(17)糖尿病与认知症-Diabetes and Dementia-公开课-关爱惟士
(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

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