Endocrinology Department, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
Geriatric Therapy and Internal Medicine Department, hôpital Saint-Julien, CHU de Rouen, 76031 Rouen cedex, France.
Diabetes Metab. 2014 Nov;40(5):331-7. doi: 10.1016/j.diabet.2014.02.002. Epub 2014 Apr 2.
This article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people.
The number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies.
Clinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.
本文更新了 2 型糖尿病（T2D）、老年人认知功能障碍和痴呆之间的关系。
由于整个人口的预期寿命延长，以及根据多项研究，老年糖尿病患者认知障碍和痴呆的风险增加，因糖尿病就诊的老年患者中出现认知困难的人数持续增加。许多研究表明，糖尿病患者血糖控制不佳与认知功能恶化之间存在关联。严重低血糖发作史也与 T2D 患者晚年认知缺陷和痴呆的风险增加相关。一些研究认为，有几个过程可导致糖尿病患者认知能力下降和痴呆。基于临床和非临床发现，最有可能改变大脑功能和结构的因素是糖尿病的脑血管并发症、葡萄糖和胰岛素的改变以及反复发生的低血糖。与其他糖尿病并发症一起，认知缺陷导致功能障碍、抑郁相关症状的频率增加、反复低血糖的发生率增加、治疗依从性较差，最后是预后较差，最近的纵向研究证实了这一点。
最近为老年糖尿病患者制定了临床指南，特别是那些有认知缺陷和自我管理能力下降的患者。对于最脆弱的患者，提出了特定的血糖控制治疗策略，以限制代谢失代偿和避免低血糖风险。根据患者的认知和功能状态，还调整了以保持患者自主性和避免住院为主要目的的教育措施。
