher精确概率检验进行组间比较。采用二元logistic回归分析确定老年DM患者衰弱的影响因素。结果 2组患者年龄、规律运动、听力障碍、近一年跌倒史、睡眠质量、DM慢性并发症、使用胰岛素、营养状况、抑郁、孤独感及轻度认知障碍情况比较,差异均有统计学意义(P<0.05)。二元logistic回归分析结果显示,增龄(OR=1.107,95%CI 1.051~1.167)、营养不良(OR=8.135,95%CI 1.680~39.399)及抑郁(OR=2.404,95%CI 1.156~4.998)是老年DM患者衰弱的危险因素;规律运动(OR=0.265,95%CI 0.117~0.600)是其保护因素。结论 老年DM患者衰弱患病状况不容乐观,营养、运动及心理干预是潜在的干预靶点,未来的研究可制定针对性的干预措施,减少老年DM患者衰弱的发生。     

Aging, frailty and age-related diseases

The concept of frailty as a medically distinct syndrome has evolved based on the clinical experience of geriatricians and is clinically well recognizable. Frailty is a nonspecific state of vulnerability, which reflects multisystem physiological change. These changes underlying frailty do not always achieve disease status, so some people, usually very elderly, are frail without a specific life threatening illness. Current thinking is that not only physical but also psychological, cognitive and social factors contribute to this syndrome and need to be taken into account in its definition and treatment. Together, these signs and symptoms seem to reflect a reduced functional reserve and consequent decrease in adaptation (resilience) to any sort of stressor and perhaps even in the absence of extrinsic stressors. The overall consequence is that frail elderly are at higher risk for accelerated physical and cognitive decline, disability and death. All these characteristics associated with frailty can easily be applied to the definition and characterization of the aging process per se and there is little consensus in the literature concerning the physiological/biological pathways associated with or determining frailty. It is probably true to say that a consensus view would implicate heightened chronic systemic inflammation as a major contributor to frailty. This review will focus on the relationship between aging, frailty and age-related diseases, and will highlight possible interventions to reduce the occurrence and effects of frailty in elderly people.     

社区老人认知衰弱相关影响因素及预防研究进展

认知衰弱(CF)是一种认知储备减少的状态,具有可逆性。有研究报道,CF可能是预防社区老人护理依赖等不良结局的重要靶点。了解社区老人CF的相关影响因素及其病理生理机制和防治措施,有利于预防及延缓CF的发生,减少护理依赖,提高老年人及照护者的生活质量,延缓入住长期照护机构或缩短入住急性医院护理单元的时间,减轻社会负担。     

老年糖尿病患者衰弱现状及相关因素分析

目的 探讨老年糖尿病患者衰弱患病现状并分析其相关因素，为老年糖尿病患者衰弱的干预提供指导。方法 采用便利抽样法选取2022年12月~2023年4月北京市某三甲医院8个医学中心内分泌科及一家一级丙等糖尿病专科医院住院治疗的老年糖尿病患者301例，采用现场面对面问卷调查的方式采集患者相关资料。根据衰弱评估结果分为衰弱组和非衰弱组，比较两组患者各指标差异，确定衰弱的独立影响因素。结果 301例老年糖尿病患者中，衰弱患者71例（23.6%），非衰弱（衰弱前期、健壮）患者230例（76.4%）。单因素分析结果显示，衰弱与非衰弱患者在年龄、运动习惯、共病状态、听力状况、近一年跌倒史、睡眠质量、是否合并糖尿病慢性并发症、是否使用胰岛素、营养状况、抑郁状况、孤独感、是否轻度认知障碍方面差异有统计学意义（P＜0.05）。多因素分析结果显示：增龄（OR=1.094，95%CI 1.037~1.154）、高共病状态（OR=2.898，95%CI 1.164~7.210）、使用胰岛素（OR=1.978，95%CI 1.003~3.904）、营养不良（OR=9.968，95%CI 1.915~51.896）、抑郁（OR=2.165，95%CI 1.033~4.536）是老年糖尿病患者衰弱的独立危险因素，规律运动（OR=0.289，95%CI 0.127~0.655）是其保护因素。结论 老年糖尿病患者衰弱患病状况不容乐观，营养、运动及心理干预是潜在的干预靶点，未来的研究可制定针对行的干预措施，减少老年糖尿病患者衰弱的发生。     

