中国全科医学 ›› 2019, Vol. 22 ›› Issue (12): 1501-1506.DOI: 10.12114/j.issn.1007-9572.2018.00.321
所属专题: 内分泌代谢性疾病最新文章合辑
魏魏1,2,陆媛1,3*
出版日期:2019-04-20
发布日期:2019-04-20
WEI Wei1,2 ,LU Yuan1,3*
Published:2019-04-20
Online:2019-04-20
摘要: 痴呆与轻度认知功能障碍正日益影响人群健康,但目前尚未找到确切有效的治疗方法。已有研究显示糖尿病是认知功能障碍的独立危险因素。糖尿病与痴呆具有很多共同的病理基础,因此,糖尿病相关治疗可能对患者认知功能产生潜在影响,对于众多糖尿病合并认知功能障碍人群有重要意义。本文通过探讨糖尿病相关治疗对认知功能的影响,寻找有益的治疗方法,为下一步治疗和研究提供思路和借鉴。
| [1]贾建平.中国痴呆与认知障碍诊治指南(2015年版)[M].北京:人民卫生出版社,2015:1. JIA J P.Guidelines for diagnosis and treatment of dementia and cognitive impairment in China (2015 Edition)[M].Beijing:People's Medical Publishing House,2015:1. [2]FERRI C P,PRINCE M,BRAYNE C,et al.Global prevalence of dementia:a Delphi consensus study[J].Lancet,2005,366(9503):2112-2117.DOI:10.1016/S0140-6736(05)67889-0. [3]FENG Q P,LI X J,SU Y,et al.Study on the relation of TCF7L2rs7903146T/C and rs7901695T/C SNPs with susceptibility to type 2 diabetes mellitus in Inner Mongolia Han people[J].Chinese Journal of Diabetes,2012,20(10):721-724.DOI:10.3969/j.issn.1006-6187.2012.10.001. [4]WENNBERG A M,GOTTESMAN R F,KAUFMANN C N,et al. Diabetes and cognitive outcomes in a nationally representative sample:the National Health and Aging Trends Study[J].Int Psychogeriatr,2014,26(10):1729-1735.DOI:10.1017/S1041610214001380. [5]GUDALA K,BANSAL D,SCHIFANO F,et al.Diabetes mellitus and risk of dementia:a meta-analysis of prospective observational studies[J].J Diabetes Investig,2013,4(6):640-650.DOI:10.1111/jdi.12087. [6]LI L,WANG Y,YAN J,et al.Clinical predictors of cognitive decline in patients with mild cognitive impairment:the Chongqing aging study[J].J Neurol,2012,259(7):1303-1311.DOI:10.1007/s00415-011-6342-0. [7]LI L,HOLSCHER C.Common pathological processes in Alzheimer disease and type 2 diabetes:a review[J].Brain Res Rev,2007,56(2):384-402.DOI:10.1016/j.brainresrev.2007.09.001. [8]MOHEET A,MANGIA S,SEAQUIST E R.Impact of diabetes on cognitive function and brain structure[J].Ann N Y Acad Sci,2015,1353:60-71.DOI:10.1111/nyas.12807. [9]PALTA P,SCHNEIDER A L,BIESSELS G J,et al.Magnitude of cognitive dysfunction in adults with type 2 diabetes:a meta-analysis of six cognitive domains and the most frequently reported neuropsychological tests within domains[J].Int Neuropsychol Soc,2014,20(3):278-291.DOI:10.1017/S1355617713001483. [10]MANSCHOT S M,BRANDS A M,VAN DER GROND J,et al.Brain magnetic resonance imaging correlates of impaired cognition in patients with type 2 diabetes[J].Diabetes,2006,55(4):1106-1113. [11]LOURIDA I,SONI M,THOMPSON-COON J,et al.Mediterranean diet,cognitive function,and dementia:a systematic review[J].Epidemiology ,2013,24:479-489.DOI:10.1097/EDE.0b013e3182944410. [12]FOTUHI M,MOHASSEL P,YAFFE K.Fish consumption,long-chain omega-3 fatty acids and risk of cognitive decline or Alzheimer disease:a complex association[J].Nat Clin PractNeurol,2009,5:140-152.DOI:10.1038/ncpneuro1044. [13]BLASKO I,HINTERBERGER M,KEMMLER G,et al.Conversion from mild cognitive