公开课-关爱惟士
公开课
(12)测量您的阿尔茨海默症的风险水平-Measuring Your Risk of Alzheimer’s Disease

http://player.youku.com/embed/XMzYwNjc1Nzg2OA



Professor Kaarin Anstey

卡兰·安斯蒂教授


If we’re talking about Alzheimer’s disease, there is a known genetic risk factor that has a known increased risk associated with it. So if you were tested for that, you could say that you have an increased risk. But, at the same time, we know many people live a full life with this genetic risk factor and don’t ever develop Alzheimer’s disease. So it’s not a sentence to find out that you have that risk. And, at the same time, there are people who don’t have that genotype, who do develop Alzheimer’s disease. So, even when we’re looking at genetics, it’s not possible to say to an individual, you will definitely develop Alzheimer’s disease. All we can do is talk about whether you have characteristics that increase your risk relative to the population, but we could never say for the individual, your personal risk is this, because there are so many other complicating factors.

如果我们谈论阿尔茨海默病话题,发现有一个已知的遗传风险因素会增加患病的风险。如果你测试了之后,发现有这个遗传风险因素,可以说你有了一个增加患病风险的因素。但是,同时我们知道,这种遗传风险因素会伴随很多人一生,但并没有发展成为阿尔茨海默病。所以,这不是说你被发现你有这种风险因素,你就一定会患阿尔茨海默病。同时,也有不具有那种基因型的人会发展为阿尔茨海默病。即使我们在做遗传学分析,我们也不可能对某个人说,你一定会患阿尔茨海默病。我们可以做的是讨论你是否具有相对于人群增加患病风险的特征,但我们不能对某个人说你的个人患病风险就是这样的,因为还有很多其他非常复杂的因素。


So the example I like to use is smoking and lung cancer. We know that if you smoke you’ve got a greatly increased risk of lung cancer, and of dying of lung cancer. But there are people who develop lung cancer who never smoke, and there are smokers who never develop lung cancer. There are also people who have a genetic risk factor for lung cancer and that can increase their risk, or if they have that genetic risk factor and they smoke, they’ve got a greatly increased risk of developing lung cancer. And it’s pretty much the same with Alzheimer’s disease. The things that we know increase the risk of Alzheimer's disease, apart from your genetics, the biggest risk factor is age. There’s nothing we can do about age.

因此我喜欢使用的例子是吸烟和肺癌。据我们所知,如果你吸烟,你患肺癌的风险会大大增加,并有可能死于肺癌。但是有些肺癌患者从来不抽烟,有些吸烟者从来没有发展成肺癌。还有一些人有肺癌的遗传风险因素,并且这可能会增加他们的患肺癌的风险,或者如果他们有这种遗传风险因素并且吸烟的话,他们患肺癌的风险会大大增加。它与阿尔茨海默病的情况几乎完全相同。我们知道增加患阿尔茨海默病的风险的因素,除了遗传因素之外,最大的风险因素是衰老。对于衰老我们什么也做不了。


So, if you wanted to assess your risk, there are a few tools that are available to assess risk. You can do some self-report risk assessment. We've developed an online self-report risk assessment tool at the ANU, that can give you feedback on your risk profile for Alzheimer's disease, and tell you if you’ve got things you can modify to reduce your risk. And there are some clinical assessments that have been used in clinics, particularly in the United States where people have developed a clinical risk assessment for midlife adults, or that have developed in Finland where they can check things like high cholesterol, high blood pressure and so forth, and they give you a score. It’s not as advanced as the field of heart disease, so in heart disease you can go and you can get a Framingham Risk Score done which will tell you your risk of developing heart disease in the next 10 years. We’re not at that point in dementia research; we haven’t been able to pin it down to a time period. We do have risk assessment, but we need the research to develop to get us to that level, the specificity of diabetes and heart disease.

