psychiatryПСИХИАТРИЯPsychiatry (Moscow) (Psikhiatriya)1683-83192618-6667FSBSI “The Mental Health Research Centre”; LLC «Publisher «MIA»2618-6667-2018-77-51-59psychiatry-317Research ArticleНАУЧНЫЕ ОБЗОРЫSCIENTIFIC REVIEWSКогнитивные нарушения при сахарном диабетеCognitive impairment in diabetesЛевинОлег СеменовичLevinOleg

доктор медицинских наук, профессор

neurolev@mail.ruЧимагомедоваАчча ШахбулатовнаChimagomedovaAchcha

postgraduate student

achcha5@mail.ruРоссийская медицинская академия непрерывного профессионального образования, МоскваРоссияRussian Medical Academy of Continuous Professional Education, MoscowRussian Federation2018311020181775159Copyright © Левин О.С., Чимагомедова А.Ш., 20182018Левин О.С., Чимагомедова А.Ш.Levin O., Chimagomedova A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.journalpsychiatry.com/jour/article/view/317

Обоснование. Сахарный диабет (СД) — одно из самых частых хронических заболеваний человека, поражающее до 10% населения. Риск развития деменции у пациентов с СД повышается в среднем в 1,6 раза, при этом риск развития сосудистой деменции возрастает в 2–2,6 раза, а риск развития болезни Альцгеймера (БА) — примерно в 1,5 раза, независимо от возраста начала СД. Цель: представить обзор научных публикаций о роли гипергликемии в развитии когнитивной дисфункции. Результаты: анализ современных работ показал, что непосредственно с гипергликемией удается связать лишь умеренный, преимущественно нейродинамический, когнитивный дефицит. По-видимому, более важное значение в развитии когнитивного снижения может играть цереброваскулярная или нейродегенеративная патология, ускоряемая метаболическими расстройствами, характерными для СД, а также гипогликемические эпизоды. Параллелизм в развитии СД и БА во многом объясняется нарушением функции инсулина. Снижение с возрастом концентрации инсулина и численности инсулиновых рецепторов в мозге частично объясняет возрастную когнитивную дисфункцию. Терапия, одновременно направленная на несколько ключевых патофизиологических звеньев развития диабетической энцефалопатии (ДЭ), по-видимому, является наиболее перспективной. Она может включать комбинацию препаратов, действующих на разные терапевтические мишени, либо те немногие многокомпонентные препараты, которые способны влиять сразу на несколько мишеней. Вывод: современные представления о патогенезе когнитивных нарушений при СД определяют комплексное терапевтическое вмешательство.

Background. Diabetes mellitus is one of the most frequent chronic diseases, affecting up to 10% of the population. The risk of dementia in patients with diabetes increases by an average of 1,6 times, with the risk of vascular dementia 2–2,6 times, and the risk of Alzheimer’s disease (AD) — about 1,5 times, regardless of age diabetes onset. The aim was to review scientifc publications on the role of hyperglycemia in the development of cognitive dysfunction. Results: on shown that only a moderate, predominantly neurodynamic cognitive defcit can be associated with it. Apparently cerebrovascular or neurodegenerative pathology, accelerated by metabolic disorders in diabetes, and hypoglycemic episodes, can play a more important role in the development of cognitive decline. A parallelism in the development of diabetes and AD is largely explained by insulin dysfunction. The decrease with age of insulin concentration and the number of insulin receptors in the brain partially explains the age-related cognitive dysfunction. Therapy, simultaneously directed to several key pathophysiological links in the development of diabetic encephalopathy, appears to be the most promising. It can include a combination of drugs acting on different therapeutic targets, or those few multicomponent drugs that can directly affect several targets. Conclusion: current conceptions of diabetes pathogenesis determine complex therapeutical intervention.

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The authors declare that there are no conflicts of interest present.