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Open Access 01-07-2014 | Review Article

Diabetes and the brain: issues and unmet needs

Authors: Natan M. Bornstein, Michael Brainin, Alla Guekht, Ingmar Skoog, Amos D. Korczyn

Published in: Neurological Sciences | Issue 7/2014

Abstract

Diabetes mellitus (DM) is associated with an increased risk of mild cognitive impairment, dementia and stroke. The association between DM and dementia appears to be stronger for vascular cognitive impairment than for Alzheimer’s disease, suggesting cerebrovascular disease may be an important factor in cognitive impairment in DM. Although the exact mechanisms by which DM affects the brain remain unclear, changes to brain vasculature, disturbances of cerebral insulin signaling, insulin resistance, glucose toxicity, oxidative stress, accumulation of advanced glycation end products, hypoglycemic episodes, and alterations in amyloid metabolism may all be involved. Cognitive impairment and dementia associated with DM may also be mediated via vascular risk factors, in particular brain ischemia, the occurrence of which can have an additive or synergistic effect with concomitant neurodegenerative processes. To date, no drug has been approved for the treatment of vascular dementia and there are no specific pharmacological treatments for preventing or reducing cognitive decline in patients with DM. Most focus has been on tighter management of vascular risk factors, although evidence of reduced cognitive decline through reducing blood pressure, lipid-lowering or tighter glycemic control is inconclusive. Tailored, multimodal therapies may be required to reduce the risk of cognitive dysfunction and decline in patients with DM. The use of pleiotropic drugs with multimodal mechanisms of action (e.g., cerebrolysin, Actovegin) may have a role in the treatment of cognitive dysfunction and their use may warrant further investigation in diabetic populations.

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Title: Diabetes and the brain: issues and unmet needs
Authors: Natan M. Bornstein
Michael Brainin
Alla Guekht
Ingmar Skoog
Amos D. Korczyn
Publication date: 01-07-2014
Publisher: Springer Milan
Published in: Neurological Sciences / Issue 7/2014
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-014-1797-2

At a glance: The STEP trials

Springer Medicine

Diabetes and the brain: issues and unmet needs

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

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