Cognitive impairment in diabetes
https://doi.org/2618-6667-2018-77-51-59
Abstract
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.
About the Authors
Oleg Levin
Russian Medical Academy of Continuous Professional Education, Moscow
Russian Federation
PhD, MD, professor
Russian Federation
PhD, MD, professor
Achcha Chimagomedova
Russian Medical Academy of Continuous Professional Education, Moscow
Russian Federation
postgraduate student
Russian Federation
postgraduate student
References
1. Ametov A.S. Sakharnyi diabet 2-go tipa. Osnovy patogeneza i terapii. M.; 2003. (In Russ.).
2. Dedov, I.I., Shestakova, M.V. Sakharnyi diabet. M.; 2003. (In Russ.)
3. Levin O.S. Diagnostika i lechenie dementsii v klinicheskoi praktike. M.: Medpress-inform; 2009. (In Russ.).
4. Biessels G.J., Staekenborg S., Brunner E., Brayne C., Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006;5:64–74.doi: 10.1016/S1474-4422(05)70284-2
5. Craft S. The role of metabolic disorders in Alzheimer disease and vascular dementia. Arch. Neurol. 2009;66:300–305. doi: 10.1001/ archneurol.2009.27
6. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group, Jacobson A.M., Musen G., Ryan C.M., Silvers N., Cleary P., Waberski B., Burwood A., Weinger K., Bayless M., Dahms W., Harth J. Long-term effect of diabetes and its treatment on cognitive function. New Engl. J. Med. 2007;356:1842–1852. doi: 10.1056/NEJMoa066397
7. Mijnhout G.S., Scheltens P., Diamant M., Biessels G.J., Wessels A.M., Simsek S., Snoek F.J., Heine R.J. Diabetic encephalopathy: a concept in need of a definition. Diabetologia. 006;49:1447–1448. doi: 10.1007/s00125-006-0221-8
8. Irie F., Fitzpatrick A.L., Lopez O.L. Enhanced risk for Alzheimer disease in persons with type 2 diabetes and APOE-4. Arch. Neurol. 2008;65:89–93. doi: 10.1001/archneurol.2007.29
9. Kalaria R.N. Diabetes, microvascular pathology and Alzheimer disease. Nature Rev. Neurology. 2009;5:305–306. doi: 10.1038/nrneurol.2009.72
10. Luchsinger J.A., Tang M.X., Stern Y., Shea S., Mayeux R. Diabetes mellitus and risk of dementia in a multiethnic cohort. Am. J. Epidemiol. 2001;154:635–641.
11. Sonnen J.A., Larson E.B., Brickell K., Crane P.K., Woltjer R., Montine T.J., Craft S. Different patterns of cerebral injury in dementia with or without diabetes. Arch. Neurol. 2009;66:315–322. doi: 10.1001/archneurol.2008.579
12. Whitmer R.A., Karter A.J., Yaffe K., Quesenberry C.P. Jr., Selby J.V. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA. 2009;301:1565–1572. doi: 10.1001/ jama.2009.460
13. van Harten B., Oosterman J., Muslimovic D., van Loon B.J., Scheltens P., Weinstein H.C. Cognitive impairment MRI correlates in the elderly patients with type 2 diabetes mellitus. Age and aging. 2007;36:164–170. doi: 10.1093/ageing/afl180
14. Barrett E.J., Liu Z., Khamaisi M. Diabetic microvascular disease: an Endocrine Society Scientific Statement. J. Clin. Endocrinol. Metab. 2017;102(12):4343–4410. doi: 10.1210/jc.2017-01922
15. Nelson P.T., Smith C.D., Abner E.A., Schmitt F.A., Scheff S.W., Davis G.J., Keller J.N., Jicha G.A., Davis D., Wang-Xia W., Hartman A., Katz D.G., Markesbery W.R. Human cerebral neuropathology of type 2 diabetes mellitus. Biochim. Biophys. Acta. 2008;1792:454–469. doi: 10.1016/j.bbadis.2008.08.005
16. Strachan M.W.J., Reynolds R.M., Frier B.M. The relationship between type 2 diabetes and dementia. British Medical Bulletin. 2008;88:131–146. doi: 10.1093/bmb/ldn042
17. MacKnight C., Rockwood K., Awalt E., McDowell I. Diabetes mellitus and the risk of Alzheimer’s disease and vascular cognitive impairment in the Canadian Study of Health and Aging. Dement. Geriatr. Cogn. Disord. 2002;14:77–83. doi: 10.1159/000064928
18. Alafuzoff I., Aho L., Helisalmi S., Mannermaa A., Soininen H. β-amyloid deposition in brains of subjects with diabetes. Neuropathol. Appl. Neurobiol. 2009;35:60–68. doi: 10.1111/j.1365-2990.2008.00948.x
19. Musicco M., Palmer K., Salamone G., Lupo F., Perri R., Mosti S., Spalletta G., di Lulio F., Pettenati C., Cravello L., Caltagirone C. Predictors of progression of cognitive decline in Alzheimer’s disease: the role of vascular and sociodemographic factors. J. Neurol. 2009;256:1288– 1295. doi: 10.1007/s00415-009-5116-4
20. Kalaria R.N. The pathology and pathophysiology of vascular dementia. Neuropharmacology. 2017. pii: S0028-3908(17)30627-5. doi: 10.1016/j.neuropharm.2017.12.030
