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[糖尿病患者认知功能的变化]

[Changes in cognitive function in patients with diabetes mellitus].

作者信息

Szémán Barbara, Nagy Géza, Varga Tímea, Veres-Székely Anna, Sasvári Mária, Fitala Dávid, Szollosi Adrienn, Katonai Rózsa, Kotyuk Eszter, Somogyi Anikó

机构信息

Semmelweis Egyetem, Általános Orvostudományi Kar II. Belgyógyászati Klinika Budapest Szentkirályi u.

出版信息

Orv Hetil. 2012 Mar 4;153(9):323-9. doi: 10.1556/OH.2012.29319.

Abstract

Patients with diabetes are approximately 1.5 times more likely to experience cognitive decline than individuals without diabetes mellitus. Most of the data suggest that patients with diabetes have reduced performance in numerous domains of cognitive function. In patients with type 1 diabetes, specific and global deficits involving speed of psychomotor efficiency, information processing, mental flexibility, attention, and visual perception seem to be present, while in patients with type 2 diabetes an increase in memory deficits, a reduction in psychomotor speed, and reduced frontal lobe (executive) functions have been found. The complex pathophysiology of changes in the central nervous system in diabetes has not yet been fully elucidated. It is important to consider the patient's age at the onset of diabetes, the glycemic control status, and the presence of diabetic complications. Neurological consequences of diabetes appear parallel to those observed in the aging brain. Neuroimaging studies highlight several structural cerebral changes, cortical and subcortical atrophy, beside increased leukoaraiosis that occurs in association with diabetes. There is supporting evidence from many hypotheses to explain the pathophysiology of cognitive decline associated with diabetes. The main hypotheses pointing to the potential, implied mechanisms involve hyperglycemia, hypoglycemia, microvascular disease, insulin resistance, hyperinsulinism, hyperphosphorylation of tau protein, and amyloid-β deposition.

摘要

糖尿病患者出现认知功能下降的可能性约为非糖尿病患者的1.5倍。大多数数据表明,糖尿病患者在认知功能的多个领域表现较差。在1型糖尿病患者中,似乎存在涉及精神运动效率速度、信息处理、心理灵活性、注意力和视觉感知的特定和整体缺陷,而在2型糖尿病患者中,已发现记忆缺陷增加、精神运动速度降低和额叶(执行)功能减退。糖尿病中枢神经系统变化的复杂病理生理学尚未完全阐明。考虑糖尿病发病时患者的年龄、血糖控制状况以及糖尿病并发症的存在很重要。糖尿病的神经学后果似乎与在衰老大脑中观察到的后果相似。神经影像学研究突出了几种脑部结构变化,除了与糖尿病相关的白质疏松增加外,还有皮质和皮质下萎缩。有许多假说的支持证据来解释与糖尿病相关的认知功能下降的病理生理学。指向潜在隐含机制的主要假说涉及高血糖、低血糖、微血管疾病、胰岛素抵抗、高胰岛素血症、tau蛋白过度磷酸化和淀粉样β蛋白沉积。

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