Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications.
Cognitive decline and dementia in diabetes mellitus: mechanisms and clinical implications.
复制标题
糖尿病的认知下降和痴呆症：机制和临床意义。
DOI：
10.1038/s41574-018-0048-7
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发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Despa F
中科院分区：
文献类型：
--
作者：
Biessels GJ;Despa F
认知功能障碍日益被认为是糖尿病的重要共病。糖尿病相关认知功能障碍的不同阶段可以被区分开来，具有不同的认知特征、受影响的年龄组、预后，可能还有不同的潜在机制。所有年龄段的人都会出现相对微妙、缓慢进行性的认知减退。更严重的阶段，特别是轻度认知障碍和痴呆症，伴随进行性缺陷，主要发生在老年人身上。后者显然与患者管理最为相关，也是本综述的重点。从风险因素、脑成像和神经病理学的研究中获得的不断发展的见解为机制提供了重要线索。在大多数患者中，多种病因可能决定了认知表型。尽管临床诊断的阿尔茨海默病和血管性痴呆症的风险都与糖尿病相关，但典型的阿尔茨海默病的大脑负担并不是这样。因此，一个主要的挑战是从糖尿病相关疾病的谱系中找出那些影响大脑并促进阿尔茨海默氏病以外的痴呆症发展的因素。来自实验模型的观察有助于应对这一挑战，但这需要进一步提高实验科学家和临床科学家之间的协同作用。制定有针对性的治疗和预防战略有赖于这些转化努力。
Cognitive dysfunction is increasingly recognized as an important comorbidity of diabetes mellitus. Different stages of diabetes-associated cognitive dysfunction can be discerned, with different cognitive features, affected age groups, prognosis, and likely also different underlying mechanisms. Relatively subtle, slowly progressive cognitive decrements occur in all age groups. More severe stages, particularly mild cognitive impairment and dementia, with progressive deficits, occur primarily in older individuals. The latter are clearly most relevant for patient management and are the focus of this review. Evolving insights from studies on risk factors, brain imaging, and neuropathology provide important clues on mechanisms. In the majority of patients multiple etiologies likely determine the cognitive phenotype. Although both the risk of -clinically diagnosed- Alzheimer’s disease and that of vascular dementia is increased in association with diabetes, the cerebral burden of the prototypical Alzheimer’s pathologies is not. A major challenge is therefore to pinpoint from the spectrum of diabetes-related disease processes those that affect the brain and contribute to development of dementia beyond Alzheimer’s pathologies. Observations from experimental models can help to meet that challenge, but this requires further improving the synergy between experimental and clinical scientists. Development of targeted treatment and preventive strategies depends on these translational efforts.
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DOI：
10.1038/nrneurol.2017.185
发表时间：
2018-03
期刊：
Nature reviews. Neurology
影响因子：
--
作者：
Arnold SE;Arvanitakis Z;Macauley-Rambach SL;Koenig AM;Wang HY;Ahima RS;Craft S;Gandy S;Buettner C;Stoeckel LE;Holtzman DM;Nathan DM
通讯作者：
Nathan DM
影响因子：
20.1
作者：
Beckman, Joshua A.;Creager, Mark A.
通讯作者：
Creager, Mark A.
影响因子：
9.3
作者：
de Bruijn RF;Bos MJ;Portegies ML;Hofman A;Franco OH;Koudstaal PJ;Ikram MA
通讯作者：
Ikram MA
影响因子：
4.2
作者：
Biessels, GJ;Gispen, WH
通讯作者：
Gispen, WH
影响因子：
6.3
作者：
Bouvy, Willem H.;Zwanenburg, Jaco J. M.;Biessels, Geert Jan
通讯作者：
Biessels, Geert Jan