Diabetic encephalopathy: features of the course and treatment

Type 1 diabetes mellitus( DM) occurs with the development of frequent complications from the kidneys, blood vessels, the retina of the eyes and the nervous system. According to WHO, in the structure of complications from the nervous system, diabetic encephalopathy occupies a large part( 60%).The first mention of the relationship between cognitive impairment and diabetes is found in 1922, the very term "diabetic encephalopathy" was introduced in the 50s of the last century.

Developmental mechanism and diagnostic principles

Diabetic encephalopathy develops in every second patient with diabetes mellitus I or IItype.

Diagnosis of the disease on the basis of patient complaints, neurological examination data, blood biochemical indicators and the results of instrumental research methods( MRI, EEG, UZDG BTSS).

Diabetic encephalopathy is a diffuse lesion of the brain on the background of violations of carbohydrate metabolism and the development of dismetabolic changes.

The development of encephalopathy is associated with the pathological changes that accompany diabetes.

• Diabetic microangiopathy.

Violation of the permeability of the vascular wall leads to the development of hypoxia and energy deficiency in nerve cells, the risk of developing acute cerebrovascular accident( stroke) increases.

• Dysmetabolic syndrome.

Metabolic changes are more typical of type 2 diabetes.

Disruption of lipid metabolism leads to the formation of atherosclerotic plaques in the vessels. Violations of carbohydrate metabolism( hypoglycemia, hyperglycemia), ketoacidosis interfere with the normal excitation of the nerve fiber, destroy the myelin sheath of nerves, contribute to the accumulation of free radicals that cause the death of nerve cells.

• Arterial hypertension can be due to kidney damage in diabetes mellitus or an independent disease. High blood pressure aggravates the course of encephalopathy.

Clinical picture of diabetic encephalopathy

Pathological changes occurring in diabetes mellitus affect different structures of the brain, which explains the variety of clinical symptoms of diabetic encephalopathy. In elderly people, mixed encephalopathy is often recorded, which develops not only against metabolic disorders, but also as a result of the development of cerebral arteriosclerosis or after a stroke.

The most common manifestations are:

• Cognitive impairment.

Decreased concentration, memory impairment, loss of interest in the world, slow thinking, learning difficulties.

• Psychoneurotic changes.

Identify depression, fear( phobia), rapid exhaustion of the nervous system( asthenia).Asthenic manifestations are represented by general weakness, decreased efficiency, increased fatigue.

In patients with diabetes mellitus, a thorough examination often reveals depressive conditions that aggravate the course of the disease. This is due to the fact that in a depressed state a person ceases to control the intake of drugs, compliance with the diet. Errors in taking antidiabetic drugs and dietary conditions lead to disruption of adaptation mechanisms and worsening of the course of the disease.

• Cephalic syndrome or headaches.

The pain can be of a compressive nature as a "tension headache" or it can be diffused without a clear localization. In some people, headaches appear sporadically, others are constantly present. Reception of analgesics in some cases facilitates cephalgic syndrome.

• Repeated violations of the cerebral circulation.

The combination of microangiopathies with high blood pressure increases the risk of strokes by several times.

• Vegetative dystonia.

The person is disturbed by a giddiness, infringement of coordination of movements, a shaky gait, repeated syncopes and presyncopal conditions.

• Epileptiform syndrome is manifested by panic attacks, a violation of consciousness.

Features of encephalopathy in type 1 diabetes

Persons with diabetic encephalopathy are prone to depression, asthenia. They are irritable and quickly get tired at work.

Clinical studies in recent years have shown that insulin deficiency plays a leading role in the development of encephalopathy in Type 1 diabetes mellitus. Normally, insulin participates in the formation of nerve fibers, a decrease in its concentration disrupts the processes of excitation through the processes of nerve cells. The onset of diabetes at an early age adversely affects the work of the brain, since during this period, the development of CNS structures that are more vulnerable to the action of pathological factors. Children are slowing down thinking processes, there are difficulties in learning.

Features of encephalopathy in type 2 diabetes

The combination of obesity, hypertension and type 2 diabetes repeatedly worsen the prognosis for encephalopathy. In patients with diabetes mellitus, the extreme degree of cognitive impairment( dementia) in recent years is registered 6 times more often. According to several scientists, diabetes increases the risk of Alzheimer's disease several times.

Treatment of diabetic encephalopathy

Therapeutic measures are directed to the vascular and metabolic links of the pathological process and are conducted against the backdrop of antidiabetic therapy.

The following groups of drugs are used:

1. Preparations that improve tissue blood flow( Memoplant).
2. Antioxidants are used to normalize metabolic processes( Tioctacid, Berlition).
3. Neuroprotectors combined with antioxidants( Thiocetam) protect cells from damaging factors, oxygen starvation.
4. Vitamins A, E reduce the manifestations of hypoxia, improve the resistance of cells to the action of active radicals.
5. Group B vitamins( Milgamma, Pyridoxine, Thiamin) are involved in the protection of nerve fibers, contribute to the restoration of nerve tissue.
6. Vascular medications( Trental) improve blood flow in capillaries, are used to prevent strokes.
7. Vasoactive drugs( Cavinton, Stugeron, etc.) expand the vessels in the brain, reduce the risk of thrombosis, are used to treat and prevent acute circulatory disorders of the brain.

Diabetic encephalopathy is a chronic progressive disease. Regular observation by an endocrinologist and a neurologist, taking antidiabetic drugs and courses of therapy for neurologic complications can slow the progression of the disease.