[Type 2 diabetes and cognitive functions in patients with chronic cerebrovascular diseases].

BACKGROUND: Type 2 diabetes (Т2DM) both directly and indirectly impacts the development of morphological and functional changes of the central nervous system. AIM: The study was to determine clinical and neurophysiological patterns of cognitive impairment (CI) in patients with chronic cerebrovascular diseases (CCD) and Т2DM. MATERIALS AND METHODS: We examined 132 patients with CCD. First group included 58 patients without Т2DM aged 64.5 [58; 72], second group 74 patients with CCD and Т2DM 63 [57; 70]. Clinical, neurological, neuropsychological, neurophysiological (cognitive evoked potentials (EP) and neurovisualisation (brain MRI) examination was carried out to all patients. RESULTS: Somatic and neurological characteristics of the patients were similar in both groups with the exception of more distinct metabolic changes in Т2DM patients. Neurovisualisation study of the brain MRI in Т2DM patients revealed more distinct changes in the form of white matter hyperintensity and subarachnoidal spaces enlargement. Neuropsychological examination in patients revealed the reduction of intellectual flexibility, constructive praxis disruption, optical spatial dysfunction and deteoration of delayed word recall. Significant disorders in the way of overall cognitive impairment, lobar dysfunction and impaired verbal associative productivity, proved by statistically lower amplitude and higher latency of P300 EP peak were noted in Т2DM patients. Correlation links were detected: for P300 amplitude and direct and inverse number listing test (r=0.366 and r=0.520; p=0.006 and p0.001 respectively); P300 latency and HbA1c (r=0.32; р0.05) in group 2 and glucose levels in both groups (r=0.30; p0.05); inverse relationship of latency with control functions evaluation (r=-0.34; p=0.008). CONCLUSION: CCD especially with Т2DM manifests with neurocognitive imbalance, including control functions disruption and are accompanied by neurophysiological and neurovisualistion changes.

Prospects of intranasal insulin for correction of cognitive impairments, in particular those associated with diabetes mellitus.

Despite the well-studied effect of insulin in peripheral tissues, its role in functioning of the central nervous system is much less understood. The effects of insulin in the brain are extremely diverse: insulin plays an important role in neuron growth and differentiation, affects higher cognitive functions (in particular, the formation of long-term memory), and also has a neuroprotective effect. Both peripheral and central insulin resistance as well as absolute insulin deficiency impairs the functional activity of neurons and neurogenesis. Several studies have investigated intranasal administration of insulin as a potential way for correction of these disorders. The review presents data on abnormalities of the insulin signaling system in the brain in diabetes mellitus, which is accompanied by cognitive dysfunction of varying severity and is associated with the development of neurodegenerative disorders, including Alzheimer's disease. We analyzed the results of studies on the use of intranasal insulin in animal models with diabetes mellitus, healthy volunteers, and patients with cognitive impairments.

[Perspectives of application of intranasally administered insulin for correction of metabolic and hormonal disorders in diabetes mellitus and metabolic syndrome].

In recent years, the possibility of using intranasally administered insulin to treat Alzheimers disease and other cognitive disorders has been widely studied. At the same time, the possibility of its use in the treatment of diabetes mellitus is practically not investigated, which is due to the insufficient study of the molecular mechanisms of its action on the hormonal and metabolic status of the organism. The review discusses literature data and the results of our own research on the role of insulin in the central regulation of energy homeostasis, as well as on the experience of using intranasally administered insulin to correct eating disorders and metabolic and hormonal dysfunctions developing under conditions of experimental diabetes mellitus and metabolic syndrome. In studies involving healthy volunteers, various effects of intranasally administered insulin were shown, including effects on cognitive function, eating behavior and weight loss, and the gender specificity of its action was found. In the course of numerous studies of intranasally administered insulin in animal models of diabetes mellitus, not only stabilization of carbohydrate homeostasis was shown, but also a positive effect in the form of restoration of the functional activity of insulin signaling pathways in the hypothalamus and other parts of the brain. We have presented and analyzed data on the systemic effects of intranasally administered insulin in rodents with experimental models of diabetes mellitus, as well as in healthy individuals.

[Diabetes mellitus and cognitive impairment].

The review discusses literature data and the results of our own studies on the effect of diabetes on cognitive functions and cerebrovascular pathology, as well as possible ptogenetic mechanisms for the implementation of this effect. The results of studies on the effects of antidiabetic drugs on cognitive function are presented.

[Diabetes mellitus and the central nervous system]. / Sakharnyi diabet i tsentral'naia nervnaia sistema.

The review considers the current views on the central nervous system (CNS) in diabetes mellitus (DM). It discusses an attitude towards the term 'diabetic encephalopathy'. The data of investigations of cognitive functions in types 1 and 2 DM and the brain structural imaging results obtained using up-to-date technologies are considered. The results of studies of the factors that induce cerebral changes in DM and their associated cognitive impairments are given. There is evidence that hyperglycemia has a more considerable impact on the above processes than hypoglycemia; other possible factors, apart from blood glucose control, are set out. The current views on the function of insulin in the CNS and the relationship of central insulin resistance to Alzheimer's disease are outlined. There are current data on intranasal insulin application that is still exploratory, but, as might be judged from the findings, may by a promising method for the treatment and prevention of cognitive decline in both patients with DM and those without this condition.

[Pain in diabetic neuropathy: psychosomatic aspects].

Diabetic neuropathy (DN) is one of the most common complications of diabetes mellitus (DM). Most clinical and population studies indicate that its prevailing form is distal symmetric, affecting about 30% of patients with diabetes. The main clinical manifestation of this form of DN is a decrease (up to a complete loss) of sensitivity, which is either not recognized by the patient or is perceived as numbness, loss of any sensations in the lower extremities. At the same time, in a relative minority of patients, the leading symptom in the DN clinical presentation is pain, which, in some cases, reaches high intensity, disrupts working ability, daily activity, and sleep.

[The effect of Furolan on the physiological and biochemical characteristics of ripening winter wheat grain].

The effects of the preparation Furolan, (2-furyl-2)-1,3-dioxolane, on the degree of mRNA polyadenylation and the pattern of protein synthesis in the ripening grain of several soft winter wheat (Triticum aestivum L.) cultivars were studied. It was demonstrated that Furolan stabilized mRNA in a cultivar-specific manner, thereby accelerating to various degrees the biochemical processes taking place in the ripening grain. Of the wheat cultivars studied, Krasnodarskaya 99 was the most responsive cultivar with respect to a set of changes in nucleic-protein metabolism; the cultivar Deya was next followed by the cultivar Bat'ko. The cultivar Kroshka did not respond to the treatment with Furolan. The cultivar specificity of this preparation allows its practical application to be optimized.

[Treatment strategy in patients with non-insulin-dependent diabetes mellitus, analysis of current approaches, basic problems, and approaches to their solution]. / Taktika lecheniia bol'nykh insulinnezavisimym sakharnym diabetom: analiz sushchestvuiushchikh podkhodov, osnovnye problemy i puti ikh resheniia.

The shortcomings of current approaches to therapy of patients with noninsulin-dependent diabetes mellitus are discussed. A tendency to early prescription of oral sugar-reducing drugs which are prescribed to 71% of patients during the first year of the disease was noted, as well as underevaluation of nondrug therapy. Poor efficacy of therapeutic and prophylactic care of patients with this condition is demonstrated as exemplified by quite a number of district health centers of Moscow, resulting in inadequate level of compensation, a high incidence of diabetes complications, and increase in the number of patients administered insulin therapy. The authors emphasize the importance of introducing practical training of patients as a means to improve the quality of specialized diabetological care.