Department of Hypertension and Diabetology, Medical University of Gdańsk, Faculty of Medicine, Gdańsk, Poland.
Department of Adult Neurology, Medical University of Gdańsk, Faculty of Medicine, Gdańsk, Poland.
J Clin Endocrinol Metab. 2019 Jun 1;104(6):2239-2249. doi: 10.1210/jc.2018-01315.
We have summarized key studies assessing the epidemiology, mechanisms, and consequences of cognitive dysfunction (CD) in type 1 diabetes.
In a number of studies, the severity of CD in type 1 diabetes was affected by the age of onset and duration, and the presence of proliferative retinopathy and autonomic neuropathy. Diabetes-related CD has been observed, not only in adults, but also in children and adolescents. Most neuroimaging studies of patients with type 1 diabetes did not show any differences in whole brain volumes; however, they did reveal selective deficits in gray matter volume or density within the frontal, posterior, and temporal cortex and subcortical gray matter. Studies of middle-age adults with long-standing type 1 diabetes using diffusion tensor imaging have demonstrated partial lesions in the white matter and decreased fractional anisotropy in posterior brain regions. The mechanisms underlying diabetes-related CD are very complex and include factors related to diabetes per se and to diabetes-related cardiovascular disease and microvascular dysfunction, including chronic hyperglycemia, hypoglycemia, macro- and microvascular disease, and increased inflammatory cytokine expression. These mechanisms might contribute to the development and progression of both vascular dementia and Alzheimer disease.
Higher rates of CD and faster progression in type 1 diabetes can be explained by both the direct effects of altered glucose metabolism on the brain and diabetes-related cardiovascular disease. Because the presence and progression of CD significantly worsens the quality of life of patients with diabetes, further multidisciplinary studies incorporating the recent progress in both neuroimaging and type 1 diabetes management are warranted to investigate this problem.
我们总结了评估 1 型糖尿病认知功能障碍（CD）的流行病学、机制和后果的关键研究。
在一些研究中，1 型糖尿病患者 CD 的严重程度受发病年龄、病程、增殖性视网膜病变和自主神经病变的影响。糖尿病相关的 CD 不仅发生在成年人中，也发生在儿童和青少年中。大多数 1 型糖尿病患者的神经影像学研究并未显示全脑体积有任何差异；然而，它们确实显示了额、后和颞皮质以及皮质下灰质的灰质体积或密度存在选择性缺陷。使用弥散张量成像对长期 1 型糖尿病的中年成年人进行的研究表明，在后脑区域存在白质部分损伤和部分各向异性分数降低。糖尿病相关 CD 的发病机制非常复杂，包括与糖尿病本身以及与糖尿病相关的心血管疾病和微血管功能障碍相关的因素，包括慢性高血糖、低血糖、大血管和微血管疾病以及促炎细胞因子表达增加。这些机制可能导致血管性痴呆和阿尔茨海默病的发生和发展。
1 型糖尿病患者认知功能障碍的发生率更高且进展更快，这可以用葡萄糖代谢对大脑的直接影响以及与糖尿病相关的心血管疾病来解释。由于 CD 的存在和进展显著恶化了糖尿病患者的生活质量，因此需要进一步进行多学科研究，将神经影像学和 1 型糖尿病管理的最新进展纳入其中，以研究这一问题。