Innovative biomarkers for predicting type 2 diabetes mellitus: relevance to dietary management of frailty in older adults

Type 2 diabetes mellitus (T2DM) increases in prevalence in the elderly. There is evidence for significant muscle loss and accelerated cognitive impairment in older adults with T2DM; these comorbidities are critical features of frailty. In the early stages of T2DM, insulin sensitivity can be improved by a “healthy” diet. Management of insulin resistance by diet in people over 65 years of age should be carefully re-evaluated because of the risk for falling due to hypoglycaemia. To date, an optimal dietary programme for older adults with insulin resistance and T2DM has not been described. The use of biomarkers to identify those at risk for T2DM will enable clinicians to offer early dietary advice that will delay onset of disease and of frailty. Here we have used an in silico literature search for putative novel biomarkers of T2DM risk and frailty. We suggest that plasma bilirubin, plasma, urinary DPP4-positive microparticles and plasma pigment epithelium-derived factor merit further investigation as predictive biomarkers for T2DM and frailty risk in older adults. Bilirubin is screened routinely in clinical practice. Measurement of specific microparticle frequency in urine is less invasive than a blood sample so is a good choice for biomonitoring. Future studies should investigate whether early dietary changes, such as increased intake of whey protein and micronutrients that improve muscle function and insulin sensitivity, affect biomarkers and can reduce the longer term complication of frailty in people at risk for T2DM.     

A community-based cross-sectional survey of orthostatic hypotension among elderly from south India

BackgroundOrthostatic hypotension (OH) increases the risk of falls and associated morbidity and mortality in elderly. Hence, determining the prevalence of OH and its associated factors is important, especially in understudied LMIC settings.MethodsA community-based cross-sectional study was conducted among randomly selected 240 community-dwelling elderly from Thiruvananthapuram, Kerala. The OH symptoms were assessed by standard clinical measurements and frailty was assessed by modified Fried frailty phenotype. Logistic regression analysis was conducted to assess the factors associated with OH.ResultsThe prevalence of OH and frailty among participants was 9.6 and 29.2 percent respectively. In the first minute, OH was associated with increased odds of falls (OR = 1.97 [95%CI = 1.05, 3.72]). Increase in number of co-morbidities (OR_adj = 1.82 [95%CI = 1.36, 2.48]), number of medicines used (OR_adj = 1.73 [95%CI = 1.28, 2.34]), and orthostatic intolerance (OR_adj = 3.67 [95%CI = 1.13, 11.94]) increased the odds of having OH. Elderly with diabetes (OR_adj = 4.81 [95%CI = 1.57, 14.77]), hypertension (OR_adj = 4.97 [95%CI = 1.01, 24.46]) and cognitive impairment (OR_adj = 5.01 [95%CI = 1.40, 18.51]) were at a higher odds of having OH.ConclusionsOH and frailty are prevalent in community dwelling elderly in Thiruvananthapuram district. Frailty may be a risk factor for OH in the first minute. The number of co-morbidities may be an independent risk factor for OH. Hence, elderly people with comorbidities and cognitive impairment may be actively assessed for OH to prevent falls and associated injuries.     

心血管疾病中认知衰弱的研究进展

认知衰弱是无痴呆的患者同时存在衰弱和轻度认知障碍的状态。认知衰弱直接影响心血管疾病患者的健康,增加失能、降低生活质量。现对老年心血管疾病患者认知衰弱的概念、评估、流行病学、预后、机制和干预措施进行综述。     

血管危险因素与老年认知功能障碍的研究进展

血管危险因素与老年认知功能障碍的发生密切相关。由血管危险因素引起的老年认知功能障碍的发病率逐年上升,严重危害老年人的健康。高血压、糖尿病、高脂血症和慢性脑低灌注等是影响老年认知功能的重要的血管危险因素。研究血管危险因素与老年认知功能障碍的关系及作用机制,对于老年认知功能障碍的早期诊断和早期干预,具有重要的社会学和医学意义。     

老年综合征与心力衰竭预后的研究进展

随着老年人口的不断增加,老年医学愈发重要。不同于年轻人,老年综合征对于老年人的生活质量,预期寿命等均有非常显著的影响。本文介绍了一些常见的老年综合征的表现和评估方法（衰弱、认知功能障碍、抑郁状态等）,同时分别综述其与心力衰竭预后之间的关系。     

Low glycated hemoglobin level is associated with severity of frailty in Japanese elderly diabetes patients

Aims/Introduction

Previously, a study using a narrowly defined (physical base) frailty scale reported that both good and bad (U‐shaped curve) glycated hemoglobin (HbA1c) levels were frailty risk factors in patients with type 2 diabetes mellitus. However, no such studies in Japan have shown this. We aimed to evaluate the frailty risk factors including HbA1c in elderly Japanese patients with type 2 diabetes mellitus using a broadly defined (both physical and psychosocial base) frailty scale, the Clinical Frailty Scale (CFS).

Materials and Methods

We randomly enrolled 132 elderly patients with type 2 diabetes mellitus (aged ≥65 years) and categorized the patients into nine stages of frailty using CFS. Because no patient had CFS 9, patients with a CFS score of 1–4 and 5–8 were defined as non‐frail and frail, respectively. We attempted to identify the risk factors of frailty by investigating the association between CFS stage and various patient factors.

Results

Multiple regression analysis showed that an increase in age, low levels of albumin, high‐density lipoprotein cholesterol, systolic blood pressure, HbA1c, total cholesterol, and bodyweight were statistically significant and strong independent risk factors for frailty, suggesting that reverse metabolism owing to malnutrition in elderly type 2 diabetes mellitus patients might be involved.

Conclusions

HbA1c level was not a U‐shaped risk for frailty, suggesting that relatively good glycemic control might be more important for frailty than poor control in elderly type 2 diabetes mellitus patients.     

Comprehensive studies of cognitive impairment of the elderly with type 2 diabetes

Type 2 diabetes mellitus is associated with cognitive dysfunction and increases the risk of dementia for the elderly. The aim of the study presented here was to provide a brief review of how disturbance of glucose and metabolic homeostasis may be implicated in the cognitive decline of patients with type 2 diabetes. Several risk factors such as nutrition, cerebrovascular disorders and the neurotoxic effects of hyperglycemia may combine for the formation of mechanisms of cognitive decline in the diabetic elderly. It should be noted that cognitive deficits of diabetes are accompanied by neuroradiological changes in the brain, so that cognitive dysfunction both with and without brain structural changes may overlap during cognitive decline of the diabetic elderly. Recently, we conducted two studies to explore, by means of brain imaging, hierarchical relationships among clinical profiles of diabetes, cognitive function, white matter hyperintensity and brain atrophy. The results suggested that subcortical brain atrophy and hyperintensity constitute predictors of the rate of progression of cognitive dysfunction in the diabetic elderly, while cortical atrophy is associated with high diastolic blood pressure and lower HbA1c. These hypotheses may explain in part the underlying mechanisms of cognitive impairment in the diabetic elderly. Prospective intervention studies are needed, however, to clarify the mechanism of cognitive dysfunction of the diabetic elderly and what the targets are for preventive measures.     

Anemia and the frail elderly

Frailty engenders a recognizable clinical syndrome of vulnerability to stressors related to impaired physiologic reserve that primarily occurs among older adults. Features of frailty include weight loss, exhaustion, muscle weakness, performance impairment, and cognitive slowing and can be identified independent of comorbid conditions. Among frail older adults, anemia prevalence is markedly increased. The interaction between anemia and frailty is complex and confidently separating cause and effect may not be possible. Nevertheless, anemia functions as a powerful prognostic factor for the development of frailty related problems such as muscle weakness, reduced performance, falls, and mortality. Further, mildly reduced hemoglobin shows a similar association with adverse outcomes. The data strongly intimate that anemia predisposes or accelerates the development of frailty. Anemia interventional studies are sorely needed to determine whether treatment may mitigate either the development of frailty and/or the sequela of frailty.     

