Hamed Sherifa A
a Department of Neurology and Psychiatry , Assiut University Hospital , Assiut , Egypt.
Expert Rev Clin Pharmacol. 2017 Apr;10(4):409-428. doi: 10.1080/17512433.2017.1293521. Epub 2017 Feb 22.
Diabetes mellitus is a risk for brain injury. Brain injury is associated with acute and chronic hyperglycaemia, insulin resistance, hyperinsulinemia, diabetic ketoacidosis (DKA) and hypoglycaemic events in diabetic patients. Hyperglycemia is a cause of cognitive deterioration, low intelligent quotient, neurodegeneration, brain aging, brain atrophy and dementia. Areas covered: The current review highlights the experimental, clinical, neuroimaging and neuropathological evidence of brain injury induced by diabetes and its associated metabolic derangements. It also highlights the mechanisms of diabetes-induced brain injury. It seems that the pathogenesis of hyperglycemia-induced brain injury is complex and includes combination of vascular disease, oxidative stress, neuroinflammation, mitochondrial dysfunction, apoptosis, reduction of neurotrophic factors, acetylcholinesterase (AChE) activation, neurotransmitters' changes, impairment of brain repair processes, impairment of brain glymphatic system, accumulation of amyloid β and tau phosphorylation and neurodegeneration. The potentials for prevention and treatment are also discussed. Expert commentary: We summarize the risks and the possible mechanisms of DM-induced brain injury and recommend strategies for neuroprotection and neurorestoration. Recently, a number of drugs and substances [in addition to insulin and its mimics] have shown promising potentials against diabetes-induced brain injury. These include: antioxidants, neuroinflammation inhibitors, anti-apoptotics, neurotrophic factors, AChE inhibitors, mitochondrial function modifiers and cell based therapies.
糖尿病是脑损伤的一个风险因素。脑损伤与糖尿病患者的急性和慢性高血糖、胰岛素抵抗、高胰岛素血症、糖尿病酮症酸中毒（DKA）及低血糖事件相关。高血糖是认知功能衰退、低智商、神经退行性变、脑老化、脑萎缩及痴呆的一个病因。涵盖领域：本综述重点介绍了糖尿病及其相关代谢紊乱所致脑损伤的实验、临床、神经影像学及神经病理学证据。还重点介绍了糖尿病性脑损伤的机制。高血糖所致脑损伤的发病机制似乎很复杂，包括血管疾病、氧化应激、神经炎症、线粒体功能障碍、细胞凋亡、神经营养因子减少、乙酰胆碱酯酶（AChE）激活、神经递质变化、脑修复过程受损、脑类淋巴系统受损、β-淀粉样蛋白积聚、tau蛋白磷酸化及神经退行性变等因素的综合作用。还讨论了预防和治疗的潜力。专家评论：我们总结了糖尿病性脑损伤的风险及可能机制，并推荐了神经保护和神经修复策略。最近，一些药物和物质[除胰岛素及其类似物外]已显示出对抗糖尿病性脑损伤的潜在前景。这些包括：抗氧化剂、神经炎症抑制剂、抗凋亡剂、神经营养因子、AChE抑制剂、线粒体功能调节剂及基于细胞的疗法。