所以,如果你想评估你的风险,这里有几个工具可以采用。您可以做一些自我报告的风险评估。我们在澳大利亚国立大学开发了一个在线自我报告的风险评估的工具,可以为您提供您患阿尔茨海默病的风险自我评估和评估反馈,告诉您是否可以纠正那些风险因素以减少您的患病风险。还有一些临床评估已经在临床中被使用,特别是在美国,人们已经开发了对中年阶段的成人的临床风险评估,或在芬兰,他们发展的评估体系是可以通过检查例如高胆固醇,高血压等指标,然后给你打个分数。它不像心脏病领域的评估体系那么先进,你可以去做心脏病患病风险评估,从而得到一个Framingham风险评分,这将告诉你在未来10年发展心脏病的风险。在认知症研究中我们还没达到那个地步;我们还未能把它固定到一个时间段。我们有认知症风险评估,但我们需要其研究水平发展到糖尿病和心脏病风险评估的那个水平。


What we did at the ANU was we did those meta-analyses that I’ve already discussed and also looked at published meta-analyses in the literature, and we created a risk assessment algorithm based on the best available evidence at the time for all of the factors known to increase the risk of Alzheimer's disease. So we developed the algorithm and we have risk and protective factors in our scores, so some things actually reduce your risk, and then we developed a questionnaire that assesses each of those risk factors. And the questionnaire is comprised of subscales which are taken from the epidemiological studies that actually linked that exposure to dementia. So, for example, cognitive engagement has been linked to the risk of dementia in two studies, and we use the actual questionnaire that was used in those two studies in our scale.

我们在ANU所做的是我已经讨论过的那些荟萃分析,并且还研究了文献中发表的荟萃分析,并且我们基于当时最好的可用证据创建了一个所有已知能增加患阿尔茨海默病的风险因素的风险评估算法。因此,我们开发了算法,并且在我们的分数中有风险因素和保护因素,所以某些东西实际降低了您的风险。然后我们开发了一个问卷来评估每个风险因素。问卷包括从流行病学研究中获得的与认知症暴露实际关联的分量表。因此,例如,认知的参与已经与两项研究中的痴呆风险相关联,并且在我们的范畴内使用这两项研究中实际使用的问卷。


And that’s another issue around measurement. So one study might find something, but if you use a different questionnaire you may not find the same result. So all the measures that we’ve used in our questionnaire have been linked to dementia. And then we’ve made that available online; it’s free to the public, anybody can assess their own risk and then we provide feedback on what you could do to modify that risk.

并且那是围绕测量的另一个问题。所以一项研究也许会发现些什么,但如果你使用不同的问卷,你可能不会找到相同的结果。因此,我们在问卷中使用的所有措施都与认知症有关。然后我们使之可以通过互联网获得;它是对公众免费的,任何人都可以评估自己的风险,然后我们提供关于你可以做些什么来纠正该风险的反馈。


So it’s at a fairly general level, because this is a publically available website, it’s not a medical clinic, and it doesn’t involve any medical tests. So, for example, we don’t test your blood pressure, which you’d need to have done by your GP. If you’re really concerned, you can print out a PDF of your assessment that we’ve created, and you could take that to your GP. Otherwise, it gives you fairly general information about risk reduction, but you can get much more detailed information from other websites or from your local doctor.

因为这是一个公开的网站,所以这只是一个相当普通的水平。它不是一个医疗诊所,并不涉及任何医学测试。举个例子,我们不会测量你的血压,这个你需要找你的GP做。如果你真的担心的话,你可以打印一份我们创建的你的评估报告的PDF,你可以把它交给你的GP。否则,它只能提供关于降低风险的相当一般的信息,但您可以从其他网站或您当地的医生处获得更多的详细信息。


So with our risk assessment tool, it focuses on understanding your risk, not telling you you’ve got this percentage or that percentage risk of developing Alzheimer's in so many years, and I think it’s important to know your risk profile so you know what you can modify. And then you can change it in time to prevent that risk factor impacting on your brain. People say to me quite often, oh, I just wish I could find out accurate information about what I can improve in my lifestyle to reduce my risk of dementia.

