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2013 | OriginalPaper | Buchkapitel

19. Demenz und Diabetes mellitus

verfasst von : Bastian Fatke, Dr., Hans Förstl, Prof. Dr.

Erschienen in: Psychodiabetologie

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Demenz ist ein Verlust geistiger Leistungen von solcher Schwere, dass der Alltag nicht mehr wie gewohnt allein bewältigt werden kann. Ursache sind überwiegend neurodegenerative und vaskuläre Hirnveränderungen. Ein Diabetes mellitus steigert das Risiko für alle Arten einer Demenz. In mehreren epidemiologischen Studien konnte eine Assoziation von Diabetes mellitus mit kognitiven Störungen nachgewiesen werden. Darüber hinaus wurde ein Zusammenhang von Diabetes mit Demenzerkrankungen allgemein sowie insbesondere mit der vaskulären Demenz und der Alzheimer-Demenz nachgewiesen. Die meisten Studien zeigen eine Risikoerhöhung für die vaskuläre Demenz etwa von 100–150 % und für die Alzheimer-Demenz von 50–100 % im Vergleich zu Menschen ohne Diabetes mellitus. Dabei erhöht sich das Risiko umso mehr, je länger der Diabetes besteht und je länger er nicht suffizient behandelt wird.
Diabetes mellitus begünstigt die Neuropathologie der Alzheimer-Erkrankung. Die diabetische Makro- und Mikroangiopathie und eine pathologische Angiogenese stimulieren inflammatorische Prozesse, führen zu einer chronischen Hypoxie und fördern die Bildung von β‑Amyloid-Plaques und Neurofibrillenbündeln. Der gestörte Glukosemetabolismus führt zur Bildung reaktiver Sauerstoff- und Stickstoffspezies, die ebenfalls inflammatorische Vorgänge begünstigen, Zellen direkt schädigen, und die Bildung von β‑Amyloid und hyperphosphoryliertem Τ‑Protein fördern. Glykation führt zu mitochrondrialer Dysfunktion und hat die Bildung von β‑Amyloid-Plaques und die Akkumulation von Neurofibrillen aus Τ‑Protein zur Folge. Chronische Hyperglykämie wie auch hypoglykämische Episoden beeinträchtigen kognitive Fähigkeiten auf Dauer. Insulin konkurriert mit β‑Amyloid um ein Insulin-abbauendes Enzym (IDE). Durch die Hyperinsulinämie wird somit der Abbau von β‑Amyloid gestört. Zahl und Sensitivität der Insulinrezeptoren nehmen auch im Gehirn ab. Durch die verringerte Insulinwirkung kommt es ebenfalls zu einer Τ‑Hyperphosphorylierung, der Abbau von Amyloid-Vorläufer-Protein wird zudem behindert. β‑Amyloid wiederum erhöht die Insulinresistenz im Gehirn, so dass die pathophysiologischen Prozesse von Diabetes mellitus und Alzheimer-Demenz sich teilweise gegenseitig verstärken. Ein Lebensstil mit regelmäßiger körperlicher Aktivität und mediterraner Diät ist mit einem geringeren Risiko auch für Demenz assoziiert. Antidiabetika wie Metformin und Insulinsensitizer zeigen eine positive Wirkung auf kognitive Leistungen. Die intranasale Insulingabe hat in Studien bereits einen positiven Effekt auf die kognitive Leistungsfähigkeit gezeigt und ist ein vielversprechender neuer Ansatz in der Therapie der Alzheimer-Demenz. Aufgrund seiner hohen Inzidenz hat der Diabetes mellitus eine wichtige epidemiologische Rolle bei der Entstehung der Demenz. Angesichts derzeit weltweit über 30 Mio. an Alzheimer-Demenz Erkrankten, kommt dem Diabetes bei der Prävention und Therapie eine besondere Bedeutung zu.
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Zurück zum Zitat Zhang H, Dellsperger KC, Zhang C (2012) The link between metabolic abnormalities and endothelial dysfunction in type 2 diabetes: an update. Basic Res Cardiol 107(1):237PubMedCrossRef Zhang H, Dellsperger KC, Zhang C (2012) The link between metabolic abnormalities and endothelial dysfunction in type 2 diabetes: an update. Basic Res Cardiol 107(1):237PubMedCrossRef
Metadaten
Titel
Demenz und Diabetes mellitus
verfasst von
Bastian Fatke, Dr.
Hans Förstl, Prof. Dr.
Copyright-Jahr
2013
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-642-29908-7_19

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