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Editorial
Diabetes mellitus and Alzheimer's disease: An unforgettable relation
Diabetes mellitus tipo 2 y enfermedad de Alzheimer: una relación para no olvidar
Andreea Ciudin
Departamento de Endocrinología y Nutrición, Hospital Universitari Vall d’Hebron, Institut de Recerca Hospital Universitari Vall d’Hebron, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Type 2 diabetes mellitus &#40;T2DM&#41; is a disease that currently affects 180 million people worldwide&#46; Furthermore&#44; it is expected that there will be more than 300 million patients with T2DM by 2025 as the result of demographic growth&#44; aging&#44; obesity&#44; and sedentary lifestyles&#46; In recent years&#44; patients with T2DM have been shown to be at greater risk of developing dementia&#44; both as vascular dementia and Alzheimer&#39;s disease &#40;AD&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">1</span></a> AD is the most common cause of dementia and is characterized by a progressive amnesic disorder with the subsequent occurrence of other cognitive&#44; behavioral&#44; and neuropsychiatric changes that prevent general social functioning and the performance of the regular activities of daily life&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In fact&#44; as compared to subjects without diabetes&#44; patients with T2DM can suffer from several degrees of cognitive impairment from the very early stages of the disease&#46; A scale of cognitive impairment associated with T2DM prior to dementia has been proposed&#58; a&#41; cognitive dysfunction associated with diabetes&#44; during which patients have subjective complaints of memory&#44; with a subtle change in neuropsychological tests &#40;usually 0&#46;3&#8211;0&#46;5 SD less than subjects with no diabetes&#41;&#59; b&#41; mild cognitive impairment &#40;MCI&#41;&#44; in which patients have a score of minus 1&#8211;1&#46;5 SD&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a> People with MCI have memory problems&#44; but are able to perform everyday activities&#46; It should be noted that the annual rate of conversion to dementia in patients with MCI ranges from 10&#37; to 30&#37;&#44; and that the risk factors that accelerate the progression of cognitive impairment are as yet unknown&#46; In recent years&#44; research on MCI has focused on the identification of the factors that promote conversion to dementia&#44; especially AD&#46; Thus&#44; several neuropsychological tests&#44; cerebrospinal fluid biomarkers&#44; and neuroimaging tests have been evaluated as predictors to assess the risk of conversion to dementia&#46; However&#44; the methods proposed have no adequate predictive value and are not sufficiently standardized for their use to be recommended in clinical practice&#46; The detection of the apolipoprotein E genotype &#40;APOE ¿4&#41;&#8212; associated with a high risk of AD&#8211;in order to assess the risk of conversion to dementia is not recommended either&#46; Biessels et al&#46; proposed a score of the 10-year risk of progression to dementia in patients with T2DM based on age&#44; the presence of chronic complications of diabetes&#44; depression&#44; and educational level&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It should be noted that the relationship between T2DM and AD is independent of vascular involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">3</span></a> Thus&#44; the increased incidence of AD seen in the population with T2DM could be attributed to neurodegeneration caused or accelerated by diabetes itself&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">An argument supporting neurodegeneration accelerated by diabetes is the pathophysiology of diabetic retinopathy&#44; traditionally described as a microvascular complication&#46; There is&#44; however&#44; ample evidence to suggest that retinal neurodegeneration is an early event in the pathogenesis of diabetic retinopathy and that it is involved in microvascular changes&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">4</span></a> The retina and the brain have the same embryological origin and share many anatomical and functional characteristics &#40;such as the microvascular bed and the blood&#8211;tissue barrier system&#41;&#46; Indeed&#44; approximately 40&#37;&#8211;50&#37; of patients with AD have some type of abnormality in electrophysiological studies of the retina&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">5</span></a> Moreover&#44; in patients with AD&#44; and even in those with MCI&#44; a decreased thickness of the retinal ganglion cell layer &#40;the retinal layer showing the earliest and greatest involvement in diabetes&#41; has been seen&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">6</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">T2DM