Hungarian Medical Journal
Volume/Issue:
Volume 2: Issue 1
Cerebral Complications of Diabetes Mellitus
Author:
Zsuzsa Aszalós Semmelweis University Medical School, Faculty of Medicine 2nd Department of Internal Medicine Szentkirályi u. 46 H-1088 Budapest Hungary

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Pages:
19–27
Online Publication Date:
14 Mar 2008
Publication Date:
01 Mar 2008
Article Category:
Research Article
DOI:
https://doi.org/10.1556/hmj.2.2008.28221
Keywords:
diabetes mellitus; cognitive function; dementia; depression; Alzheimer’s disease
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According to WHO estimates, more than 180 million people suffer from diabetes mellitus worldwide and this number could double within 15 years. Normal function of the brain is dependent on continuous supply of glucose. In hypoglycemia, production of counterregulatory hormones (glucagon, epinephrine, growth hormone, and cortisol) increases, the sympathetic system becomes stimulated, and features of neuroglycopenia appear in order to save the homeostasis. Hypoglycemia is an alarming, actually life-threatening condition, but the exposures to chronic hyperglycemia have a more detrimental effect on the brain than recurrent exposure to severe hypoglycemia. The active neural response to hyperglycemia induces changes in gene expression and function. The first steps against hyperosmolality are initially adaptive, but later hyperactivation of the hypothalamic magnocellular neurosecretory cells leads to their structural damage. Changes in hippocampal gene transcription are partially implicated in the deterioration of declarative memory. Neurologically passive shunting of excess glucose through alternative cellular metabolic pathways induces atherogenic, vascular lesions, free radicals, leukoencephalopathy and atrophy of the brain, thus leading to cognitive deficits. In physiological conditions insulin has a neuroprotective effect. However, insulin resistance in the central nervous system correlates with insulin resistance in the periphery. Loss of responsiveness to insulin could render neurons more susceptible to neurotoxic insults, the protective effect of insulin diminishes, and apoptosis, neurodegeneration and the resultant cognitive decline are all increased in insulin-resistant patients. Some unclear relations appear between diabetes mellitus and Alzheimer’s disease. Diabetic patients with APOE-4 gene have an increased risk for Alzheimer’s disease. Prevalence of depression is higher in patients with diabetes mellitus and in turn, depression is a risk factor for diabetes mellitus. Simultaneous presence of depression and diabetes mellitus tends to worsen the course of both.

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Cover Hungarian Medical Journal
Hungarian Medical Journal
Print ISSN:
1788-6139
Online ISSN:
1789-0403

Hungarian Medical Journal
Language English
Size  
Year of
Foundation		 2007
Publication
Programme		 ceased
Volumes
per Year		  
Issues
per Year		  
Publisher Akadémiai Kiadó
Publisher's
Address		 H-1117 Budapest, Hungary 1516 Budapest, PO Box 245.
Responsible
Publisher		 Chief Executive Officer, Akadémiai Kiadó
ISSN 1788-6139 (Print)
ISSN 1789-0403 (Online)

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