Geriatric Unit and Gerontology-Geriatrics Research Laboratory, Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy.
J Alzheimers Dis. 2012;30 Suppl 2:S31-75. doi: 10.3233/JAD-2012-111496.
In the last decade, cumulative epidemiological evidence suggested that vascular- and metabolic-based risk factors may be important in the development of mild cognitive impairment and dementia. Epidemiological and basic research have also proposed a model of cognitive impairment linked to metabolic syndrome (MetS) and metabolic disorders, suggesting for research purposes a "metabolic-cognitive syndrome" (MCS) in patients with MetS plus cognitive impairment of degenerative or vascular origin. In particular, MetS has been associated with the risk of age-related cognitive decline and vascular dementia, but contrasting findings also existed on the possible role of MetS in overall dementia and Alzheimer's disease. Among metabolic determinants of cognitive impairment, a better approach to the understanding of mechanisms could be to hypothesize a continuum leading to various degrees of late-life cognitive disorders in older subjects with metabolic-based risk factors. The MCS model could help us to explain the complex relationship between metabolic disorders and cognitive disturbances and the boundaries between normal and pathological conditions, with a better understanding of clinical and neuropathological features of these metabolic-based cognitive disorders. Strategies toward early and effective risk factor management could be of value in reducing the risk of MCS, so delaying the onset or preventing the progression of predementia syndromes. In the near future, clinical trials could be undertaken to determine if addressing MetS and metabolic-based risk factors, including inflammation, through lifestyle modification holds out the possibility of slowing down or ameliorating the cognitive aging process itself.
在过去的十年中，累积的流行病学证据表明，血管和代谢相关的危险因素可能在轻度认知障碍和痴呆的发展中起重要作用。流行病学和基础研究还提出了一种与代谢综合征（MetS）和代谢紊乱相关的认知障碍模型，这表明在患有 MetS 且认知障碍具有退行性或血管性起源的患者中，存在一种“代谢-认知综合征”（MCS）。特别是，MetS 与年龄相关性认知能力下降和血管性痴呆的风险相关，但关于 MetS 在总体痴呆和阿尔茨海默病中可能发挥的作用，也存在相互矛盾的发现。在认知障碍的代谢决定因素中，更好地理解机制的方法可能是假设存在一个连续体，该连续体可导致具有代谢风险因素的老年受试者出现不同程度的迟发性认知障碍。MCS 模型可以帮助我们解释代谢紊乱和认知障碍之间的复杂关系，以及正常和病理条件之间的界限，从而更好地了解这些基于代谢的认知障碍的临床和神经病理学特征。采取早期和有效的危险因素管理策略可能有助于降低 MCS 的风险，从而延缓前驱综合征的发生或阻止其进展。在不久的将来，可以进行临床试验，以确定通过生活方式改变来解决 MetS 和基于代谢的危险因素（包括炎症）是否有可能减缓或改善认知老化过程本身。
