Treatment of diabetes for the prevention of dementia

Atsushi Araki¹⁾, Yoshinori Fujiwara²⁾, Yoshiaki Tamura¹⁾, Hideki Ito¹⁾, Ryouta Maeba³⁾

¹⁾Department of Diabetes, Metabolism, and Endocrinology
²⁾Tokyo Metropolitan Geriatric Hospital, Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology
³⁾Department of Biochemistry, Faculty of Medicine, Teikyo University

    Diabetes is associated with cognitive impairment and dementia.  Risk factors for cognitive impairment is 1)insulin resistance and insulin deficiency, 2)hyperglycemia, severe hypoglycemia, and high glucose fluctuations, 3)hypertension, dyslipidemia, metabolic syndrome, and hyperhomocysteinemia, 4)albuminuria and decrease in GFR.  These risk factors are in common with those of arteriosclerotic disease.
    Early diagnosis of mild cognitive impairment is of great importance in diabetic patients.  Information about instrumental ADLs and changes in mood and relationships are important for early recognition of cognitive impairment.  Since low levels of serum plasmalogen are associated with diabetes and cognitive impairment using the MoCA-J, plasmalogen level may be one of early markers for cognitive impairment in diabetes.
    For the prevention of cognitive decline in diabetes, comprehensive management of risk factors for dementia including exercise is necessary.  Oral hypoglycemia agents such as DPP-4 inhibitors, biguanides, α-glucosidase inhibitors, and glinides should be used to reduce hypoglycemia and glucose fluctuations.  SU drugs should be used in a smaller dose.

Address correspondence to Dr. Atsushi Araki, Department of Diabetes, Metabolism, and Endocrinology, Tokyo Metropolitan Geriatric Hospital (35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan)