The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press4810.17650/1818-8338-2012-3-4-10-16REVIEWОБЗОРDiabetic encephalopathy: Pathogenesis, clinical manifestations, therapy approachesДиабетическая энцефалопатия: патогенез, клинические проявления, подходы к терапииKhairullinI. Kh.ХайруллинИ. Х.
Russian Federation
ZyangirovaS. T.ЗянгироваС. Т.
Russian Federation
IsayevaYu. N.ИсаеваЮ. Н.
Russian Federation
EsinO. R.ЕсинО. Р.
Russian Federation
Kazan State Medical Academy, Ministry of Health of RussiaГБОУ ДПО «Казанская государственная медицинская академия» Минздрава РоссииKazan Endocrinology DispensaryГУЗ «Казанский эндокринологический диспансер»1510201263-410161507201415072014Copyright ©; 2012, Khairullin I.K., Zyangirova S.T., Isayeva Y.N., Esin O.R.Copyright ©; 2012, Хайруллин И.Х., Зянгирова С.Т., Исаева Ю.Н., Есин О.Р.2012Khairullin I.K., Zyangirova S.T., Isayeva Y.N., Esin O.R.Хайруллин И.Х., Зянгирова С.Т., Исаева Ю.Н., Есин О.Р.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/48

The paper considers the epidemiology, morphology, and clinical manifestations of diabetic encephalopathy. It shows the differences of diabetic encephalopathy in types 1 and 2 diabetes mellitus. Pathogenetic treatment options for diabetic encephalopathy are given.

Рассмотрены вопросы эпидемиологии, морфологии и клинических проявлений диабетической энцефалопатии. Показаны различия диабетической энцефалопатии при сахарном диабете 1-го и 2-го типов. Представлены методы патогенетического лечения диабетической энцефалопатии.

diabetic encephalopathydiabetes mellitusEGb 761®диабетическая энцефалопатиясахарный диабетEGb 761®1. Sima A.A. Encephalopathies: the emerging diabetic complications. Acta Diabetol 2010;47(4):279–93.Sima A.A. Encephalopathies: the emerging diabetic complications. Acta Diabetol 2010;47(4):279–93.2. Чуйко М.Р., Бодыхов М.К., Скворцова В.И. Характеристика и особенности течения энцефалопатии при инсулинзависимом сахарном диабете. Журн неврол психиатр им. С.С. Корсакова 2010;110(5):4–8.Чуйко М.Р., Бодыхов М.К., Скворцова В.И. Характеристика и особенности течения энцефалопатии при инсулинзависимом сахарном диабете. Журн неврол психиатр им. С.С. Корсакова 2010;110(5):4–8.3. Строков И.А., Захаров В.В., Строков К.И. Диабетическая энцефалопатия. Неврол, нейропсихиатр, психосом 2012;(2):30–9.Строков И.А., Захаров В.В., Строков К.И. Диабетическая энцефалопатия. Неврол, нейропсихиатр, психосом 2012;(2):30–9.4. Miles W.R., Root H.F. Psychological tests applied in diabetic patients. Arch Intern Med 1922;30:767–77.Miles W.R., Root H.F. Psychological tests applied in diabetic patients. Arch Intern Med 1922;30:767–77.5. Ott A., Stolk R.P., van Harskamp F. et al. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology 1999;53(9):1937–41.Ott A., Stolk R.P., van Harskamp F. et al. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology 1999;53(9):1937–41.6. Arvanitakis Z., Wilson R.S., Bienias J.L. et al. Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Arch Neurol 2004;61(5):661–6.Arvanitakis Z., Wilson R.S., Bienias J.L. et al. Diabetes mellitus and risk of Alzheimer disease and decline in cognitive function. Arch Neurol 2004;61(5):661–6.7. Xu W.L., Qui C.X., Wahlin A. et al. Diabetes mellitus and risk of dementia in the Kungsholmen project: a 6-year follow-up study. Neurology 2004;63(7):1181–6.Xu W.L., Qui C.X., Wahlin A. et al. Diabetes mellitus and risk of dementia in the Kungsholmen project: a 6-year follow-up study. Neurology 2004;63(7):1181–6.8. Kumari M., Marmot M. Diabetes and cognitive function in a middle-aged cohort: findings from the Whitehall II study. Neurology 2005;65(10):1597–603.Kumari M., Marmot M. Diabetes and cognitive function in a middle-aged cohort: findings from the Whitehall II study. Neurology 2005;65(10):1597–603.9. Worrall G., Moulton E., Briffett E. Effect of type II diabetes mellitus on cognitive function. J Fam Pract 1993;36(6):639–43.Worrall G., Moulton E., Briffett E. Effect of type II diabetes mellitus on cognitive function. J Fam Pract 1993;36(6):639–43.10. Fontbonne A., Berr C., Ducimetiere P., Alperovitch A. Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 2001;24(2):366–70.Fontbonne A., Berr C., Ducimetiere P., Alperovitch A. Changes in cognitive abilities over a 4-year period are unfavorably affected in elderly diabetic subjects: results of the Epidemiology of Vascular Aging Study. Diabetes Care 2001;24(2):366–70.11. van Harten B., Oosterman J., Muslimovic D. et al. Cognitive impairment of MRI correlates in the elderly patients with type 2 diabetes mellitus. Age Ageing 2007;36(2):164–170.van Harten B., Oosterman J., Muslimovic D. et al. Cognitive impairment of MRI correlates in the elderly patients with type 2 diabetes mellitus. Age Ageing 2007;36(2):164–170.12. Hassing L.B., Grant M.D., Hofer S.M. et al. Type 2 diabetes mellitus contributes to cognitive decline in old age: a longitudinal population-based study. J Int Neuropsychol Soc 2004;10(4):599–607.Hassing L.B., Grant M.D., Hofer S.M. et al. Type 2 diabetes mellitus contributes to cognitive decline in old age: a longitudinal population-based study. J Int Neuropsychol Soc 2004;10(4):599–607.13. Komulainen P., Lakka T.A., Kivipelto M. et al. Metabolic syndrome and cognitive function: a population-based follow-up study in elderly women. Dement Geriatr Cogn Disord 2007;23(1):29–34.Komulainen P., Lakka T.A., Kivipelto M. et al. Metabolic syndrome and cognitive function: a population-based follow-up study in elderly women. Dement Geriatr Cogn Disord 2007;23(1):29–34.14. Convit A., Wolf O.T., Tarshish C., de Leon M.J. Reduced glucose tolerance is associated with poor memory performance and hippocampal atrophy among normal elderly. Proc Natl Acad Sci USAConvit A., Wolf O.T., Tarshish C., de Leon M.J. Reduced glucose tolerance is associated with poor memory performance and hippocampal atrophy among normal elderly. Proc Natl Acad Sci USA2003;100(4):2019–22.;100(4):2019–22.15. Pinkston J.B., Alekseeva N., Gonzalez Toledo E. Stroke and dementia. Neurol Res 2009;31(8):824–31.Pinkston J.B., Alekseeva N., Gonzalez Toledo E. Stroke and dementia. Neurol Res 2009;31(8):824–31.16. Чугунов А.В., Семенова И.В. Сахарный диабет и когнитивные нарушения. Сах диабет 2008;(1):61–8.Чугунов А.В., Семенова И.В. Сахарный диабет и когнитивные нарушения. Сах диабет 2008;(1):61–8.17. Diabetes Control Complications Trial/Epidemiology of Diabetes Interventions, Complications (DCCT/EDIC) Study Research Group; Jacobson A.M., Musen G., Ryan C.M. et al. Long-term effect ofDiabetes Control Complications Trial/Epidemiology of Diabetes Interventions, Complications (DCCT/EDIC) Study Research Group; Jacobson A.M., Musen G., Ryan C.M. et al. Long-term effect ofdiabetes and its treatment on cognitive function. N Engl J Med 2007;356(18):1842–52.18. Sima A.A., Zhang W., Muzik O. et al. Sequential abnormalities in type 1 diabetic encephalopathy and the effects of C-peptide. Rev Diabet Stud 2009;6(3):211–22.Sima A.A., Zhang W., Muzik O. et al. Sequential abnormalities in type 1 diabetic encephalopathy and the effects of C-peptide. Rev Diabet Stud 2009;6(3):211–22.19. Brismar T., Hyllienmark L., Ekberg K., Johansson B.L. Loss of temporal lobe beta power in young adults with type 1 diabetes mellitus. Neuroreport 2002;13(18):2469–73.Brismar T., Hyllienmark L., Ekberg K., Johansson B.L. Loss of temporal lobe beta power in young adults with type 1 diabetes mellitus. Neuroreport 2002;13(18):2469–73.20. Peila R., Rodriguez B.L., Launer L.J.; Honolulu-Asia Aging Study. Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: the Honolulu-Asia Aging Study. Diabetes 2002;51(4):1256–62.Peila R., Rodriguez B.L., Launer L.J.; Honolulu-Asia Aging Study. Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: the Honolulu-Asia Aging Study. Diabetes 2002;51(4):1256–62.21. Etgen T., Sauder D., Bichel H. et al. Cognitive decline: the relevance of diabetes, hyperlipidaemia and hypertension. Br J Diab Vasc Dis 2010;10(3):115–22.Etgen T., Sauder D., Bichel H. et al. Cognitive decline: the relevance of diabetes, hyperlipidaemia and hypertension. Br J Diab Vasc Dis 2010;10(3):115–22.22. Hassing L.B., Hofer S.M., Nilsson S.E. et al. Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal study. Age Ageing 2004;33(4):355–61.Hassing L.B., Hofer S.M., Nilsson S.E. et al. Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal study. Age Ageing 2004;33(4):355–61.23. Posner H.B., Tang M.X., Luchsinger J. et al. The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function. Neurology 2002;58(8):1175–81.Posner H.B., Tang M.X., Luchsinger J. et al. The relationship of hypertension in the elderly to AD, vascular dementia, and cognitive function. Neurology 2002;58(8):1175–81.24. Tezapsidis N., Johnston J.M., Smith M.A. et al. Leptin: a novel therapeutic strategy for Alzheimer’s disease. J Alzheimer Dis 2009;16(4):731–40.Tezapsidis N., Johnston J.M., Smith M.A. et al. Leptin: a novel therapeutic strategy for Alzheimer’s disease. J Alzheimer Dis 2009;16(4):731–40.25. Nourhashémi F., Deschamps V., Larrieu S. et al.; PAQUID Study. Personnes Agées Quid. Body mass index and incidence of dementia: the PAQUID study. Neurology 2003;60(1):117–9.Nourhashémi F., Deschamps V., Larrieu S. et al.; PAQUID Study. Personnes Agées Quid. Body mass index and incidence of dementia: the PAQUID study. Neurology 2003;60(1):117–9.26. Henderson V.W., Guthrie J.R., Dennerstein L. Serum lipids and memory in a population based cohort of middle age women. J Neurol Neurosurg Psychiatry 2003;74(11):1530–5.Henderson V.W., Guthrie J.R., Dennerstein L. Serum lipids and memory in a population based cohort of middle age women. J Neurol Neurosurg Psychiatry 2003;74(11):1530–5.27. de la Monte S.M., Wands J.R. Alzheimer’s disease is type 3 diabetesevidence reviewed. J Diabetes Sci Technol 2008;2(6):1101–13.de la Monte S.M., Wands J.R. Alzheimer’s disease is type 3 diabetesevidence reviewed. J Diabetes Sci Technol 2008;2(6):1101–13.28. Inoguchi T., Li P., Umeda F. et al. High glucose level and free fatty acid stimulate reactive oxygen species production through protein-kinase C-dependent activation of NAD(P)H oxidase in cultured vascular cells. Diabetes 2000;49(11):1939–45.Inoguchi T., Li P., Umeda F. et al. High glucose level and free fatty acid stimulate reactive oxygen species production through protein-kinase C-dependent activation of NAD(P)H