OBJECTIVE The impact of age of diabetes diagnosis on dementia risk across the life course is poorly characterized. We estimated the lifetime risk of dementia by age of diabetes diagnosis. RESEARCH DESIGN AND METHODS We included 13,087 participants from the Atherosclerosis Risk in Communities Study who were free from dementia at age 60 years. We categorized participants as having middle age–onset diabetes (diagnosis <60 years), older-onset diabetes (diagnosis 60–69 years), or no diabetes. Incident dementia was ascertained via adjudication and active surveillance. We used the cumulative incidence function estimator to characterize the lifetime risk of dementia by age of diabetes diagnosis while accounting for the competing risk of mortality. We used restricted mean survival time to calculate years lived without and with dementia. RESULTS Among 13,087 participants, there were 2,982 individuals with dementia and 4,662 deaths without dementia during a median follow-up of 24.1 (percentile 25–percentile 75, 17.4–28.3) years. Individuals with middle age–onset diabetes had a significantly higher lifetime risk of dementia than those with older-onset diabetes (36.0% vs. 31.0%). Compared with those with no diabetes, participants with middle age–onset diabetes also had a higher cumulative incidence of dementia by age 80 years (16.1% vs. 9.4%), but a lower lifetime risk (36.0% vs. 45.6%) due to shorter survival. Individuals with middle age–onset diabetes developed dementia 4 and 1 years earlier than those without diabetes and those with older-onset diabetes, respectively. CONCLUSIONS Preventing or delaying diabetes may be an important approach for reducing dementia risk throughout the life course.

中文翻译：

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糖尿病诊断年龄和痴呆症终生风险：社区动脉粥样硬化风险 （ARIC） 研究


目的 糖尿病诊断年龄对整个生命历程中痴呆风险的影响特征不佳。我们按糖尿病诊断年龄估计了痴呆的终生风险。研究设计和方法 我们纳入了来自社区动脉粥样硬化风险研究的 13,087 名参与者，他们在 60 岁时没有痴呆。我们将受试者分为患有中年发病的糖尿病（诊断<60 岁）、老年发病的糖尿病（诊断 60-69 岁）或无糖尿病。通过裁决和主动监测确定事件痴呆。我们使用累积发生函数估计器按糖尿病诊断年龄描述痴呆的终生风险，同时考虑竞争性的死亡风险。我们使用限制性平均生存时间来计算没有和有痴呆的寿命。结果 在 13,087 名参与者中，有 2,982 名痴呆患者和 4,662 名无痴呆死亡，中位随访时间为 24.1 年（百分位数 25-百分位数 75,17.4-28.3）。中年发病糖尿病患者患痴呆的终生风险显著高于老年糖尿病患者（36.0% 对 31.0%）。与无糖尿病患者相比，中年糖尿病患者到80岁时痴呆的累积发病率也较高（16.1%对9.4%），但由于生存期较短，终生风险较低（36.0%对45.6%）。中年发病糖尿病患者分别比无糖尿病患者和老年糖尿病患者早 4 年和 1 年发生痴呆。结论 预防或延缓糖尿病可能是降低整个生命过程中痴呆风险的重要方法。