impairment to dementia:influence of folic acid and vitamin B12 use in the VITA cohort[J].Nutr Health Aging,2012,16(8):687-694.DOI:10.1007/s12603-012-0051-y. [14]DEVORE E E,KANG J H,BRETELER M M,et al.Dietary intakes of berries and flavonoids in relation to cognitive decline[J].Ann Neurol,2012,72(1):135-143.DOI:10.1002/ana.23594. [15]VOSS M W,VIVAR C,KRAMER A F,et al.Bridging animal and human models of exercise-induced brain plasticity[J].Trends Cogn Sci,2013,17(10):525-544.DOI:10.1016/j.tics.2013.08.001. [16]Look AHEAD Research Group,WING R R.Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus:four-year results of the look ahead trial[J].Arch Intern Med,2010,170(17):1566 -1575.DOI:10.1001/archinternmed.2010.334. [17]ZHENG G,XIA R,ZHOU W,et al.Aerobic exercise ameliorates cognitive function in older adults with mild cognitive impairment:a systematic review and meta-analysis of randomised controlled trials[J].Br J Sports Med,2016 ,50(23):1443-1450.DOI:10.1136/bjsports-2015-095699. [18]RAJANI S,ARCHANA R,INDLA Y R,et al.Beneficial effects of yogasanas and pranayama in limiting the cognitive decline in type 2 diabetes[J].Natl J Physiol Pharm Pharmacol,2017,7(3):232-235.DOI:10.5455/njppp.2017.7.0825508092016. [19]FIATARONE SINGH M A,GATES N,SAIGAL N,et al.The Study of Mental and Resistance Training(SMART) study-resistance training and/or cognitive training in mild cognitive impairment:a randomized,double-blind,double-sham controlled trial[J].J Am Med Dir Assoc,2014,15(12):873-880.DOI:10.1016/j.jamda.2014.09.010. [20]TEIXEIRA R B,MARINS J C,DE SA JUNIOR A R,et al.Improved cognitive,affective and anxiety measures in patients with chronic systemic disorders following structured physical activity[J].Diab Vasc Dis Res,2015,12(6):445-454.DOI:10.1177/1479164115602651. [21]TEIXEIRA R B,MARINS J C B,AMORIM P R S,et al.Evaluating the effects of exercise on cognitive function in hypertensive and diabetic patients using the mental test and training system[J].World J Biol Psychiatry,2017,28:1-10.DOI:10.1080/15622975.2017.1337222. [22]LUCHSINGER J A,PALMAS W,TERESI J A,et al.Improved diabetes control in the elderly delays global cognitive decline[J].J Nutr Health Aging,2011,15(6):445-449. [23]PINTANA H,APAIJAI N,PRATCHAYASAKUL W,et al.Effects of metformin on learning and memory behaviors and brain mitochondrial functions in high fat diet induced insulin resistant rats[J].Life Sci,2012,91(11/12):409-414.DOI:10.1016/j.lfs.2012.08.017. [24]HAFFINER S,TEMPROSA M,CRANDALL J,et al.Intensive lifestyle intervention or metformin on inflammation and coagulation in participants with impaired glucose tolerance[J].Diabetes,2005,54(5):1566-1572. [25]CHEN F,DONG R R,ZHONG K L,et al.Antidiabetic drugs restore abnormal transport of amyloid-β across the blood-brain barrier and memory impairment in db/db mice[J].Neuropharmacology,2016,101:123-136.DOI:10.1016/j.neuropharm.2015.07.023. [26]NG T P,FENG L,YAP K B,et al.Long-term metformin usage and cognitive function among older adults with diabetes[J].J Alzheimers Dis,2014,41(1):61-68.DOI:10.3233/JAD-131901. [27]梁城铭,安刚,韩昕彤,等.