oxidase in cultured vascular cells. Diabetes 2000;49(11):1939–45.29. Li Z.G., Zhang W., Sima A.A. Alzheimer-like changes in rat models of spontaneous diabetes. Diabetes 2007;56(7):1817–24.Li Z.G., Zhang W., Sima A.A. Alzheimer-like changes in rat models of spontaneous diabetes. Diabetes 2007;56(7):1817–24.30. Li Z.G., Zhang W., Sima A.A. C-peptide enhances insulin-mediated cell growth and protection against high glucose induced apoptosis in SH-SY5Y cells. Diabetes Metab Res Rev 2003;19(5):375–85.Li Z.G., Zhang W., Sima A.A. C-peptide enhances insulin-mediated cell growth and protection against high glucose induced apoptosis in SH-SY5Y cells. Diabetes Metab Res Rev 2003;19(5):375–85.31. Hayden M.S., Ghosh S. Signaling to NF-kappaB. Genes Dev 2004;18(18):2195–224.Hayden M.S., Ghosh S. Signaling to NF-kappaB. Genes Dev 2004;18(18):2195–224.32. Brunton S. Beyond glycemic control: treating the entire type 2 diabetes disorder. Postgrad Med 2009;121(5):68–81.Brunton S. Beyond glycemic control: treating the entire type 2 diabetes disorder. Postgrad Med 2009;121(5):68–81.33. Chen G.J., Xu J., Lahousse S.A. et al. Transient hypoxia causes Alzheimer-type molecular and biochemical abnormalities in cortical neurons: potential strategies for neuroprotection. J Alzheimers Dis 2003;5(3):209–28.Chen G.J., Xu J., Lahousse S.A. et al. Transient hypoxia causes Alzheimer-type molecular and biochemical abnormalities in cortical neurons: potential strategies for neuroprotection. J Alzheimers Dis 2003;5(3):209–28.34. Farris W., Mansourian S., Chang Y. et al. Insulin-degrading enzyme regulates the levels of insulin, amyloid beta-protein, and the beta-amyloid precursor protein intracellular domain in vivo. Proc Natl Acad Sci USA 2003;100(7):4162–7.Farris W., Mansourian S., Chang Y. et al. Insulin-degrading enzyme regulates the levels of insulin, amyloid beta-protein, and the beta-amyloid precursor protein intracellular domain in vivo. Proc Natl Acad Sci USA 2003;100(7):4162–7.35. Ehehalt R., Keller P., Haass C. et al. Amyloidogenic processing of the Alzheimer beta-amyloid precursor protein depends on lipid rafts. J Cell Biol 2003;160(1):113–23.Ehehalt R., Keller P., Haass C. et al. Amyloidogenic processing of the Alzheimer beta-amyloid precursor protein depends on lipid rafts. J Cell Biol 2003;160(1):113–23.36. Refolo L.M., Malester B., LaFrancois J. et al. Hypercholesterolemia accelerates the Alzheimer’s amyloid pathology in a transgenic mouse model. Neurobiol Dis 2000;7(4):321–31.Refolo L.M., Malester B., LaFrancois J. et al. Hypercholesterolemia accelerates the Alzheimer’s amyloid pathology in a transgenic mouse model. Neurobiol Dis 2000;7(4):321–31.37. Jurevics H., Morell P. Cholesterol for synthesis of myelin is made locally, not imported into brain. J Neurochem 1995;64(2):895–901.Jurevics H., Morell P. Cholesterol for synthesis of myelin is made locally, not imported into brain. J Neurochem 1995;64(2):895–901.38. Sima A.A., Kamiya H. Is C-peptide replacement the missing link for successful treatment of neurological complications in type 1 diabetes? Curr Drug Targets 2008;9(1):37–46.Sima A.A., Kamiya H. Is C-peptide replacement the missing link for successful treatment of neurological complications in type 1 diabetes? Curr Drug Targets 2008;9(1):37–46.39. Sima A.A., Li Z.G. The effect of C-peptide on cognitive dysfunction and hippocampal apoptosis in type 1 diabetic rats. Diabetes 2005;54(5):1497–505.Sima A.A., Li Z.G. The effect