因此,我们的风险评估工具只专注于了解您的风险,而不是告诉您这么多年来患有阿尔茨海默症的百分比或风险百分比,我认为您能了解您的风险特征很重要,这样您知道您的风险并可以纠正它,以防止这种风险因素影响你的大脑。人们常常对我说,哦,我只是希望能找到可以改善我的生活方式,从而减少我的患认知症的风险的准确信息。


We don’t have a single blood test or medical test that will directly tell you your risk of developing Alzheimer's or another type of dementia. There’s a lot of research ongoing at the moment that’s trying to develop blood tests, and you might see things in the media about research results, but so far there’s nothing that’s been validated and rigorously tested and released onto the market.

我们没有一个单一的血液测试或医疗测试,来直接告诉你发展阿尔茨海默病或另一种类型的认知症的风险。目前有很多研究正在尝试开发血液检测,你可能会在媒体上看到关于研究结果的方面的东西,但到目前为止还没有什么已经过验证和严格的测试,并且投放到市场上。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


塔斯马尼亚大学预防认知症MOOC
2018-05-21
(13)证据的状况 - 咖啡-State of the evidence - Coffee

课程视频:http://player.youku.com/embed/XMjY3ODM1MDk0NA



Dr Shannon Klekociuk

Shannon Klekociuk博士

Coffee is a drink that many of us enjoy and, as most of us know, the main ingredient in coffee is caffeine, a stimulant that excites the nervous system and is responsible for that pick-me-up feeling. Scientists have known for a long time that caffeine can provide us with a short boost to our attentional processing, as well as our memory. So it seems logical to think that something that helps our cognition might actually be beneficial for diseases that impair our cognition.

咖啡是我们许多人喜欢的一种饮料。正如我们大多数人所知道的,咖啡的主要成分是咖啡因,它是一种刺激神经系统并负责挑剔感觉的兴奋剂。很长一段时间科学家已经知道,咖啡因可以为我们短暂提高我们的注意处理能力和我们的记忆力。因此,认为帮助我们的认知可能实际上会有益于修复疾病对我们的认知能力的损害似乎是合乎逻辑的。


Some studies have observed coffee drinkers over a long period of time and found that moderate coffee consumption may be associated with reduced dementia risk.

在很长一段时间内观察咖啡饮用者的一些研究发现中等的咖啡消费可能与减少患认知症的风险有关。


Unfortunately, this finding has not been consistently replicated. Other researchers have suggested that it might be the caffeine itself, rather than the coffee, that is beneficial to reducing dementia risk.

不幸的是,这一发现并没有持续地被重复出来。其他研究人员认为可能是由于咖啡因本身,而不是咖啡,有利于减少患认知症的风险的缘故。


However, a recent meta-analysis, looking at many of these observational studies, was unable to reliably link caffeine consumption with a reduced risk of developing diseases like Alzheimer’s.

然而最近的一项考察了许多这些观察性研究的荟萃分析,仍然无法可靠地将咖啡因消费与发展如阿尔茨海默症等疾病的风险的降低联系起来。


It is important to remember that coffee is a stimulant, and that too much coffee can have major ramifications for your health. Overall, its status as a protective factor against diseases like Alzheimer’s remains unclear, and certainly it represents an area where more research is needed.

重要的是要记住,咖啡是一种兴奋剂,喝太多的咖啡会严重影响你的健康。总体而言,咖啡作为对抗阿尔茨海默病等疾病的保护因子的地位仍不清楚,并且它确实代表了一个需要更多研究的领域


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


塔斯马尼亚大学预防认知症MOOC
2018-05-21
(14)证据的状况 – 姜黄-State of the evidence - Turmeric

课程视频:http://player.youku.com/embed/XMzYyMDIxMDk1Ng




Dr Shannon Klekociuk

Turmeric is a plant, the root of which can be dried and used as a spice in food, or in alternative medicine.

