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DOI: 10.1055/a-1146-7607
Diabetes mellitus und Demenz
Diabetes mellitus and dementia
Diabetes mellitus und Demenz werden mit zunehmendem Lebensalter häufiger, sind wegen der demografischen Entwicklung in Deutschland auf dem Vormarsch und beeinträchtigen die Lebensqualität erheblich. Sie hängen auch in ihrer Krankheitsentstehung zusammen: Bei Demenz liegt eine Insulinresistenz des Gehirns vor. Das Zusammentreffen der beiden Störungen erschwert die Behandlung erheblich, sodass neue Therapieziele und Konzepte erforderlich sind.
Abstract
Patients suffering from diabetes mellitus have an almost twofold increased risk of developing dementia in later life. Brain insulin resistance appears to play a crucial role in the pathogenesis of diabetes related dementia, which shares features of Alzheimer´s disease and vascular dementia. Midlife obesity is another powerful risk factor of later cognitive decline. However, in the early course of clinical dementia, weight loss is frequently observed, leading to a paradoxical association of weight and dementia. Unexplained weight loss in previously obese type-2 diabetes patients may be a first clinical sign of imminent cognitive decline. This is of particular clinical relevance, since weight loss may lead to hypoglycemia if hypoglycemic treatment is not adjusted.
Diabetes management in patients with overt dementia poses various problems, as patients may become less efficient in self-management. In parallel, remaining life expectancy is limited by dementia. Therefore, the focus of diabetes management shifts from prevention of long-term complications to short term treatment safety, avoidance of hypoglycemia and quality of life.
Publication History
Article published online:
22 December 2021
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