21. Levin O.S. Osnovnye lekarstvennye sredstva, primenyaemye v nevrologii. M.: Medpress-inform; 2009. (In Russ.).
22. Ott V., Benedict C., Schultes B., Born J., Hallschmid M. Intranasal ad- ministration of insulin to the brain impacts cognitive function and peripheral metabolism. Diabetes Obes. Metab. 2012;14(3):214–221. doi: 10.1111/j.1463-1326.2011.01490.x
23. Zhang Y.W., Zhang J.Q., Liu C., Wei P., Zhang X., Yuan Q.Y., Yin X.T., Wei L.Q., Cui J.G., Wang J. Memory dysfunction in type 2 diabetes mellitus correlates with reduced hippocampal CA1 and subiculum volumes. Chin. Med. J. (Engl). 2015;128(4):465–471. doi: 10.4103/0366-6999.151082
24. van der Flier W.M., Skoog I., Schneider J.A., Pantoni L., Mok V., Chen C.L.H., Scheltens P. Vascular cognitive impairment. Nat. Rev. Dis. Primers. 2018;4:18003. doi: 10.1038/nrdp.2018.3
25. Stewart R., Liolitsa D. Type 2 diabetes mellitus, cognitive impair- ment and dementia. Diabet. Med. 1999;16(2):93–112.
26. Li W., Huang E. An update on type 2 diabetes mellitus as a risk factor for dementia. J. Alzheimers. Dis. 2016;53(2):393–402. doi: 10.3233/ JAD-160114
27. Riederer P., Korczyn A.D., Ali S.S., Bajenaru O., Choi M.S., Chopp M., Dermanovic-Dobrota V., Grünblatt E., Jellinger K.A., Kamal M.A., Kamal W., Leszek J., Sheldrick-Michel T.M., Mushtaq G., Meglic B., Natovich R., Pirtosek Z., Rakusa M., Salkovic-Petrisic M., Schmidt R., Schmitt A., Sridhar G.R., Vécsei L., Wojszel Z.B., Yaman H., Zhang Z.G., Cukierman-Yaffe T. The diabetic brain and cognition. J. Neural. Transm. (Vienna). 2017;124(11):1431–1454. doi: 10.1007/s00702-017-1763-2
28. Einhorn D., Fonseca V. Revisiting the use of pioglitazone in the treatment of type 2 diabetes. Endocr. Pract. 2016;22(11):1343–1346. doi: 10.4158/EP161409.CO
29. Sigala S., Imperato A., Rizzonelli P., Casolini P., Missale C., Spano P. L-alpha-glycerylphosphorylcholine antagonizes scopolamine-induced amnesia and enhances hippocampal cholinergic transmission in the rat. Eur. J. Pharmacol. 1992;211(3):351–358.
30. Tousoulis D., Simopoulou C., Papageorgiou N., Oikonomou E., Hatzis G., Siasos G., Tsiamis E., Stefanadis C. Endothelial dysfunction in conduit arteries and in microcirculation. Novel therapeutic approaches. Pharmacol. Ther. 2014;144(3):253–267. doi: 10.1016/j. pharmthera.2014.06.003.
Review
For citations:
Levin O., Chimagomedova A. Cognitive impairment in diabetes. Psychiatry (Moscow) (Psikhiatriya). 2018;1(77):51-59. (In Russ.) https://doi.org/2618-6667-2018-77-51-59
Views:
1600
Email this article 