二甲双胍联合有氧运动对2型糖尿病患者认知功能的改善作用[J].中国老年学杂志,2017,37(12):2958-2959.DOI:10.3969/j.issn.1005-9202.2017.12.043. LIANG C M,AN G,HAN X T,et al.Effect of metformin combined with aerobic exercise on cognitive function in patients with type 2 diabetes mellitus[J].Chinese Journal of Gerontology,2017,37(12):2958-2959.DOI:10.3969/j.issn.1005-9202.2017.12.043. [28]LIN Y,WANG K,MA C,et al.Evaluation of metformin on cognitive improvement in patients with non-dementia vascular cognitive impairment and abnormal glucose metabolism[J].Front Aging Neurosci,2018,27(10):227.DOI:10.3389/fnagi.2018.00227. [29]HSU C C,WAHLQVIST M L,LEE M S,et al.Incidence of dementia is increased in type 2 diabetes and reduced by the use of sulfonylureas and metformin[J].J Alzheimers Dis,2011,24(3):485-493.DOI:10.3233/JAD-2011-101524. [30]IMFELD P,BODMER M,JICK S S,et al.Metformin,other antidiabetic drugs,and risk of Alzheimer's disease:a population-based case-control study[J].J Am Geriatr Soc,2012,60(5):916-921.DOI:10.1111/j.1532-5415.2012.03916.x. [31]MOORE E M,MANDER A G,AMES D,et al.Increased risk of cognitive impairment in patients with diabetes is associated with metformin [J].Diabetes Care,2013,36(10):2981-2987.DOI:10.2337/dc13-0229. [32]KHANFAR M A,ABUKHADER M M,ALQTAISHAT S,et al. Pharmacophore modeling,homology modeling,and in silico screening reveal mammalian target of rapamycin inhibitory activities for sotalol,glyburide,metipranolol,sulfamethizole,glipizide,and pioglitazone[J].Mol Graph Model,2013,42:39-49.DOI:10.1016/j.jmgm.2013.02.009. [33]OSBORNE C,WEST E,NOLAN W,et al.Glimepiride protects neurons against amyloid-beta-induced synapse damage[J].Neuropharmacology,2016,101:225-236.DOI:10.1016/j.neuropharm.2015.09.030. [34]綦雯雯,贾凯英,孙达,等.吡格列酮对糖尿病大鼠中枢神经系统11β-羟类固醇脱氢酶1 型表达的影响[J].神经疾病与精神卫生,2017,17(3):184-186.DOI:10.3969/j.issn.1009-6574.2017.03.009. QI W W,JIA K Y,SUN D,et al.Effects of pioglitazone on expressions of 11β-hydroxysteroid dehydrogenase type 1 in central nervous system of diabetic rats[J].Journal of Neuroscience and Mental Health,2017,17(3):184-186.DOI:10.3969/j.issn.1009-6574.2017.03.009. [35]SEARCY J L,PHELPS J T,PANCANI T,et al.Long-term pioglitazone treatment improves learning and attenuates pathological markers in a mouse model of Alzheimer's disease[J].Alzheimers Dis,2012,30(4):943-961.DOI:10.3233/JAD-2012-111661. [36]SATO T,HANYU H,HIRAO K,et al.Efficacy of PPAR-gamma agonist pioglitazone in mild Alzheimer disease[J].Neurobiol Aging,2011,32(9):1626-1633.DOI:10.1016/j.neurobiolaging.2009.10.009. [37]于海燕,王群松,张梓威,等.吡格列酮治疗2 型糖尿病轻度认知功能障碍患者的临床疗效[J].