Biessels Geert Jan, Staekenborg Salka, Brunner Eric, Brayne Carol, Scheltens Philip
Department of Neurology, Rudolf Magnus Institute of Neurosciences, University Medical Center Utrecht, Netherlands.
Lancet Neurol. 2006 Jan;5(1):64-74. doi: 10.1016/S1474-4422(05)70284-2.
The relation between diabetes and major types of dementia is controversial. This systematic review examines the incidence of dementia in people with diabetes mellitus. We identified 14 eligible longitudinal population-based studies of variable methodological quality. The incidence of "any dementia" was higher in individuals with diabetes than in those without diabetes in seven of ten studies reporting this aggregate outcome. This high risk included both Alzheimer's disease and vascular dementia (eight of 13 studies and six of nine studies respectively). Detailed data on modulating and mediating effects of glycaemic control, microvascular complications, and comorbidity (eg, hypertension and stroke) were generally absent. The findings of mechanistic studies suggest that vascular disease and alterations in glucose, insulin, and amyloid metabolism underlie the pathophysiology, but which of these mechanisms are clinically relevant is unclear. Further high quality studies need to be initiated, with objective diabetes assessment, together with reliable methods to establish the contribution of vascular disease and other comorbidity to dementia.
糖尿病与主要类型痴呆症之间的关系存在争议。本系统评价研究了糖尿病患者中痴呆症的发病率。我们确定了14项符合条件的基于人群的纵向研究，这些研究方法学质量各异。在报告这一总体结果的十项研究中的七项中，糖尿病患者中“任何痴呆症”的发病率高于非糖尿病患者。这种高风险包括阿尔茨海默病和血管性痴呆（分别在13项研究中的8项和9项研究中的6项）。关于血糖控制、微血管并发症和合并症（如高血压和中风）的调节和中介作用的详细数据普遍缺乏。机制研究结果表明，血管疾病以及葡萄糖、胰岛素和淀粉样蛋白代谢的改变是病理生理学的基础，但这些机制中哪些在临床上具有相关性尚不清楚。需要开展进一步的高质量研究，采用客观的糖尿病评估方法，以及可靠的方法来确定血管疾病和其他合并症对痴呆症的影响。