胱抑素C与老年2型糖尿病患者认知功能障碍的相关性探讨

目的：探讨血清胱抑素C（Cys C）水平与老年2型糖尿病患者认知功能障碍的相关性。方法选取老年2型糖尿病患者352例,其中认知功能正常组（NC组）146例、轻度认知功能障碍组（MCI组）112例,阿尔茨海默病组（AD组）94例。采用简易智能状态检查量表（MMSE）、蒙特利尔认知评估量表（MoCA）评定患者认知功能。检测所有患者血糖、血脂、Cys C水平和肝肾功能等,比较3组间临床特征及Cys C水平差异。结果3组间血清Cys C水平差异具有统计学意义（均P＜0.05）。NC、MCI、AD组血清Cys C水平依次升高。相关分析表明,血清Cys C水平与年龄、糖尿病病程、甘油三酯（TG）、血肌酐（Cr）、糖化血红蛋白（HbA1c）呈正相关（r＝0.352,0.199,0.177,0.616,0.368,均P＜0.05）,与MMSE分数、MoCA分数、高密度脂蛋白胆固醇（HDL-C）呈负相关（r＝-0.186,-0.237,-0.185,均P＜0.05）。logistic回归分析显示Cys C（P＝0.011,OR＝2.120）、年龄（P＝0.021,OR＝3.401）、病程（P＝0.033, OR＝3.102）、HbA1c（P＝0.010,OR＝2.691）是老年2型糖尿病患者认知功能障碍的独立危险因素。结论血清Cys C水平与老年2型糖尿病患者认知功能障碍相关,老年2型糖尿病患者高血清 Cys C水平提示认知功能障碍患病风险增加。     

Cognitive Impairment Improves the Predictive Validity of the Phenotype of Frailty for Adverse Health Outcomes: The Three-City Study

OBJECTIVES: To determine whether adding cognitive impairment to frailty improves its predictive validity for adverse health outcomes.
DESIGN: Four-year longitudinal study.
SETTING: The French Three-City Study.
PARTICIPANTS: Six thousand thirty community-dwelling persons aged 65 to 95.
MEASUREMENTS: Frailty was defined as having at least three of the following criteria: weight loss, weakness, exhaustion, slowness, and low physical activity. Subjects meeting one or two criteria were prefrail and those meeting none as nonfrail. The lowest quartile in the Mini-Mental State Examination (MMSE) and the Isaacs Set Test (IST) was used to identify subjects with cognitive impairment. The predictive validity of frailty for incident disability, hospitalization, dementia, and death was calculated first for frailty subgroups and then rerun after stratification according to the presence or absence of cognitive impairment.
RESULTS: Four hundred twenty-one individuals (7%) met frailty criteria. Cognitive impairment was present in 10%, 12%, and 22% of the nonfrail, prefrail, and frail subjects, respectively. Those classified as frail scored lower on the MMSE and IST than those classified as prefrail and nonfrail. After adjustment, frail persons with cognitive impairment were significantly more likely to develop disability in activities of daily living (ADLs) and instrumental ADLs over the following 4 years. The risk of incident mobility disability and hospitalization was marginally greater. Incident dementia was greater in the groups with cognitive impairment irrespective of their frailty status. Conversely, frailty was not a significant predictor of mortality.
CONCLUSION: Cognitive impairment improves the predictive validity of the operational definition of frailty, because it increases the risk of adverse health outcomes in this particular subgroup of the elderly population.     

Frailty in patients affected by atrial fibrillation

Atrial fibrillation (AF) is the most common arrhythmia among elderly people. However its relationship with the frailty syndrome is not well understood. It has been suggested that AF may be a marker of frailty in elderly, leading to the loss of independence in performing of routine daily activities. The aim of this study is to investigate the association between AF, frailty and cognitive decline in elderly patients. A total of 140 hospitalized patients, mean age 79.2 ± 7.4 years were enrolled in our study. Of these, 70 were affected by parossistic, persistent or permanent AF and 70, matched for age and gender, were concurrently studied as control. Cognitive impairment and frailty state has been evaluated in each patient using the Mini Mental State Examination (MMSE) and a standard score of accumulated deficits for constructing a frailty index. We have observed a higher number of frail patients in the AF group as compared with controls (88.6% vs 67.1%, p = 0.004). The group of patients with frailty syndrome had MMSE score significantly lower than those of the nonfrail group (16.8 ± 9.8 vs 22.2 ± 6.4, p = 0.005). Furthermore, a negative correlation between MMSE score and frailty index (rho = −0.517, p < 0.001) has been shown. Our study points out a statistical association between frailty and AF. Atrial fibrillation could worsen the frailty state, but perspective studies are necessary to confirm an increased mortality in patients affected by AF and frailty.     

