Calsolaro Valeria, Bottari Marina, Coppini Giulia, Lemmi Bianca, Monzani Fabio
Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy.
Geriatrics Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Pisa, Italy -
Minerva Endocrinol (Torino). 2021 Sep;46(3):335-349. doi: 10.23736/S2724-6507.20.03295-2. Epub 2021 Jan 12.
Dementia is a highly prevalent chronic disease among the older population, affecting more than 50 million people worldwide and representing a huge healthcare, social and economic burden. Dementia, and in particular Alzheimer's disease, prevalence is expected to raise within the next few years. Unfortunately, no disease-modifying therapies are available so far, despite a plethora of clinical trials targeting the hallmarks of Alzheimer's disease. Given these premises, it appears crucial to address not only the neuropathological correlates of the disease, but also the modifiable risk factors. Among them, evidence suggest a role of the endocrine system not only in the brain development, but also in the maintenance of its health, having neurotrophic, antioxidant and metabolic functions crucial for the cognitive abilities. This review focuses on the evidence evaluating the impact of the endocrine systems, in particular thyroid function, insulin resistance, parathyroid hormone, vitamin D and sexual hormones on cognitive status. Results from epidemiological, preclinical and some clinical studies demonstrated the link between thyroid, parathyroid hormone and vitamin D and cognitive status, between diabetes, and insulin resistance in particular, and dementia, between sexual and adrenal hormones, particularly estrogen variation at menopause, and cognitive decline. The growing interest on the modifiable risks factors of cognitive decline increased the knowledge about the complex interplay of endocrine systems and cognition, highlighting the need and the usefulness of a multidisciplinary approach to the prevention of a complex and devastating disease.
痴呆症是老年人群中一种高度流行的慢性疾病，全球有超过5000万人受其影响，是一个巨大的医疗、社会和经济负担。痴呆症，尤其是阿尔茨海默病，预计在未来几年患病率还会上升。不幸的是，尽管针对阿尔茨海默病的标志性特征进行了大量临床试验，但目前尚无改变疾病进程的疗法。基于这些前提，不仅解决该疾病的神经病理学关联因素，而且解决可改变的风险因素似乎至关重要。其中，有证据表明内分泌系统不仅在大脑发育中起作用，而且在维持大脑健康方面也发挥作用，其具有对认知能力至关重要的神经营养、抗氧化和代谢功能。这篇综述重点关注评估内分泌系统，特别是甲状腺功能、胰岛素抵抗、甲状旁腺激素、维生素D和性激素对认知状态影响的证据。流行病学、临床前和一些临床研究的结果表明，甲状腺、甲状旁腺激素和维生素D与认知状态之间存在联系，糖尿病，尤其是胰岛素抵抗与痴呆症之间存在联系，性和肾上腺激素，特别是绝经时雌激素变化与认知能力下降之间存在联系。对认知能力下降的可改变风险因素的兴趣日益增加，增进了人们对内分泌系统与认知之间复杂相互作用的了解，突出了采用多学科方法预防这种复杂且具有破坏性疾病的必要性和实用性。
