The risk of developing senile dementia can be calculated in a ten-year perspective for a patient with type 2 diabetes, say scientists from the Netherlands and the USA, whose work is published in the journal Lancet Diabetes & Endocrinology.
Researchers from the University Medical Center in Utrecht (University Medical Center Utrecht) and the Kaiser Center in California studied the data of about 30 thousand diabetics aged 60 years and older over a ten-year period. They found 8 factors that most often precede the development of dementia (senile dementia). Among them, disturbances in the work of capillaries, the so-called "diabetic foot" (ulcers on the feet), a violation of the blood supply to the brain. Each of the factors was assigned its own number of points in order to calculate the individual risk of dementia.
“Patients with type 2 diabetes are twice as likely to develop dementia as those without diabetes. We were the first to calculate individual risks for this particular category of patients, ”says lead author, Dr. Rachel Whitmer of the Kaiser Permanente Center in the USA.
Researchers found that among diabetics with the lowest score according to the developed 20-point system, the risk of dementia was 5.3%, while those with the highest score, dementia developed in 73% of cases (or 37 times more often) within 10 years.
Table from an article by Exalto et al. Risk score for prediction of 10 year dementia risk
in individuals with type 2 diabetes: a cohort study - VM.
The authors say that all the signs are easy to find on the patient’s medical record and the risk of developing dementia can be calculated with a regular visit to the doctor. This will not require any laboratory tests or MRI images, and the patient will be able to receive preventive treatment on time.
According to the Centers for Disease Control and Prevention, more than 25 million children and adults suffer from type 2 diabetes in the United States. In addition to the high risk of dementia, diabetes leads to kidney failure, gangrene and amputation of the extremities and blindness.
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Causes of brain damage in diabetes
Brain cells are most sensitive to fluctuations in blood glucose. For them, it is the main energy source. Therefore, in diabetes mellitus, regardless of its type, changes develop both in the vessels and in the brain tissue itself.
Symptoms of vascular disorders progress as diabetes progresses, the longer the duration of the disease, the more they affect thinking processes. It also depends on diabetes compensation and the presence of sudden fluctuations in sugar levels.
The second type of diabetes is accompanied by a slowed metabolism, a decrease in high-density lipoproteins and an increase in cholesterol. With type 2 diabetes, patients are obese and have high blood pressure more often than with the first type.
Vascular dementia accompanies the second type of diabetes much more often because the age of patients usually leads to a decrease in vascular elasticity, as well as to atherosclerotic lesions and thrombosis in them.
In addition, in older people, vein arterial anastomoses are less likely to form to compensate for blood circulation in the area of damaged brain tissue. Factors leading to dementia in diabetes mellitus are:
- Reduced ability of the body to break down amyloid proteins with a lack of insulin or insulin resistance.
- Destruction of the vascular wall by hyperglycemia.
- Impaired lipid metabolism, which provokes deposition of cholesterol in the vessels
- Attacks of hypoglycemia leading to the death of brain cells.
Scientists who have investigated the relationship between diabetes and Alzheimer's disease have found that the risk of memory loss in diabetes is two times higher than with normal carbohydrate metabolism. One hypothesis of the relationship between these diseases is the similarity of the amyloid protein in the pancreas and the brain.
In Alzheimer's disease, amyloid protein deposits are the reason for the loss of ability to establish connections between brain neurons. This causes symptoms such as a decrease in memory and intelligence in this pathology. In case of damage to the beta cells that produce insulin, amyloid accumulations are found in the tissues of the pancreas.
Since vascular dementia exacerbates the manifestations of the disease, it is considered the second most important risk factor for the development of the disease described by Alzheimer.
The resulting tissue hypoxia leads to the activation of enzymes that provoke a weakening of brain activity.
How does diabetes affect the brain?
Diabetes mellitus destructively affects all processes in the body. Glucose is the main nutrient and energy source for the brain. Fluctuations in the level negatively affect the brain, disrupting cellular processes and causing the gradual death of brain tissue. The severity of symptoms and the severity of the course of the disease depend on its type, the patient’s lifestyle, control and maintenance of blood sugar. Over time, after diagnosis and natural aging of the body, the likelihood of developing dementia increases.
Dementia develops more often with type 2 diabetes and is more difficult due to a number of disorders:
- overweight, obesity,
- constantly high blood pressure,
- increased blood cholesterol.
Causes of dementia in diabetes:
- circulatory disorders, decreased vascular elasticity, tendency to form blood clots,
- oxygen starvation of cells, organs and tissues,
- violation of lipid metabolism, causing deposition of cholesterol,
- protein breakdown
- violation of water and fat metabolism,
- isolation and circulation of decay products in the blood,
- reduced antibody formation, susceptibility to infections,
- hypoglycemia - a sharp decrease in glucose levels, causing loss of consciousness, coma, death of brain cells.
Symptoms of dementia in diabetes
Disease and natural aging of the body have a destructive effect on brain activity. With an increase in the concentration of glucose in the blood, the manifestations of dementia intensify. Symptoms of developing dementia:
- memory impairment
- impaired concentration,
- decreased perception of new incoming information,
- deterioration of orientation in time and space,
- fast fatiguability,
- difficulty reading, writing,
- development of emotional disorders - indifference to others, distraction from external stimuli, lethargy,
- reduction in vocabulary, difficulties in formulating thoughts and making coherent sentences.
The danger of dementia in diabetes mellitus lies in the patient’s inability to control his health condition, blood glucose level and adequately respond to changes in well-being without outside help.
With the course of the disease, the patient loses the ability to self-service and perform simple actions:
- there is disorientation in space,
- changes in behavior increase - the patient becomes aggressive, agitated,
- auditory and visual hallucinations occur, delusions,
- the ability to recognize people, objects is lost.
Therapy is aimed at lowering sugar levels, stabilizing and maintaining the amount of glucose in the blood, lowering blood pressure, lowering cholesterol. In severe cases of the disease and the patient's inability to self-service themselves, drug therapy is carried out in a hospital.
The drugs used to relieve the symptoms of dementia are presented in the table:
In addition to drug therapy, the patient is recommended:
- Compliance with diet and diet. Enrichment of the diet with seafood, fish dishes, fresh vegetables and fruits, olive oil. Refusal of meat, dairy products, flour, sweet, fried and fatty foods.
- Performing feasible permitted physical activity, breathing exercises. It helps to reduce excess weight, improve blood circulation, the general endurance of the body.
- Intellectual training. The intensification of mental activity by reading fiction, solving crosswords and puzzles, playing chess.
- Exclusion of bad habits - smoking, alcohol.
- Stabilization of psychoemotional balance.
It is possible to prevent the development of dementia in diabetes mellitus and stop the development of symptoms by the constant use of antidiabetic drugs, maintaining a healthy lifestyle, regular medical supervision and timely elimination of manifestations of brain activity disorders.