Acute coronary syndromes: an old age problem

The increasing population in older age will lead to greater numbers of them presenting with acute coronary syndromes (ACS). This has implications on global healthcare resources and necessitates better management and selection for evidenced-based therapies. The elderly are a high risk group with more significant treatment benefits than younger ACS. Nevertheless, age related inequalities in ACS care are recognised and persist. This discrepancy in care, to some extent, is explained by the higher frequency of atypical and delayed presentations in the elderly, and less diagnostic electrocardiograms at presentation, potentiating a delay in ACS diagnosis. Under estimation of mortality risk in the elderly due to limited consideration for physiological frailty, co-morbidity, cognitive/psychological impairment and physical disability, less input by cardiology specialists and lack of randomised, controlled trials data to guide management in the elderly may further confound the inequality of care. While these inequalities exist, there remains a substantial opportunity to improve age related ACS outcomes. The selection of elderly patients for specific therapies and medication regimens are unanswered. There is a growing need for randomised, controlled trial data to be more representative of the population and enroll those of advanced age with co-morbidity. A lack of reporting of adverse events, such as renal impairment post coronary angiography, in the elderly further limit risk benefit decisions. Substantial improvements in care of elderly ACS patients are required and should be advocated. Ultimately, these improvements are likely to lead to better outcomes post ACS. However, the improvement in outcome is not infinite and will be limited by non-modifiable factors of age-related risk.     

Hypertension and frailty in older adults

The association between hypertension and frailty syndrome in older adults remains unclear. There is scarce information about the prevalence of hypertension among frail elderly patients or on its relationship with frailty. Up to one quarter of frail elderly patients present without comorbidity or disability, yet frailty is a leading cause of death. The knowledge and better control of frailty risk factors could influence prognosis. The present study evaluated: (1) the prevalence of hypertension in robust, prefrail, and frail elderly; and (2) factors that might be associated with frailty including hypertension. A cross‐sectional study was conducted in 619 older adults at a university‐based outpatient center. Study protocol included sociodemographic data, measures of blood pressure and body mass index, frailty screening according to the internationally validated FRAIL (fatigue, resistance, ambulation, illnesses, and loss of weight) scale, number of comorbidities, drug use assessment, physical activity, cognitive status, and activities of daily living. Ordinal logistic regression was used to evaluate factors associated with frailty. Prevalence of hypertension and frailty was 67.3% and 14.8%, respectively, in the total sample. Hypertension was more prevalent in the prefrail (72.5%) and frail (83%) groups than among controls (51.7%). Hypertension, physical activity, number of prescribed drugs, and cognitive performance were significantly associated with frailty status. Hypertension presented an odds ratio of 1.77 towards frailty (95% confidence interval, 1.21–2.60; P = .002). Hypertension was more prevalent in frail elderly patients and was significantly associated with frailty. Intensive control of hypertension could influence the trajectory of frailty, and this hypothesis should be explored in future prospective clinical trials.     

Physical frailty and cognitive function among men with cardiovascular disease

AimsTo assess the relationship between physical frailty and cognitive function among elderly men with a history of cardiovascular disease (CVD).MethodsThree-hundred-twenty-four community-dwelling men with chronic CVD (mean age 77.2 ± 6.4 years) who previously participated in the Bezafibrate Infarction Prevention (BIP) trial (1990–1998) underwent assessment of frailty and cognitive function between 2011 and 2013. Physical frailty was assessed using the Fried phenotypic model, and cognitive performance overall and in memory, executive function, visuospatial and attention domains was evaluated using a validated set of computerized cognitive tests. Linear regression models were used to assess the cross-sectional relationship of frailty status and its components (gait speed, grip strength, weight loss, exhaustion and activity) with cognitive function overall and in specific domains, adjusting for age, education, smoking status, physical activity, history of myocardial infarction, hypertension, diabetes and dyslipidemia, systolic blood pressure, BMI and depression.ResultsOf the 324 men, 91 (28%) were frail and 121 (37%) were pre-frail. After controlling for potential confounders, severity of frailty was strongly associated with global cognitive function (β = −8.0, 95%CI = −11.9,−4.1 and β = −3.3, 95%CI = −6.0,−0.5 comparing frail and pre-frail to non-frail, respectively), with the most profound associations observed in executive function and attention. Gait speed was associated with overall cognitive performance and with all cognitive domains assessed in this study, and activity with none.ConclusionCognitive function is poor among frail and pre-frail men with CVD, particularly in non-memory domains. Future research is warranted to address mechanisms and to assess the efficacy of interventions to improve physical and cognitive health.