title: Inside the Diabetic Brain: Role of Different Players Involved in Cognitive Decline.
abstract: Diabetes mellitus is the most common metabolic disease, and its prevalence is increasing. A growing body of evidence, both in animal models and epidemiological studies, has demonstrated that metabolic diseases like obesity, insulin resistance, and diabetes are associated with alterations in the central nervous system (CNS), being linked with development of cognitive and memory impairments and presenting a higher risk for dementia and Alzheimer's disease. The rising prevalence of diabetes together with its increasing earlier onset suggests that diabetes-related cognitive dysfunction will increase in the near future, causing substantial socioeconomic impact. Decreased insulin secretion or action, dysregulation of glucose homeostasis, impairment in the hypothalamic-pituitary-adrenal axis, obesity, hyperleptinemia, and inflammation may act independently or synergistically to disrupt neuronal homeostasis and cause diabetes-associated cognitive decline. However, the crosstalk between those factors and the mechanisms underlying the diabetes-related CNS complications is still elusive. During the past few years, different strategies (neuroprotective and antioxidant drugs) have emerged as promising therapies for this complication, which still remains to be preventable or treatable. This Review summarizes fundamental past and ongoing research on diabetes-associated cognitive decline, highlighting potential contributors, mechanistic mediators, and new pharmacological approaches to prevent and/or delay this complication.
authors.affiliation: CEDOC, Chronic Diseases Research Centre, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa , Edifício CEDOC - IIRua Câmara Pestana no. 6, 6A e 6B, 1150-082 Lisboa, Portugal.|Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra , 3000-548 Coimbra, Portugal.|Portuguese Diabetes Association (APDP) , R. do Salitre 118-120, 1250-203 Lisboa, Portugal.
authors.forename: Joana M
authors.initials: JM
authors.lastname: Gaspar
authors.affiliation: Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra , 3000-548 Coimbra, Portugal.|CNC.IBILI Consortium, University of Coimbra , 3004-517 Coimbra, Portugal.
authors.forename: Filipa I
authors.initials: FI
authors.lastname: Baptista
authors.affiliation: CEDOC, Chronic Diseases Research Centre, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa , Edifício CEDOC - IIRua Câmara Pestana no. 6, 6A e 6B, 1150-082 Lisboa, Portugal.|Portuguese Diabetes Association (APDP) , R. do Salitre 118-120, 1250-203 Lisboa, Portugal.
authors.forename: M Paula
authors.initials: MP
authors.lastname: Macedo
authors.affiliation: Institute for Biomedical Imaging and Life Sciences (IBILI), Faculty of Medicine, University of Coimbra , 3000-548 Coimbra, Portugal.|CNC.IBILI Consortium, University of Coimbra , 3004-517 Coimbra, Portugal.|AIBILI , 3000-548 Coimbra, Portugal.
authors.forename: António F
authors.initials: AF
authors.lastname: Ambrósio
mesh_terms: D001921:Brain / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D003072:Cognition Disorders / Q000209:etiology*; D048909:Diabetes Complications / Q000473:pathology / Q000503:physiopathology*; D003920:Diabetes Mellitus / Q000473:pathology*; D006801:Humans
keywords: Diabetes; brain; cognition; hyperglycemia; insulinemia; obesity; synapse