Lardaro Antonio, Quarta Ludovica, Pagnotta Stefania, Sodero Giorgio, Mariani Sandro, Del Ben Maria, Desideri Giovambattista, Ettorre Evaristo, Baratta Francesco
Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy.
Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy.
Biomedicines. 2024 Aug 3;12(8):1750. doi: 10.3390/biomedicines12081750.
Dementia is an age-related syndrome characterized by the progressive deterioration of cognition and capacity for independent living. Diabetes is often associated with cognitive decline and shares similar pathophysiological mechanisms with dementia, such as systemic inflammation, oxidative stress, insulin resistance, and advanced glycation end-products formation. Therefore, adequate diabetes management may reduce the risk of cognitive decline, especially in patients with other comorbidities and risk factors. The sodium glucose cotransporter inhibitors (SGLT2i) regulate renal glucose reabsorption by blocking the SGLT2 cotransporters located in the proximal tubules, causing glycosuria and intraglomerular pressure reduction. Their use helps to lower blood pressure by modifying sodium and water homeostasis; these drugs are also commonly used in the treatment of heart failure and chronic kidney disease, while recently, a potential neuroprotective role in the central nervous system has been suggested. The aim of our scoping review is to analyze current evidence about the potential neuroprotective effects of SGLT2i in adult patients. We performed a scoping literature review to evaluate the effect of SGLT2i on dementia, mild cognitive impairment (MCI) and Alzheimer's disease incidence and progression. The screening process was performed through different searches on PubMed and EMBASE, evaluating original works published up to January 2024. In conclusion, the use of SGLT2i could be associated with a neuroprotective effect in patients with diabetes, reducing the incidence or the progression of MCI and dementia. Further prospective studies are needed to validate this hypothesis and to evaluate the effectiveness of this class of drugs in normal glycemic profile patients.
痴呆是一种与年龄相关的综合征，其特征是认知和独立生活能力逐渐衰退。糖尿病常与认知功能下降相关，且与痴呆具有相似的病理生理机制，如全身炎症、氧化应激、胰岛素抵抗和晚期糖基化终产物形成。因此，充分的糖尿病管理可能会降低认知功能下降的风险，尤其是在患有其他合并症和风险因素的患者中。钠-葡萄糖协同转运蛋白抑制剂（SGLT2i）通过阻断位于近端小管的SGLT2协同转运蛋白来调节肾脏对葡萄糖的重吸收，从而导致糖尿和肾小球内压降低。它们的使用有助于通过调节钠和水平衡来降低血压；这些药物也常用于治疗心力衰竭和慢性肾脏病，而最近，有人提出它们在中枢神经系统中具有潜在的神经保护作用。我们的范围综述旨在分析关于SGLT2i对成年患者潜在神经保护作用的现有证据。我们进行了一项范围文献综述，以评估SGLT2i对痴呆、轻度认知障碍（MCI）以及阿尔茨海默病发病率和进展的影响。筛选过程通过在PubMed和EMBASE上进行不同的检索来完成，评估截至2024年1月发表的原创作品。总之，使用SGLT2i可能对糖尿病患者具有神经保护作用，可降低MCI和痴呆的发病率或进展。需要进一步的前瞻性研究来验证这一假设，并评估这类药物在血糖正常的患者中的有效性。