姜黄是一种植物,它的根可以被干燥并用作食物中的香料或替代药物。

The main ingredient in turmeric is curcumin, and curcumin is thought to have anti-inflammatory properties which may help alleviate some of the inflammation that occurs in the brains of people with Alzheimer’s Disease. It’s also been suggested that curcumin may help prevent the burden of amyloid protein in the brain, in diseases like Alzheimer’s.

姜黄中的主要成分是姜黄素,姜黄素被认为具有抗炎特性,可能会帮助缓解阿尔茨海默病患者大脑中发生的一些炎症。还有人认为,姜黄素可以帮助防止在阿尔茨海默病等疾病的患者脑中的淀粉样蛋白的负担。

It has also been suggested that curcumin might help prevent the amyloid protein from clustering into plaques in the brain of those with Alzheimer’s Disease. Unfortunately, many of these findings are based on limited animal studies.

另外姜黄素或许可以帮助阻止在那些患有阿尔茨海默氏病的脑中的淀粉样蛋白聚集成斑块。很可惜,许多这些发现是基于有限的动物研究。

Observational data from countries like India have reported a lower incidence of diseases like Alzheimer’s. Some have suggested that this may be due to the relatively high consumption of turmeric. However, it is important to note that differences in life expectancy and the health system may contribute to this finding.

来自印度等国家的观察数据表明这些国家的阿尔茨海默病等疾病的发病率较低。有人建议这可能是由于姜黄的相对高的消耗。然而,重要的是要注意预期寿命和卫生系统的差异可能有助于这一发现。

There is no evidence to date that suggests that consuming turmeric will be beneficial for either reducing your dementia risk or treating diseases like Alzheimer’s.

迄今为止,没有证据表明消耗姜黄将有益于减少你患痴呆症的风险或治疗阿尔茨海默症这类疾病


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-24
(15)模块2---认知症的心血管风险因素-Cardiovascular Risk Factors for Dementia

课程视频 :http://player.youku.com/embed/XMjY3ODM2MDY4NA




Professor Kaarin Anstey

Kaarin Anstey教授


At a general level, we would say now that what is good for your heart is good for your brain. The vascular risk factors, things that influence your heart health or your vascular system, will also influence your vascular system in the brain, your cerebrovascular health. For example, hypertension is a risk factor for heart disease but it’s also a risk factor for stroke and for dementia.

一般我们会说,对你心脏好的东西也会对你的大脑好。影响你心脏健康或血管系统的血管因素也会影响你的脑血管系统和脑血管健康。例如高血压是心脏病的一个风险因素,但它也是中风和认知症的风险因素。


High cholesterol in midlife appears to, although we don’t have as robust evidence as we’d like on that, but from the evidence we do have, it seems to increase the risk. Diabetes, type 2 diabetes and type 1 both increase the risk. Sedentary lifestyle increases the risk, depression increases the risk. And depression is actually a cardiovascular risk factor, and very much linked with heart health, although it’s sometimes not considered a cardiovascular risk factor in the same way.

尽管我们还没有可靠的证据表明中年期的高胆固醇是风险因素,但我们已有的证据表明它似乎能够增加患认知症的风险。1型和2型糖尿病都能增加患病风险。久坐和抑郁症也能增加患病风险。抑郁症实际上是一个与心脏健康密切关联的心血管风险因素,虽然有时它不被人们认为是一个导致认知症的心血管风险因素。


We focus on the two most common types of causes of dementia, we have vascular dementia and Alzheimer's disease. Vascular dementia is caused by small strokes and large strokes and through hardening of the arteries. The risk factors that increase blood pressure and cause arthrosclerosis, they’re all going to increase the risk of vascular dementia. But, similarly, what’s being discovered more and more is that the vascular risk factors also increase Alzheimer's pathology in the brain. We don’t understand all the mechanism underpinning that, but they seem to increase that at the same time.