induces both functional and structural changes in the brain&#46; Interestingly&#44; several studies of patients with T2DM have demonstrated a loss of brain volume similar to or up to three times greater than the atrophy rate due to natural aging&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">7</span></a> In addition&#44; smaller brain volumes in patients with T2DM have been associated with greater insulin resistance and longer diabetes duration&#46; However&#44; controversy still exists as to whether brain atrophy contributes specifically to memory deficits in patients with T2DM&#46; Magnetic resonance imaging with diffusion tensor imaging &#40;MRI-DTI&#41; allows white matter function to be evaluated&#46; Using this technology&#44; patients with T2DM have been shown to have microstructural abnormalities in white matter tracts that condition defects in information processing&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">8</span></a> It should be noted that such abnormalities in white matter may already be seen in patients with T2DM&#44; and even in patients with metabolic syndrome&#44; with no cognitive impairment&#46; Such patients have a poorer score in neuropsychological assessment tests&#46; The presence of T2DM has also been shown to alter glucose uptake by neurons&#44; as assessed by SPECT of the brain&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">9</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The relation between T2DM and AD is even more interesting bearing in mind that the metabolic pathways triggered by hyperglycemia and insulin resistance &#40;decreased insulin signaling&#44; inflammation&#44; oxidative stress&#44; advanced glycation end products&#41; are precisely those involved in the pathogenesis of AD&#46; Insulin is essential for neuron survival&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">10</span></a> and a decreased number of insulin receptors have been seen in the brains of patients with AD&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">11</span></a> Defective insulin signaling in the brain may play an essential role in the conversion to dementia in patients with T2DM&#46; It has also been reported that the administration of intranasal insulin &#40;which has no systemic effects&#41; is associated with a significant improvement in cognitive performance in healthy adults<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">12</span></a> and patients with early AD&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">13</span></a> In fact&#44; clinical trials are ongoing to assess the value of intranasal insulin to prevent the conversion of MCI to AD&#46; On the other hand&#44; neurons are known to have a receptor for GLP-1&#46; GLP-1 bound to its receptor triggers the same signaling pathways as insulin itself&#44; critical pathways for neuron survival&#44; conferring a neuroprotective effect<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">14</span></a>&#46; Clinical trials are ongoing to assess the effect of GLP-1 analogs on the conversion to AD in patients with MCI&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally&#44; T2DM and AD each have a significant genetic load&#46; A systematic search carried out by our group through the AlzGene and PubMed databases identified the following 10 genes common to T2DM and AD&#58; APP &#40;amyloid &#946; A4 precursor protein&#41;&#44; APOE &#40;apolipoprotein E&#41;&#44; AMPK &#40;protein kinase&#44; AMP-activated&#44; &#947;2 subunit&#41;&#44; FTO &#40;fat mass and obesity&#41;&#44; PPAR-&#947; &#40;peroxisome proliferator activated receptor&#947;&#41;&#44; SORCS1 &#40;sortilin-related VPS10 domain containing receptor 1&#41;&#44; IDE &#40;insulin-degrading enzyme&#41;&#44; ABCA1 &#40;ATP-binding cassette sub-family A member 1&#41;&#44; VEGF &#40;vascular endothelial growth factor&#41;&#44; and PCK1&#46; Most these genes encode proteins involved in both the development of T2DM or its complications and in AD&#44; but their role in the relationship between the two diseases has yet to be elucidated&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Finally&#44; T2DM and AD are both age-related and highly prevalent diseases&#46; An established relation exists between them&#44; with T2DM acting as an accelerator of the progression to AD&#46; New approaches that will allow us to identify those diabetic patients at the greatest risk of experiencing AD are needed&#46; This would make possible the early implementation of potential therapeutic strategies that prevent or slow the development of this devastating disease&#46;</p></span>"
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ISSN: 21735093
Original language: English
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos