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Diabetes und Gehirn

Diabetes and the brain

Zusammenfassung

Hintergrund

Ein Diabetes erhöht das Schlaganfallrisiko um den Faktor 2−4. Bei Frauen ist dieses Risiko zusätzlich um 20–30% gesteigert.

Ziel der Arbeit

Die vorliegende Übersichtsarbeit referiert und kommentiert Publikationen der Jahre 2013−2015 zu Beeinträchtigungen des Gehirns durch eine Diabeteserkrankung.

Ergebnisse

In der Akutbehandlung des ischämischen Schlaganfalls zeichnet sich mit den aktuellen positiven Studien zur mechanischen Thrombektomie bei schweren Hemisphäreninfarkten ein Paradigmenwechsel ab. Für die Entwicklung einer Post-Stroke-Hyperglykämie sind Läsionen in der rechten Insel- und Operkulumregion verantwortlich. Verschiedene Studien konnte keine Überlegenheit einer strengen Blutzuckerkontrolle durch i.v.-Insulin in der Akutphase des Schlaganfalls gegenüber einer Standardtherapie zeigen. Multimodale Maßnahmen zur Schlaganfallprävention konnten das Risiko für Diabetespatienten in den letzten 20 Jahren um etwa 50 % senken. Eine Diabeteserkrankung führt zu einer Erhöhung des Risikos für eine vaskuläre Demenz, aber auch für die neurodegenerative Alzheimerform. Eine aktuelle Studie konnte eine Besserung der kognitiven Leistungen von Demenzrisikopersonen durch multimodale Interventionen nachweisen.

Abstract

Background

People with diabetes have a 2–4-fold increased risk of stroke. In women, this risk is even more pronounced.

Purpose

This review describes and comments on data published between 2013 and 2015 about the influence of diabetes on the brain.

Results

The current positive studies on mechanical thrombectomy in severe hemispheric stroke shows a paradigm shift towards this intervention. Lesions in the right insular and operculum regions have been found to be responsible for the development of poststroke hyperglycemia. Several studies showed no superiority of strict glycemic control by intravenous insulin in the acute phase of stroke compared with standard therapy. Multimodal measures for stroke prevention were able to reduce the stroke risk for diabetes patients by 50 % during the last 20 years. Diabetes also leads to an increased risk for the development of vascular dementia and for the neurodegenerative form of Alzheimer’s disease. Using multimodal interventions, a recent study showed an improvement in cognitive performance of individuals with a high risk for dementia.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Im Zusammenhang mit referierten Studien hat der Autor Honorare für Beratungstätigkeit und Vorträge erhalten von: Bayer Pharma, BMS Pharma, Boehringer Pharma, Daiichi Sankyo, Pfizer Pharma.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Correspondence to F. Erbguth.

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Erbguth, F. Diabetes und Gehirn. Diabetologe 11, 300–308 (2015). https://doi.org/10.1007/s11428-015-1341-x

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  • DOI: https://doi.org/10.1007/s11428-015-1341-x

Schlüsselwörter

  • Diabetes mellitus
  • Hyperglykämie
  • Erkrankungen des zentralen Nervensystems
  • Schlaganfall
  • Demenz

Keywords

  • Diabetes mellitus
  • Hyperglycemia
  • Central nervous system diseases
  • Stroke
  • Dementia