Utility of the NIH Toolbox Cognition Battery in middle to older aged adults with longstanding type 1 diabetes: The DCCT/EDIC study

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.研究目的：1型糖尿病（T1D）患者发生认知衰退与痴呆的风险显著升高。既往通过精细化神经心理学测试的研究已证实，糖尿病相关及血管危险因素与认知衰退存在关联，但目前尚不明确认知筛查量表能否检出1型糖尿病患者随年龄增长出现的认知变化。 研究方法：本研究纳入来自糖尿病控制与并发症试验（Diabetes Control and Complications Trial, DCCT）及其随访研究——糖尿病干预与并发症流行病学研究（Epidemiology of Diabetes Interventions and Complications, EDIC）的1049名1型糖尿病患者，受试者中位年龄为59岁（年龄范围43~74岁）。所有参与者均完成了美国国立卫生研究院工具盒认知量表（NIH Toolbox Cognition Battery, NIHTB-C）与蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）。研究团队在长达32年的随访周期内，重复评估了受试者的神经心理学功能、抑郁状态、糖化血红蛋白（HbA1c）水平、严重低血糖事件、1型糖尿病并发症及血管危险因素，以明确上述指标与当前NIHTB-C认知测试成绩的关联。同时对可获取的认知数据进行临床判定，以确定受试者的认知损害状态。 研究结果：NIHTB-C评分与同期实施的神经心理学测试结果呈中等程度相关（相关系数r=0.36~0.53）。多变量模型分析显示，既往严重低血糖发作、抑郁症状、肾病、较低的体质量指数（BMI）以及较高的糖化血红蛋白与低密度脂蛋白胆固醇（LDL-C）水平，均与较差的NIHTB-C流体认知综合评分显著相关。NIHTB-C可有效检出经临床判定的认知损害（曲线下面积=0.86；最佳截断值≤90分）。MoCA的检测效能与之相近（曲线下面积=0.83；最佳截断值≤25分）。 研究结论：NIHTB-C可敏感反映糖尿病相关及血管危险因素对认知功能的影响，与神经心理学测试结果具有良好相关性，且可准确检出经临床判定的认知损害。本研究数据支持将NIHTB-C作为中老年1型糖尿病患者的认知筛查工具，以判断是否需要转诊接受精细化神经心理学评估。