Когнитивные нарушения при предиабете и диабете: от патогенеза к комплексной терапии

Когнитивные нарушения, от легких когнитивных нарушений до деменции, все чаще признаются потенциальным осложнением диабета. Рост распространенности диабета вместе со старением населения может привести к значительному увеличению распространенности когнитивных нарушений среди людей с диабетом. Связь диабета и когнитивных нарушений может отражать прямое влияние гипергликемии на мозг или влияние сопутствующих заболеваний, связанных с диабетом, таких как гипертония, дислипидемия или гиперинсулинемия. Существуют доказательства влияния диабетических процессов как на нейродегенеративные, так и на сосудистые процессы, что способствует как когнитивным нарушениям, подобным болезни Альцгеймера, т. е. амнестическим, так и цереброваскулярным когнитивным нарушениям, характеризующимся нарушением исполнительных когнитивных функций. Гипергликемия, ожирение и инсулинорезистентность могут вызывать микрососудистую дисфункцию головного мозга, которая уже проявляется у взрослых с предиабетом, приводя к структурным аномалиям головного мозга, таким как васкуляризированные лакуны, церебральные микрокровоизлияния, периваскулярные пространства, глобальная атрофия головного мозга и микроинфаркты, и все больше данных свидетельствует о том, что это один из ключевых факторов когнитивного снижения. Кроме того, инсулин или побочные продукты, связанные с диабетом, могут влиять на амилоидный каскад, который, как считается, ответственен за болезнь Альцгеймера. Таким образом, потенциальные механизмы, связывающие диабет с когнитивными нарушениями, классифицируются как цереброваскулярные и нецереброваскулярные. Оптимизация лечения сердечно-сосудистых факторов риска у людей с предиабетом и диабетом может стать потенциально важной терапевтической возможностью. Перспективными в этом направлении являются препараты, обладающие антиоксидантной и антигипоксической активностью. Поиск литературных источников проводился в электронных базах данных PubMed/MEDLINE, eLIBRARY.RU, Cochrane Library, Google Scholar за период с 1989 по 2025 г. Оценены 216 источников литературы, из них включены в обзор 90 источников литературы.

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