Zhao Xue, Han Qing, Lv You, Sun Lin, Gang Xiaokun, Wang Guixia
Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, 130021, Jilin Province, China.
Hospital of Orthopedics, The Second Hospital of Jilin University, Changchun, 130021, Jilin Province, China.
Oncotarget. 2017 Dec 14;9(7):7710-7726. doi: 10.18632/oncotarget.23284. eCollection 2018 Jan 26.
Diabetes mellitus is considered as an important factor for cognitive decline and dementia in recent years. However, cognitive impairment in diabetic patients is often underestimated and kept undiagnosed, leading to thousands of diabetic patients suffering from worsening memory. Available reviews in this field were limited and not comprehensive enough. Thus, the present review aimed to summarize all available clinical studies on diabetic patients with cognitive decline, and to find valuable biomarkers that might be applied as diagnostic and therapeutic targets of cognitive impairment in diabetes. The biomarkers or risk factors of cognitive decline in diabetic patients could be classified into the following three aspects: serum molecules or relevant complications, functional or metabolic changes by neuroimaging tools, and genetic variants. Specifically, factors related to poor glucose metabolism, insulin resistance, inflammation, comorbid depression, micro-/macrovascular complications, adipokines, neurotrophic molecules and Tau protein presented significant changes in diabetic patients with cognitive decline. Besides, neuroimaging platform could provide more clues on the structural, functional and metabolic changes during the cognitive decline progression of diabetic patients. Genetic factors related to cognitive decline showed inconsistency based on the limited studies. Future studies might apply above biomarkers as diagnostic and treatment targets in a large population, and regulation of these parameters might shed light on a more valuable, sensitive and specific strategy for the diagnosis and treatment of cognitive decline in diabetic patients.
近年来，糖尿病被认为是认知功能下降和痴呆的一个重要因素。然而，糖尿病患者的认知障碍常常被低估且未得到诊断，导致成千上万的糖尿病患者记忆力恶化。该领域现有的综述有限且不够全面。因此，本综述旨在总结所有关于糖尿病伴认知功能下降患者的临床研究，并寻找可能作为糖尿病认知障碍诊断和治疗靶点的有价值生物标志物。糖尿病患者认知功能下降的生物标志物或危险因素可分为以下三个方面：血清分子或相关并发症、神经影像学工具检测的功能或代谢变化以及基因变异。具体而言，与糖代谢不良、胰岛素抵抗、炎症、共病抑郁、微血管/大血管并发症、脂肪因子、神经营养分子和 Tau 蛋白相关的因素在糖尿病伴认知功能下降患者中呈现出显著变化。此外，神经影像学平台可以为糖尿病患者认知功能下降过程中的结构、功能和代谢变化提供更多线索。基于有限的研究，与认知功能下降相关的遗传因素表现出不一致性。未来的研究可能会将上述生物标志物应用于大规模人群的诊断和治疗靶点，对这些参数的调控可能会为糖尿病患者认知功能下降的诊断和治疗提供更有价值、更敏感和特异的策略。