我们聚焦在血管性痴呆症和阿尔茨海默氏病这两种最常见的认知症的病因上。血管性痴呆症是由动脉硬化导致的多次大中风和小中风造成的。血压升高和关节内动脉硬化这些风险因素会增加患血管性痴呆症的风险。但是,同样这些血管风险因素也会增加患阿尔茨海默氏病的风险。我们尚未完全理解所有机制,但它们似乎同时增加患病风险。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任


塔斯马尼亚大学预防认知症MOOC
2018-05-24
(16)心血管疾病,中风,肥胖和认知症的风险-Cardiovascular Disease, Stroke, Obesity and Dementia Risk?

课程视频:http://http://player.youku.com/embed/XMjY3ODM2MDk2NA



Professor Velandai Srikanth

When we talk about cardiovascular disease, we’re referring to major disease such as having strokes, or heart attacks, or having heart failure. Our research has clearly shown that people who have strokes, heart failure or heart attacks are at very high risk of dementia in the future. Strokes can directly destroy brain cells and hence reduce the capacity of the brain to withstand other insults that might occur in the brain later on, such as Alzheimer’s Disease. Now, while these major events are important in increasing the risk of dementia, it must be kept in mind that the risk factors that lead to these diseases are also important. So, by controlling risk factors such as high blood pressure, diabetes, cholesterol, maintaining activity, stopping smoking; these can all reduce the risk of major cardiovascular disease and, by that, reduce the risk of a future dementia.

当我们谈论心血管疾病时,我们主要指像中风,心脏病或心力衰竭这样的疾病。我们的研究清楚的表明心脏病或心力衰竭病人将来得认知症的风险会很高。中风可以直接破坏脑细胞,从而降低以后大脑经受像阿尔茨海默氏病之类发生在大脑中的伤害的能力。我们承认这些主要事件在增加患认知症的风险中是很重要的同时,还必须牢记导致这些疾病的风险因素也很重要。因此通过控制像高血压,糖尿病,胆固醇这些风险因素,保持运动和戒烟可以降低将来患认知症的风险。


Blood pressure tends to increase first as people reach middle age, so middle age is between 40 and 60 years of age. At this point in time, control of blood pressure is likely to reduce the risk of brain injury later on, so one advocates the careful monitoring and control of blood pressure during middle age. But as one gets older and gets a bit frailer so, for example, those in their late 70s or 80s might have difficulty walking, might have poor balance, can have a risk of falling; in such people we are a bit more careful about how aggressively we treat their blood pressure. As one gets even older, blood pressure drops and tends to go down to the lower side of things in some people. Hence at that age, it is quite important to maintain blood pressure at a reasonable level so they can actually function well, and such people we don’t tend to put on high doses of blood pressure reducing medication or even sometimes take them off blood pressure reducing medication.

人到中年后血压会升高。这里的中年是指40岁到60岁之间。在这个时间点,控制血压会大大降低后期脑损伤的风险。因此有人建议人在中年应该严格检测和控制血压。但当一个人变老时血管会更脆弱。例如那些七八十岁的老人也许会行走困难,也许平衡能力差,可能会有跌倒的危险。对于这样的人,我们就要小心的控制他们的血压了。因为人变得更老后,某些人的血压会下降并且血液会倾向于下降到身体的下方。因此到了那个年纪,维持血压在一个合理的水平上,从而使他们的身体功能正常是非常重要的。对于这样的人,我们不会用大剂量的降压药,甚至有时不给他们服用降压药。


The relationship between body weight and dementia is quite complicated. As people develop dementia in older age, they tend to lose weight because the brain is probably telling them not to eat much, in some fashion, and hence they lose not just body weight but muscle weight as well. So the risk or the association between body weight and dementia is different in older people compared with younger or middle aged people. In contrast, if you look at middle age, having greater levels of obesity is associated with the risk of dementia in the future. For example, people who have a very large waist circumference, what we call central adiposity, more fat around their hips, tend to have a higher risk of dementia. Such fat can be a source of chronic inflammation and this can affect blood vessel health and brain health directly. So treatment of adiposity or obesity in middle age should be quite aggressive, and can potentially reduce the risk of dementia in the future.

