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DOI: 10.1055/a-1146-7607
Diabetes mellitus und Demenz
Diabetes mellitus and dementiaDiabetes mellitus und Demenz werden mit zunehmendem Lebensalter häufiger, sind wegen der demografischen Entwicklung in Deutschland auf dem Vormarsch und beeinträchtigen die Lebensqualität erheblich. Sie hängen auch in ihrer Krankheitsentstehung zusammen: Bei Demenz liegt eine Insulinresistenz des Gehirns vor. Das Zusammentreffen der beiden Störungen erschwert die Behandlung erheblich, sodass neue Therapieziele und Konzepte erforderlich sind.
Abstract
Patients suffering from diabetes mellitus have an almost twofold increased risk of developing dementia in later life. Brain insulin resistance appears to play a crucial role in the pathogenesis of diabetes related dementia, which shares features of Alzheimer´s disease and vascular dementia. Midlife obesity is another powerful risk factor of later cognitive decline. However, in the early course of clinical dementia, weight loss is frequently observed, leading to a paradoxical association of weight and dementia. Unexplained weight loss in previously obese type-2 diabetes patients may be a first clinical sign of imminent cognitive decline. This is of particular clinical relevance, since weight loss may lead to hypoglycemia if hypoglycemic treatment is not adjusted.
Diabetes management in patients with overt dementia poses various problems, as patients may become less efficient in self-management. In parallel, remaining life expectancy is limited by dementia. Therefore, the focus of diabetes management shifts from prevention of long-term complications to short term treatment safety, avoidance of hypoglycemia and quality of life.
Publication History
Article published online:
22 December 2021
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Literatur
- 1 Nicastri C, Hensley J, Lane S. Managing the Forgetful Patient: Best Practice for Cognitive Impairment. Med Clin North Am 2021; 105 (01) 75-91 DOI: 10.1016/j.mcna.2020.09.001.. (PMID: 33246524)
- 2 Matej R, Tesar A, Rusina R. Alzheimer's disease and other neurodegenerative dementias in comorbidity: A clinical and neuropathological overview. Clin Biochem 2019; 73: 26-31 DOI: 10.1016/j.clinbiochem.2019.08.005. (PMID: 31400306)
- 3 Zhang Q, Sidorenko J, Couvy-Duchesne B. et al. Risk prediction of late-onset Alzheimer's disease implies an oligogenic architecture. Nat Commun 2020; 11 (01) 4799 DOI: 10.1038/s41467-020-18534-1. (PMID: 32968074)
- 4 Mons U, Parna L, Brenner H. Alzheimer-Risikofaktor ApoE-E4: Hat der Cholesterinspiegel Einfluss auf die Kognition?. Dtsch Arztebl 2016; 113 (37) 28 DOI: 10.3238/PersNeuro.2016.09.16.06.
- 5 Liang JH, Lu L, Li JY. et al. Contributions of Modifiable Risk Factors to Dementia Incidence: A Bayesian Network Analysis. J Am Med Dir Assoc 2020; 21 (11) 1592-1599.e13 DOI: 10.1016/j.jamda.2020.04.006.
- 6 Musen G, Tinsley LJ, Marcinkowski KA. et al. Cognitive function deficits associated with long-duration type 1 diabetes and vascular complications. Diabetes Care 2018; 41 (08) 1749-1756 DOI: 10.2337/dc17-1955.. (PMID: 29871904)
- 7 Kopf D, Frölich L. Risk of incident Alzheimer's disease in diabetic patients: a systematic review of prospective trials. J Alzheimers Dis 2009; 16 (04) 677-85 DOI: 10.3233/JAD-2009-1011. (PMID: 19387104)
- 8 Craft S, Raman R, Chow TW. et al. Safety, efficacy, and feasibility of intranasal insulin for the treatment of mild cognitive impairment and Alzheimer disease dementia: a randomized clinical trial. JAMA Neurol 2020; 77 (09) 1099-1109 DOI: 10.1001/jamaneurol.2020.1840. (PMID: 32568367)
- 9 Fitzpatrick AL, Kuller LH, Lopez OL. et al. Diehr P et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol 2009; 66 (03) 336-342 DOI: 10.1001/archneurol.2008.582. (PMID: 19273752)
- 10 Perera G, Rijnbeek PR, Alexander M. et al. Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case-control study using European electronic health records. BMJ Open 2020; 10 (11) e038753 DOI: 10.1136/bmjopen-2020-038753. (PMID: 33191253)
- 11 Willette AA, Bendlin BB, Starks EJ. et al. Association of Insulin Resistance With Cerebral Glucose Uptake in Late Middle-Aged Adults at Risk for Alzheimer Disease. JAMA Neurol 2015; 72 (09) 1013-1020 DOI: 10.1001/jamaneurol.2015.0613. (PMID: 26214150)
- 12 Kellar D, Craft S. Brain insulin resistance in Alzheimer's disease and related disorders: mechanisms and therapeutic approaches. Lancet Neurol 2020; 19 (09) 758-766 DOI: 10.1016/S1474-4422(20)30231-3. (PMID: 32730766)
- 13 Peters A. The selfish brain: Competition for energy resources. Am J Hum Biol 2011; 23 (01) 29-34 DOI: 10.1002/ajhb.21106. (PMID: 21080380)
- 14 Folstein MF, Folstein SE, McHugh PR. „Mini-mental state“. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12 (03) 189-198 DOI: 10.1016/0022-3956 (75)90026-6. (PMID: 1202204)
- 15 Shulman KI, Gold DP, Cohen CA. et al. A longitudinal study. Int J Geriatr Psych 1993; 8: 487-496 DOI: 10.1002/gps.930080606.
