INTERNATIONAL JOURNAL OF ENDOCRINOLOGY (Ukraine), Год журнала: 2025, Номер 21(2), С. 215 - 225
Опубликована: Апрель 1, 2025
This review analyzes current data on the epidemiology, pathogenesis, clinical features, and approaches to treatment of cognitive impairments in diabetes mellitus (DM). DM is recognized as an independent risk factor for dementia, particularly Alzheimer’s disease vascular increasing their likelihood by 50–91 %. The mechanism disorders includes brain insulin resistance, hyperglycemia, beta-amyloid accumulation, tau pathology, oxidative stress, dysfunction, neuroinflammation. Insulin resistance disrupts signaling pathways (IRS-1/PI3K/AKT), contributing neurodegeneration, while chronic hyperglycemia damages endothelium, accelerates atherosclerosis, increases dementia due ischemic neuronal damage. According guidelines, impairment screening recommended all individuals with over 65 years old (earlier if mental changes are observed) using psychodiagnostic tests. Diagnosis also neuroimaging, cerebral hemodynamics analysis, cerebrospinal fluid biomarker testing (beta-amyloid, protein), PET scans amyloid tau, along damage markers, promising early detection staging disease. Treatment strategies should be individualized, focusing glycemic control (target HbA1c < 8.0 % elderly), minimizing hypo-/hyperglycemia, preventing complications. Dementia involves combining antidiabetic therapy standard approaches: cholinesterase inhibitors, NMDA receptor antagonists, or anti-amyloid monoclonal antibodies. strategy aims slow decline improve patient quality life. Metformin, a pathogenetically relevant drug, plays key role not only but treatment, it reduces burden, suppresses inflammation, activates AMPK pathway, stimulates neurogenesis, improves function even non-diabetic patients. Long-term metformin use associated 29–84 reduced depending duration, its combination other drugs may provide synergy slowing neurodegeneration. prevention lifestyle modifications (physical activity, healthy diet), correction harmful habits, avoiding environmental risks, controlling body weight, blood pressure, lipid levels.
Язык: Английский