Impaired fasting glucose as a metabolic marker of impaired cognitive function in the elderly
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Elevated plasma glucose may damage the brain through various mechanisms, including increased oxidant generation, formation of advanced glycation end-products and by promoting atherosclerosis of brain vasculature. There exists also an association between hyperhomocysteinaemia (Hhcy) and cognitive function in the elderly, while Hhcy is frequently associated with insulin resistance (IR). The latter may mediate part of the deleterious effect of Hhcy on cognitive function. The impact of impaired fasting glucose (IFG), IR, and Hhcy on cognitive function was evaluated in 182 non-diabetic elderly subjects without signs of previous stroke using the Mini Mental State Examination (MMSE) score. For IFG, subjects were categorized according to both the 1997 and 2003 criteria while IR and Hhcy were defined by the upper quartile of insulin (11.0 UI/L) and Hcy (18.6 μmol/L) distribution, respectively. The frequency of IFG (1997), Hhcy, and IR showed a linear trend across tertiles of MMSE (P < 0.001) whereas that of IFG (2003) did not. The odds ratio for impaired cognitive function was 9.08 for IGF (1997), 3.66 for Hhcy, 2.83 for IR, and 1.32 for IFG (2003). In conclusion, IFG (1997), Hhcy and IR appear to be powerful markers of impaired cognitive function in the elderly.
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