- 16 Kessler J, Calabrese P, Kalbe E. et al. DemTect: A new screening method to support diagnosis of dementia. Psycho 2000; 26: 343-347
- 17 Nasreddine ZS, Phillips NA, Bédirian V. et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53: 695-699 DOI: 10.1111/j.1532-5415.2005.53221.x. (PMID: 15817019)
- 18 Nikolaus T, Bach M, Specht-Leible N. et al. The Timed Test of Money Counting: a short physical performance test for manual dexterity and cognitive capacity. Age Ageing 1995; 24 (03) 257-258 DOI: 10.1093/ageing/24.3.257. (PMID: 7645449)
- 19 Gardener SL, Rainey-Smith SR. The Role of Nutrition in Cognitive Function and Brain Ageing in the Elderly. Curr Nutr Rep 2018; 7 (03) 139-149 DOI: 10.1007/s13668-018-0229-y.. (PMID: 29974344)
- 20 Stephen R, Hongisto K, Solomon A. et al. Physical Activity and Alzheimer's Disease: A Systematic Review. J Gerontol A Biol Sci Med Sci 2017; 72 (06) 733-739 DOI: 10.1093/gerona/glw251. (PMID: 28049634)
- 21 Jacobson AM, Musen G. DCCT/EDIC research group. et al. Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med 2007; 356 (18) 1842-1852 DOI: 10.1056/NEJMoa066397..
- 22 Frier BM. Cognitive functioning in type 1 diabetes: the Diabetes Control and Complications Trial (DCCT) revisited. Diabetologia 2011; 54 (02) 233-236 DOI: 10.1007/s00125-010-1983-6.. (PMID: 21109995)
- 23 Murray AM, Hsu FC, Williamson JD. et al. Action to Control Cardiovascular Risk in Diabetes Follow-On Memory in Diabetes (ACCORDION MIND) Investigators. ACCORDION MIND: results of the observational extension of the ACCORD MIND randomised trial. Diabetologia 2017; 60 (01) 69-80 DOI: 10.1007/s00125-016-4118-x.. (PMID: 27766347)
- 24 Whitmer RA, Karter AJ, Yaffe K. et al. Hypoglycemic episodes and risk of dementia in older patients with type 2 diabetes mellitus. JAMA 2009; 301 (15) 1565-1572 DOI: 10.1001/jama.2009.460. (PMID: 19366776)
- 25 Lacy ME, Gilsanz P, Eng C. et al. Severe Hypoglycemia and Cognitive Function in Older Adults With Type 1 Diabetes: The Study of Longevity in Diabetes (SOLID). Diabetes Care 2020; 43 (03) 541-548 DOI: 10.2337/dc19-0906.. (PMID: 31882410)
- 26 Kaiser MJ, Bauer JM, Ramsch C. et al. MNA-International Group. Validation of the Mini Nutritional Assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging 2009; 13 (09) 782-788 DOI: 10.1007/s12603-009-0214-7.. (PMID: 20863332)
- 27 Deutsche Diabetes Gesellschaft. S2k-Leitlinie Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Alter. 2. Auflage. 2018. AWMF-Registernummer: 057–017. https://www.awmf.org/leitlinien/detail/ll/057–017.html