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[Diabetes and cognitive decline - An often overlooked association]
Åke Sjöholm1, Peter M Nilsson2
1professor, överläkare, VO internmedicin, sektionen för diabetologi och endokrinologi, Gävle sjukhus; Centrum för forskning och utveckling, Uppsala universitet/Region Gävleborg.
Lakartidningen
|June 15, 2023
Summary
Diabetes can lead to cognitive decline through brain insulin resistance. Physical activity and certain medications show promise in reversing these effects and improving brain function.
Area of Science:
- Neuroscience
- Endocrinology
- Metabolic disorders
Context:
- Diabetes mellitus is linked to both peripheral and central nervous system complications.
- Cognitive decline, including premature dementia, is an underrecognized consequence of diabetes.
- The precise role of hyperglycemia in diabetic cognitive impairment remains unclear.
Purpose:
- To review the current understanding of diabetes-associated cognitive decline.
- To explore the pathogenic mechanisms involving cerebral insulin resistance and signaling defects.
- To discuss potential therapeutic strategies for mitigating cognitive impairment in diabetes.
Summary:
- Central neuropathy in diabetes contributes to cognitive decline, potentially independent of hyperglycemia.
- Cerebral insulin resistance and impaired insulin signaling are key factors in diabetic cognitive impairment.
- Physical activity has demonstrated potential to reverse brain insulin resistance and improve cognitive function.
- Emerging pharmacological interventions, including nasal insulin and GLP-1 receptor agonists, show therapeutic promise but require further clinical validation.
Impact:
- Highlights the significant but underappreciated link between diabetes and cognitive impairment.
- Identifies critical molecular pathways (insulin resistance/signaling) implicated in diabetic brain dysfunction.
- Suggests lifestyle modifications (physical activity) and novel pharmacological agents as future treatment avenues for preserving cognitive health in diabetic patients.
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