Kouta Yoshiyuki, Sakurai Takashi, Yokono Koichi
Department of Internal and Geriatric Medicine, Kobe University Graduate School of Medicine.
Nihon Rinsho. 2006 Jan;64(1):119-23.
Diabetes mellitus and cognitive decline are major public health concerns among the elderly. In diabetic subjects without dementia, certain cognitive domains are impaired, such as memory, attention, and executive/frontal lobe function (diabetic cognitive dysfunction). Recent epidemiological studies have suggested that diabetes increases the risks for vascular dementia as well as Alzheimer's disease. There are accumulating evidences that indicate biological linkage between impaired brain glucose metabolism homeostasis and cognitive decline. Diabetes may cause serious brain damages through several mechanisms and induce a variety of cognitive decline. Most critical issue to be resolved is to identify the mechanism of dementia leading from diabetic cognitive dysfunction. Once elderly diabetics had severe cognitive decline, effective treatment of diabetes were hardly obtained. Thus, diabetic cognitive decline should be considered as an important comorbidity of the elderly diabetes and long-term management of hyperglycemia is required from a view point to sustain healthy brain function. In this short review, we are summarizing the clinical features and current biological findings of diabetic cognitive decline. Also, we introduce the comprehensive treatment of demented diabetic elderly, including therapeutic strategy, nursing and care.
糖尿病和认知功能减退是老年人面临的主要公共卫生问题。在没有痴呆症的糖尿病患者中，某些认知领域会受到损害，如记忆、注意力和执行/额叶功能（糖尿病认知功能障碍）。最近的流行病学研究表明，糖尿病会增加患血管性痴呆和阿尔茨海默病的风险。越来越多的证据表明，大脑葡萄糖代谢稳态受损与认知功能减退之间存在生物学联系。糖尿病可能通过多种机制导致严重的脑损伤，并引发各种认知功能减退。亟待解决的最关键问题是确定从糖尿病认知功能障碍发展为痴呆症的机制。一旦老年糖尿病患者出现严重的认知功能减退，就很难获得有效的糖尿病治疗。因此，糖尿病认知功能减退应被视为老年糖尿病的一种重要合并症，从维持健康脑功能的角度来看，需要对高血糖进行长期管理。在这篇简短的综述中，我们总结了糖尿病认知功能减退的临床特征和当前的生物学研究结果。此外，我们还介绍了对患有痴呆症的老年糖尿病患者的综合治疗，包括治疗策略、护理和照料。