体重和认知症之间的关系是非常复杂的。人们在老年患认知症时,他们会体重减轻,因为大脑或许告诉他们不要多吃,因此在某些方面,他们不仅仅失去体重,还失去肌肉的重量。因此老年人体重和认知症之间的关系或风险,和青年人以及中年人相比,是不同的。相反,如果你观察中年人,就会发现肥胖与将来患认知症密切相关。例如,一个具有很大腰围,臀部有很多脂肪的人,也就是向心性肥胖的人,会有更高的患认知症的风险。


People with advanced dementia tend to lose weight. We don’t know exactly why this happens, but it is probably as a result of the hunger centre in their brains becoming different in the way it acts, so their appetite and their desire for food goes down and we can’t exactly work out, or haven’t been able to work out until now, how to offset this. Research is under way to try and understand what parts of the brain are signalling to stop hunger from happening in people with advanced dementia.

认知症晚期患者容易丧失体重。我们不知道发生这个的确切的原因,但也许是他们大脑的饥饿中心无法正常工作,以至于他们的食欲减退。迄今为止,我们无法阻止这个。目前正在进行的研究在试图搞清大脑的什么部位在发信号来阻止认知症晚期患者的饥饿感。


So in people who have already developed strokes or heart attacks, it is still not too late to make a difference to their risk of dementia in the future. We found in our studies that having one stroke by itself may not increase the risk of dementia too much, but having more than one stroke clearly increases the risk of dementia. So, in people who have had a stroke, it is important to do everything you can, with the help of your specialist, to try and have treatments in place that reduce the risk of a further stroke. Now this might mean having blood thinning medications, anti-coagulant medications such as Warfarin, blood pressure reducing medications, and controlling your diabetes. Apart from this, stopping smoking and increasing physical activity are also important. Again, if you haven’t developed major cardiovascular disease, but have risk factors such as high blood pressure and diabetes, it is still not too late to make a difference. In fact, the earlier we treat people before they develop cardiovascular disease, the better it is. So control of blood pressure during mid-life and early older life, control of diabetes, again stopping smoking, increasing your physical activity, reducing your weight, are all important things that need to be aggressively done during middle life.

因此已经有心脏病和发生中风的人想改变将来患认知症的风险仍为时不晚。我们在研究中发现一次中风本身也许不会怎么增加患认知症的风险。但是多次中风会明显增加患病风险。所以,发生过一次中风的人在医生专家的帮助下进行治疗,竭尽所能来降低再次发生中风的可能性是非常重要的。目前这可能意味着服用收缩血管的药物,像华法林这样的抗凝血药,降压药,以及控制糖尿病的药。除了这些,戒烟和增加体育锻炼也非常重要。还有如果你尚未患主要的心血管疾病,但有高血压和糖尿病这样的风险因素,想做出改变仍为时不晚。实际上,在人们发展为心血管疾病之前,我们越早治疗,效果越好。所以,在中年期和老年早期控制血压,在中年期控制血糖,戒烟,增加体育锻炼,降低体重都是需要积极去做的事情。


It is very important to treat vascular risk factors to prevent major cardiovascular disease, and by that I mean preventing strokes and heart attacks. We know that preventing strokes reduces the risk of dementia, and we know that preventing heart attacks reduces the risk of heart failure, which is a risk factor for dementia.

通过处理血管风险因素来预防中风和心脏病等主要的心血管疾病是非常重要的。我们知道预防中风会降低患认知症的风险,并且知道预防心脏病可以降低心脏衰竭的风险,这是患认知症的风险因素之一。


There are a lot of studies currently under way trying to find out if reducing blood pressure or diabetes by themselves can reduce the risk of future dementia. The difficulty with planning studies of this nature is that they require very large numbers of people to participate in these studies, and a very long follow up to see if they do develop cognitive impairment or not. We need to wait for the results of these studies to come out before we can conclusively say which way the evidence goes.

目前很多研究试图搞清降低血压和控制糖尿病本身是否能降低患认知症的风险。计划这些研究的困难之处在于需要大量的人来参与这些研究,并且需要长期随访来看看他们是否后来发展成为认知障碍。在我们能够做出结论之前,我们需要等待这些研究结果出来。


The most important focus needs to be on identifying people who are at highest risk of dementia and trying to design studies to intervene in such people. For example, people with clusters of vascular risk factors such as diabetes and hypertension could be most at risk of dementia, and trying to develop medications, or other lifestyle interventions, in such people will provide the maximum benefit in future dementia reduction.

我们要把最重要的焦点放在鉴定具有患认知症高风险的那些人身上,并试图设计研究来干预这样的人。例如,搜集有糖尿病和高血压这些血管风险因素的人群,然后进行药物和生活方式的干预,从而提供将来降低这些人患认知症风险的最大好处。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-24
(17)糖尿病与认知症-Diabetes and Dementia

课程视频:http://player.youku.com/embed/XMjY3ODM2MTM0MA




Professor Velandai Srikanth


There is very good evidence from longitudinal or long term large studies - more than ten such studies have been performed until now - confirming that type two diabetes is associated with a twofold increase in the risk of dementia. More recently, there have been large studies performed in the United States confirming that type one diabetes is also associated with an increased risk of dementia, in a similar twofold increase in the risk of dementia.

纵向和大型长期研究提供很好了的证据-迄今为止进行了超过十项的研究-确认了二型糖尿病与患认知症的风险两倍增长有关。最近已经在美国进行的大型研究确认了一型糖尿病也与患认知症的风险有关,也有两倍的增长。

So type one diabetes is an important disease, affecting mainly younger people, and in such people, there is difficulty in controlling their blood sugar within a good range of blood sugar, with the treatments that we have. They are more prone to have very low blood sugar, and those people who have more than one episode of low blood sugar can have damage to brain cells or the white matter, which is the wiring connecting brain cells. Annually, about 30% of people with type one diabetes have low blood sugar episodes or hypoglycemia. Any more than four such episodes in a year can be associated with a very high risk of cognitive impairment, or slowing of brain function, and, as such people get older, it is possible that this reduction in cognitive function lowers their brain capacity to withstand other insults to the brain. So, as they get older, they become more prone to the risk of dementia.

一型糖尿病是一种主要影响年轻人的重大疾病。用我们现有的治疗方法来控制这些年轻人的血糖在一个良好的范围内是很困难的。他们倾向于有很低的血糖,那些具有多于一次低血糖发作的人可能对脑细胞或连接脑细胞的连线-大脑白质有损害。每年大约有百分之三十的一型糖尿病患者有低血糖症。一年多于四次低血糖发作的患者与认知障碍或大脑功能变慢的高风险相关。当这些人变老后,认知功能的下降会降低他们大脑承受其他伤害的能力。因此当他们变老时,他们更容易患老年认知症。


Type two diabetes can increase the risk of dementia by affecting health of blood vessels in the brain and the health of neurons, which are the brain cells. In type two diabetes, the cells of the brain are resistant to the action of insulin, and insulin is quite an important chemical in the brain to allow other chemicals to talk between cells. So this might be one way in which type two diabetes affects cognitive function. Another way insulin can be important is to affect the transport of a substance called beta amyloid, which is known to be important for the development of Alzheimer’s Disease. So insulin resistance in cells of the brain can, theoretically, be involved in the deposition of plaques in the brain due to beta amyloid.

二型糖尿病可以通过影响脑血管和脑细胞神经元的健康来增加患认知症的风险。 在二型糖尿病中,大脑细胞对胰岛素拮抗,而胰岛素是大脑中允许其他化学物质在细胞间交流的重要化学物质。因此这或许是二型糖尿病影响认知功能的一个途径。胰岛素十分重要的另一个途径是影响一种叫β淀粉样蛋白的物质运输。β淀粉样蛋白对发展阿尔茨海默病十分重要。所以理论上讲,在大脑细胞中的胰岛素拮抗与由β淀粉样蛋白引起的斑块堆积有关。


In people with type two diabetes, we found that the levels of a protein called tau is increased in the spinal fluid of patients. Tau is an important protein for neuronal health and, if we find increased levels in spinal fluid, it means that nerve cells are being damaged. It is possible that diabetes causes a low grade chronic inflammation in nerve cells, and this might provoke their death.

