糖尿病と認知症

Diabetes Mellitus and Dementia

糖尿病は血管性認知症（VaD）やアルツハイマー病（AD）の発症リスクを高めるが，さらにAD病理や脳血管性病変よりも，糖代謝異常に伴う神経障害が密接に関連している一群に対して「糖尿病性認知症」と呼ぶべき新たな臨床単位を提唱した。臨床像や経過，脳画像所見からもADやVaDとは異なり，今後，糖尿病を伴う認知症の臨床においては，診断や治療の観点からも本症の病理・病態の解明が必要である。

Abstract

Diabetes mellitus (DM) has been proposed as a risk factors for the development of vascular dementia (VaD) and Alzheimer's disease (AD). We characterized a new clinical entity of a dementia subgroup associated with specific DM-related factors rather than with AD pathology or vascular disease. This type of dementia, not showing hypoperfusion in the parietotemporal lobe on SPECT or cerebrovascular lesions on MRI, was characterized by old age, high hemoglobin A1c level, long duration of diabetes, high frequency of insulin therapy, low frequency of apolipoprotein E 4 carrier, less severe medial temporal lobe atrophy, impaired attention, less impaired word recall, and slow progression of cognitive impairment, all of which differed from the characteristics of AD, and may be referred to as "diabetes-related dementia." In addition to insulin resistance, elevated inflammatory cytokines and oxidative stress were associated with cognitive impairment in this type of dementia. Characterization of a novel entity of diabetes-related dementia may have diagnostic and therapeutic implications.