of C-peptide on cognitive dysfunction and hippocampal apoptosis in type 1 diabetic rats. Diabetes 2005;54(5):1497–505.40. Matsui T., Ramasamy K., Ingelsson M. et al. Coordinated expression of caspase 8, 3 and 7 mRNA in temporal cortex of Alzheimer disease: relationship to formic acid extractable abeta42 levels.Matsui T., Ramasamy K., Ingelsson M. et al. Coordinated expression of caspase 8, 3 and 7 mRNA in temporal cortex of Alzheimer disease: relationship to formic acid extractable abeta42 levels.J Neuropathol Exp Neurol 2006; 65(5):508–15.41. Northam E.A., Anderson P.J., Jacobs R. et al. Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care 2001;24(9):1541–6.Northam E.A., Anderson P.J., Jacobs R. et al. Neuropsychological profiles of children with type 1 diabetes 6 years after disease onset. Diabetes Care 2001;24(9):1541–6.42. Northam E.A., Rankins D., Lin A. et al. Central nervous system function in youth with type 1 diabetes 12 years after disease onset. Diabetes Care 2009;32(3):445–50.Northam E.A., Rankins D., Lin A. et al. Central nervous system function in youth with type 1 diabetes 12 years after disease onset. Diabetes Care 2009;32(3):445–50.43. Ryan C.M. Why is cognitive dysfunction associated with the development of diabetes early in life? The diathesis hypothesis. Pediatr Diabetes 2006;7(5):289–97.Ryan C.M. Why is cognitive dysfunction associated with the development of diabetes early in life? The diathesis hypothesis. Pediatr Diabetes 2006;7(5):289–97.44. Fox M.A., Chen R.S., Holmes C.S. Gender differences in memory and learning in children with insulin-dependent diabetes mellitus (IDDM) over a 4-year follow-up interval. J Pediatr Psychol 2003;28(8):569–78.Fox M.A., Chen R.S., Holmes C.S. Gender differences in memory and learning in children with insulin-dependent diabetes mellitus (IDDM) over a 4-year follow-up interval. J Pediatr Psychol 2003;28(8):569–78.45. Austin E.J., Deary I.J. Effects of repeated hypoglycemia on cognitive function: a psychometrically validated reanalysis of the diabetes control and complications trial data. Diabetes Care 1999;22(8):1273–7.Austin E.J., Deary I.J. Effects of repeated hypoglycemia on cognitive function: a psychometrically validated reanalysis of the diabetes control and complications trial data. Diabetes Care 1999;22(8):1273–7.46. Ho M.S., Weller N.J., Ives F.J. et al. Prevalence of structural central nervous system abnormalities in early-onset type 1 diabetes mellitus. J Pediatr 2008;153(3):385–90.Ho M.S., Weller N.J., Ives F.J. et al. Prevalence of structural central nervous system abnormalities in early-onset type 1 diabetes mellitus. J Pediatr 2008;153(3):385–90.47. Musen G., Lyoo I.K., Sparks C.R. et al. Effects of type 1 diabetes on gray matter density as measured by voxel-based morphometry. Diabetes 2006;55(2):326–33.Musen G., Lyoo I.K., Sparks C.R. et al. Effects of type 1 diabetes on gray matter density as measured by voxel-based morphometry. Diabetes 2006;55(2):326–33.48. Salem M.A., Matta L.F., Tantawy A.A. et al. Single photon emission tomography (SPECT) study of regional cerebral blood flow in normoalbuminuric children and adolescents with type 1 diabetes. Pediatr Diabetes 2002;3(3):155–62.Salem M.A., Matta L.F., Tantawy A.A. et al. Single photon emission tomography (SPECT) study of regional cerebral blood flow in normoalbuminuric children and adolescents with type 1 diabetes. Pediatr Diabetes 2002;3(3):155–62.49. Perantie D.C., Wu J., Koller J.M. et al. Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1diabetes. Diabetes Care 2007;30(9):2331–7.Perantie D.C., Wu J., Koller J.M. et al. Regional brain volume differences associated with hyperglycemia and severe hypoglycemia in youth with type 1diabetes. Diabetes Care 2007;30(9):2331–7.50. Malone J.I., Hanna S., Saporta S. et al. Hyperglycemia not hypoglycemia alters neuronal dendrites and impairs spatial memory. Pediatr Diabetes 2008;9(6):531–9.Malone J.I., Hanna S., Saporta S. et al. Hyperglycemia not hypoglycemia alters neuronal dendrites and impairs spatial memory. Pediatr Diabetes 2008;9(6):531–9.51. Hoffman W.H., Artlett C.M., Zhang W. et al. Receptor for advanced glycation end products and neuronal deficit in the fatal brain edema of diabetic ketoacidosis. Brain Res 2008;1238:154–62.Hoffman W.H., Artlett C.M., Zhang W. et al. Receptor for advanced glycation end products and neuronal deficit in the fatal brain edema of diabetic ketoacidosis. Brain Res 2008;1238:154–62.52. Biessels G.J., Kamal A., Urban I.J. et al. Water maze learning and hippocampal synaptic plasticity in streptozotocin-diabetic rats: effects of insulin treatment. Brain Res 1998;800(1):125–35.Biessels G.J., Kamal A., Urban I.J. et al. Water maze learning and hippocampal synaptic plasticity in streptozotocin-diabetic rats: effects of insulin treatment. Brain Res 1998;800(1):125–35.53. Kamijo M., Cherian P.V., Sima A.A. The preventive effect of aldose reductase inhibition on diabetic optic neuropathy in the BB/W-rat. Diabetologia 1993;36(10):893–8.Kamijo M., Cherian P.V., Sima A.A. The preventive effect of aldose reductase inhibition on diabetic optic neuropathy in the BB/W-rat. Diabetologia 1993;36(10):893–8.54. Balakrishnan S., Mathew J., Paulose C.S. Cholinergic and glutamergic receptor functional regulation in long-term, low dose somatotropin and insulin treatment to ageing rats: rejuvenation of brain function. Mol Cell Endocrinol 2010;314(1):23–30.Balakrishnan S., Mathew J., Paulose C.S. Cholinergic and glutamergic receptor functional regulation in long-term, low dose somatotropin and insulin treatment to ageing rats: rejuvenation of brain function. Mol Cell Endocrinol 2010;314(1):23–30.55. Conner J.M., Franks K.M., Titterness A.K. et al. NGF is essential for hippocampal plasticity and learning. J Neurosci 2009;29(35):10883–9.Conner J.M., Franks K.M., Titterness A.K. et al. NGF is essential for hippocampal plasticity and learning. J Neurosci 2009;29(35):10883–9.56. Francis G.J., Martinez J.A., Liu W.Q. et al. Intranasal insulin prevents cognitive decline, cerebral atrophy and white matter changes in murine type I diabetic encephalopathy. Brain 2008;131(Pt 12):Francis G.J., Martinez J.A., Liu W.Q. et al. Intranasal insulin prevents cognitive decline, cerebral atrophy and white matter changes in murine type I diabetic encephalopathy. Brain 2008;131(Pt 12):3311–34.–34.57. Камчатнов П.Р. Возможности применения экстракта гинкго билоба (мемоплант) в неврологической практике. Журн неврол и психиатр 2010;110(5):51–6.Камчатнов П.Р. Возможности применения экстракта гинкго билоба (мемоплант) в неврологической практике. Журн неврол и психиатр 2010;110(5):51–6.58. Камчатнов П.Р. Экстракт Гинкго билоба EGb 761® – современные возможности клинического применения. М.: Изд-во ГУП РТ «ИИЦ УДП РТ», 2012.Камчатнов П.Р. Экстракт Гинкго билоба EGb 761® – современные возможности клинического применения. М.: Изд-во ГУП РТ «ИИЦ УДП РТ», 2012.