二型糖尿病患者的脊髓液中,我们发现一种叫tau蛋白的含量升高。tau蛋白是在神经健康中起重要作用的蛋白。如果我们发现这种蛋白在脊髓液中含量升高,这就意味着神经细胞正在受伤害。糖尿病可能会导致神经细胞中的低度慢性炎症,这或许会引起它们的死亡。


So, in summary, the effects of type two diabetes on the brain can be a combination of causes. It can be due to the effects of vascular disease and also due to the effect of neuronal death, or what we call neurodegeneration. Although Alzheimer’s Disease is associated with the development of amyloid plaques, it is not clear whether diabetes is a provocative factor in the development of plaque definitely, and further research or investigations are currently happening to try and work this problem out. While type two diabetes increases the risk of dementia overall, it is not clear whether everyone with type two diabetes will develop dementia, and we’re trying to work out in our research who might be more prone to do so.

总之,二型糖尿病对大脑的影响是一个多种原因的综合。它可以归因于心血管疾病的影响,也可以归因于神经细胞死亡或神经变性的结果。虽然阿尔茨海默病与淀粉样斑块有关,但人们还尚未搞清糖尿病是否在斑块形成中起促进因子的作用。目前进一步的研究和调查正在试图解决这一问题。虽然总体上来说,二型糖尿病会增加患认知症的风险,但尚不清楚是否每个二型糖尿病患者最终会发展成患认知症,我们正在试图通过研究搞清楚谁会更倾向于这样。


Pre-diabetes is an important condition that’s been recognised in the last 10 years or so. When we diagnose diabetes, we require a plasma or blood glucose level of 7 millimoles or greater. It has now been recognised that people with blood levels of glucose of about six millimoles are also at risk of complications of diabetes, and will be developing diabetes within the next 10 years. The important thing about pre-diabetes is that it is a preventable condition. Now more recently, studies from the United States have shown that those with pre-diabetes can be at fourfold risk of dementia in the future. Mechanisms by which this might occur are not quite clear, but it is important to realise that, if we treat and prevent diabetes - exercise and diet are important interventions that can help people with pre-diabetes and stop them from developing diabetes in the future - it is possible that such lifestyle interventions can also reduce the risk of dementia in such people.

糖尿病前期是一个重要的阶段,被认为大约持续十年左右。当血糖大于或等于7毫摩尔就被诊断为糖尿病。目前已确认,当人们的血糖水平在6毫摩尔时,他们有患糖尿病的风险,并将会在十年内发展成糖尿病。重要的是糖尿病前期是可预防的条件。目前美国最新的研究表明处于糖尿病前期的患者有四倍的风险将来会得认知症。发生的机制尚未搞清。但是认识这一点很重要,那就是如果我们治疗和预防糖尿病-锻炼和饮食是重要的干预手段来帮助糖尿病前期的人们-阻止他们将来发展成糖尿病-这样的生活方式的干预也会降低这些人的患认知症的风险。


In people who have pre-diabetes or diabetes, attending your practitioner or specialist on a regular basis, having your medications regularly, making sure that your blood sugar is well controlled but not too aggressively controlled, making sure that your blood pressure is treated effectively and your cholesterol levels are watched carefully; all these things could have an impact on your future health and the risk of dementia, possibly by reducing the risk of vascular disease going into the future.

糖尿病前期或糖尿病患者定期见你们的医生,按时服药从而确保你们的血糖被很好的而不是粗暴的控制,并且确保你们的血压被有效的控制,还确保你们的血脂水平被认真地监控,所有的这些还可能会通过降低将来患血管疾病的风险来影响你们将来的健康和患认知症的风险。


翻译:关爱惟士-未经允许不得转载,违者必追究法律责任

塔斯马尼亚大学预防认知症MOOC
2018-05-24