中国老年学杂志,2017,37(17):4224-4226.DOI:10.3969/j.issn.1005-9202.2017.17.026. YU H Y,WANG Q S,ZHANG Z W,et al.Clinical efficacy of pioglitazone in the treatment of mild cognitive impairment in type 2 diabetes mellitus [J].Chinese Journal of Geriatrics,2017,37(17):4224-4226.DOI:10.3969/j.issn.1005-9202.2017.17.026. [38]LU C H,YANG C Y,LI C Y,et al.Lower risk of dementia with pioglitazone,compared with other second-line treatments,in metformin-based dual therapy:a population-based longitudinal study[J].Diabetologia,2018,61(3):562-573.DOI:10.1007/s00125-017-4499-5. [39]TALBOT K.Brain insulin resistance in Alzheimer's disease and its potential treatment with GLP-1 analogs[J].Neurodegener Dis Manag,2014,4(1):31-40.DOI:10.2217/nmt.13.73. [40]CHEN S,LIU AR,AN FM,et al.Amelioration of neurodegenerative changes in cellular and rat models of diabetes-related Alzheimer's disease by exendin-4[J].Age(Dordr),2012,34:1211-1224.DOI:10.1007/s11357-011-9303-8. [41]HOLSCHER C.Central effects of GLP-1:new opportunities for treatments of neurodegenerative diseases[J].J Endocrinol,2014,221(1):T31-41.DOI:10.1530/JOE-13-0221. [42]MCCLEAN P L,PARTHSARATHY V,FAIVRE E,et al.The diabetes drug liraglutide prevents degenerative processes in a mouse model of Alzheimer's disease[J].Neurosci,2011,31(17):6587-6594.DOI:10.1523/JNEUROSCI.0529-11.2011. [43]GEJL M,GJEDDE A,EGEFJORD L,et al.In Alzheimer's disease,6-month treatment with GLP-1 analog prevents decline of brain glucose metabolism:randomized,placebo-controlled,double-blind clinical trial[J].Front Aging Neurosci,2016 ,8:108.DOI:10.3389/fnagi.2016.00108. [44]洪世华,吴菊琴,方向南,等.GLP-1受体激动剂对2 型糖尿病合并阿尔茨海默病患者认知功能的影响[J].中国当代医药,2016 ,23(29):60-62. HONG S H,WU J Q,FANG X N,et al.Influence of GLP-1 receptor stimulant on the cognitive function in patients with type 2 diabetes complicated with Alzheimer disease [J].China Modern Medicine,2016,23(29):60-62. [45]张萌,张璐,李玉中,等.利拉鲁肽对2型糖尿病患者认知功能的影响及可能机制[J].中华糖尿病杂志,2014,6(2):91-96.DOI:10.3760/cma.j.issn.1674-5809.2014.02.007. ZHANG M,ZHANG L,LI Y Z,et al.Effects of liraglutide on the cognitive function in patients with type 2 diabetes mellitus and the underlying mechanism [J].Chin J Diabetes Mellitus,2014,6(2):91-96.DOI:10.3760/cma.j.issn.1674-5809.2014.02.007. [46]CAI H Y,HOLSCHER C,YUE X H,et al.Lixisenatide rescues spatial memory and synaptic plasticity from amyloid beta protein-induced impairments in rats[J].Neuroscience,2014,277:6-13.DOI:10.1016/j.neuroscience.2014.02.022. [47]PIPATPIBOON N,PINTANA H,PRATCHAYASAKUL W,et al. DPP4-inhibitor improves neuronal insulin receptor function,brain mitochondrial function and cognitive function in rats with insulin resistance induced by high-fat diet consumption[J].Eur J Neurosci,2013,37(5):839-849.DOI:10.1111/ejn.12088. [48]KOSARAJU J,MURTHY V,KHATWAL R B,et al.Vildagliptin:an anti-diabetes agent ameliorates cognitive deficits and pathology observed in streptozotocin-induced Alzheimer's disease[J].J Pharm Pharmacol,2013,65(12):1773-1784.DOI:10.1111/jphp.12148. [49]黄文湧,韩志琰,杨敬源,等.老年糖尿病患者降糖治疗与认知功能的关系[J].