MALATTIA CARDIOVASCOLARE NELL ANZIANO DIABETICO. Diabete e demenza. Enzo Manzato
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1 MALATTIA CARDIOVASCOLARE NELL ANZIANO DIABETICO Diabete e demenza Enzo Manzato
2 Lancet 2016; 387: 1513
3 Lancet 2016; 387: 1377
4 MEN Diabetes Care 2016;39:300
5 WOMEN Diabetes Care 2016;39:300
6 Multiple-adjusted women to men RR for any dementia, vascular dementia, and nonvascular dementia MEN vs WOMEN Diabetes Care 2016;39:300
7 Lancet Diabetes Endocrinol 2014; 2: 246
8 Lancet Diabetes Endocrinol 2014; 2: 246
9 Lancet Diabetes Endocrinol 2014; 2: 246
10 Timecourse from preclinical to clinical Alzheimer s disease Biol Psychiatry 2013;74:340
11 Timecourse from preclinical to clinical Alzheimer s disease FUNZIONE STRUTTURA CLINICA Biol Psychiatry 2013;74:340
12 Default mode network: brain regions that show increased functional MRI signals during inwardly oriented mental activity and decreased functional MRI signals during attention demanding tasks. Nature Reviews Neuroscience 17, 777, 2016
13 Componenti del Default-Mode Network Porzione posteriore della corteccia cingolata Precuneo Porzione mediale della corteccia prefrontale Circonvoluzioni angolari 13
14 Default mode network: brain regions that show increased functional MRI signals during inwardly oriented mental activity and decreased functional MRI signals during attention demanding tasks. Amyloid deposits (red) predominate in brain regions of the default mode network (blue), which shows deactivation deficits in Alzheimer disease. Nature Reviews Neuroscience 17, 777, 2016
15 Brain regions within the default mode network are particularly vulnerable to aging and dementia. They are the first to develop amyloid deposition as well as to show decreased glucose metabolism and a loss in functional connectivity. The disruption of functional connectivity and reduced cerebral glucose metabolism in these regions is related to the severity of peripheral insulin resistance and cognitive impairment. Physiol Rev 96: 1169, 2016
16 medial frontal gyrus precuneus middle temporal gyrus T2DM patients showed reduced functional connectivity in the default mode network compared with control subjects, which was associated with insulin resistance in selected brain regions, but there were no group effects of brain structure or cognition. Diabetes 61:2375, 2012
17 J Nucl Med 2014; 55:759
18 diffusion tensor imaging struttura functional magnetic resonance imaging funzione cognitive assessment clinica CINGULUM BUNDLE UNCINATE FASCICULI SUP LONGITUD FASCICULI middle-aged patients with type 2 diabetes show white matter abnormalities that correlate with disrupted functional connectivity in the default mode network (a network of brain regions most active during rest) common mechanisms may underlie structural and functional connectivity Diabetes 2014;63:728
19 Diabetes 64, 687, 2015
20 Differences in connectivity A single dose of intranasal insulin increases resting-state functional connectivity between the hippocampal regions and multiple DMN regions in older adults with T2DM. Diabetes 64, 1025, 2015
21 intensive glycaemic control targeting HbA1c to less than 6 0% vs standard strategy targeting HbA1c to % significant differences in total brain volume favoured the intensive treatment but cognitive outcomes were not different. Lancet Neurol 2011; 10: 969
![of volumes examined in normalized space [RAVENS]).](/docs-images/88/116117241/images/22-1.jpg "there are spatially specific patterns of brain changes that vary by diabetes characteristics the progression of gray matter volume loss is slowed by")
22 Three-dimensional surface renderings of optimally-discriminative voxel-based analysis results Subjects in the intensive treatment arm (n = 221) had lower longitudinal decrease in gray matter tissue volume in the highlighted areas compared with subjects in the standard treatment arm (n = 267) (regional analysis of volumes examined in normalized space [RAVENS]). there are spatially specific patterns of brain changes that vary by diabetes characteristics the progression of gray matter volume loss is slowed by intensive glycemic treatment, particularly in regions adjacent to areas affected by diabetes. Diabetes Care 2015;38:97
23 Updated meta-analysis of major statin trials that assessed the effect of statins on fatal and non-fatal stroke Lancet Neurol 2009; 8: 453
24 Updated meta-analysis of major statin trials that assessed the effect of statins on haemorrhagic stroke Lancet Neurol 2009; 8: 453
25 Diabetes Care 2016;39(Suppl. 2):S253
26 Diabetes Care 2016;39(Suppl. 2):S253
27 Heart Outcomes Prevention Evaluation (HOPE) 3 N Engl J Med 2016; 374:2021
28 Heart Outcomes Prevention Evaluation (HOPE) 3 Effect on cognitive function Assessed in patients 70 years (available n = 1,626). Median age 74 years; 59% female. Cognitive decline was noted in all patients. The primary outcome: processing speed (measured by Digit Symbol Substitution Test at study end): rosuvastatin vs. placebo: 29.1 vs (p = 0.38) BP lowering vs. placebo: 29.1 vs (p = 0.86) combination vs. placebo: 29.3 vs (p = 0.63). Any functional impairment for rosuvastatin vs. placebo: 57% vs. 59%, p = 0.89; for BP lowering vs. placebo: 59% vs. 56%, p = No signal of differential cognitive decline with all three strategies compared with placebo. Presented by Dr. Jackie Bosch at the American Heart Association Annual Scientific Sessions New Orleans, LA, November 13, 2016
29 Risk factors for late-life cognitive decline in diabetes Lancet Diabetes Endocrinol 2014; 2: 246
30
31 BRAIN INSULIN RESISTANCE IN COGNITIVE AND METABOLIC DISTURBANCES Physiol Rev 96: 1169, 2016
32 PHYSIOLOGICAL AND BEHAVIORAL EFFECTS OF BRAIN INSULIN ACTION Physiol Rev 96: 1169, 2016
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