中国糖尿病杂志,2009,17(11):850-852.DOI:10.3969/j.issn.1006-6187.2009.11.017. HUANG W Y,HAN Z Y,YANG J Y,et al.The relationship between diabetic treatment and cognitive function among the elderly[J].Chin J Diabetes,2009,17(11):850-852.DOI:10.3969/j.issn.1006-6187.2009.11.017. [50]ARAKI A.Insulin therapy in elderly patients with diabetes mellitus[J].Nihon Ronen Igakkai Zasshi,2004,41(2):157-160. [51]RDZAK G M,ABDELGHANY O.Does insulin therapy for type 1 diabetes mellitus protect against Alzheimer's disease?[J].Pharmacotherapy,2014,34(12):1317-1323.DOI:10.1002/phar.1494. [52]杨雁,马德琳,王玉萍,等.鼻腔滴入胰岛素改善2型糖尿病大鼠海马阿尔茨海默病样改变[J].中国病理生理杂志,2013,29(1):56-61.DOI:10.3969/j.issn.1000-4718.2013.01.009. YANG Y,MA D L,WANG Y P,et al.Intranasal insulin treatment ameliorates Alzheimer disease-like changes in hippocampus in a rat model of type 2 diabetes[J].Chinese Journal of Pathophysiology,2013,29(1):56-61.DOI:10.3969/j.issn.1000-4718.2013.01.009. [53]FREIHERR J,HALLSCHMID M,FREY W H 2nd,et al.Intranasal insulin as a treatment for Alzheimer's disease:a review of basic research and clinical evidence[J].CNS Drugs,2013,7(7):505-514.DOI:10.1007/s40263-013-0076-8. [54]CRAFT S,BAKER L D,MONTINE T J ,et al.Intranasal insulin therapy for Alzheimer disease and amnestic mild cognitive impairment:a pilot clinical trial[J].Arch Neurol,2012 ,69(1):29-38.DOI:10.1001/archneurol.2011.233. [55]FEART C,SAMIERI C,RONDEAU V,et al.Adherence to a Mediterranean diet,cognitive decline,and risk of dementia[J].JAMA,2009 ,302(6):638-648.DOI:10.1001/jama.2009.1146. [56]ANGEVAREN M,AUFDEMKAMPE G,VERHAAR H J,et al.Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment[J].Cochrane Database Syst Rev,2008,16(3):CD005381.DOI:10.1002/14651858.CD005381.pub3. [57]PODOLSKI N,BRIXIUS K,PREDEL H G,et al.Effects of regular physical activity on the cognitive performance of type 2 diabetic patients:a systematic review[J].Metab Syndr Relat Disord,2017,15(10):481-493.DOI:10.1089/met.2017.0120. [58]中国痴呆与认知障碍诊治指南写作组.2018中国痴呆与认知障碍诊治指南(四):认知障碍疾病的辅助检查[J].中华医学杂志,2018,98(15):1130-1142.DOI:10.3760/cma.j.issn.0376-2491.2018.15.003. Chinese dementia and cognitive impairment guidelines writing group.2018 guidelines for diagnosis and treatment of dementia and cognitive impairment in China(four):auxiliary examination for cognitive impairment[J].Natl Med J China,2018,98(15):1130-1142.DOI:10.3760/cma.j.issn.0376-2491.2018.15.003. [59]Consensus report of the Working Group on:"Molecular and Biochemical Markers of Alzheimer's Disease".The Ronald and Nancy Reagan Research Institute of the Alzheimer's Association and the National Institute on Aging Working Group [J].Neurobiol Aging,1998,19(2):109-116. [60]中国痴呆与认知障碍诊治指南写作组.2018中国痴呆与认知障碍诊治指南(二):阿尔茨海默病诊治指南[J].中华医学杂志,2018,98(13):971-977.DOI:10.3760/cma.j.issn.0376-2491.2018.13.004. Chinese dementia and cognitive impairment guidelines writing group.2018 guidelines for diagnosis and treatment of dementia and cognitive impairment in China(two):guidelines for the diagnosis and treatment of alzheimer's disease [J].Natl Med J China,2018,98(13):971-977.DOI:10.3760/cma.j.issn.0376-2491.2018.13.004. |
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