Cerebrovascular Structural Alterations/Dysautonomic Disorders in Diabetes Mellitus

According to existing scientific evidence, diabetes mellitus is associated with mild to modest decrements in cognitive function. Domains of psychomotor speed, mental flexibility, attention, and general intelligence are those most frequently affected. Hypoglycemia is not usually risk factor for cognitive decline; however, this may not be true for children with young age at onset of diabetes. Relevant risk factors for the development of cognitive decline are an early age of onset and the presence of microvascular complications. Since age and duration of diabetes are important contributors to the changes in cognitive function, we need longitudinal studies looking at cognitive function, especially in elderly subject with type 1 diabetes mellitus. In addition, more information is needed in order to better understand the clinical implications of these mild-moderate decrements in cognitive function, also in terms of impact on daily lives and habits. In addition, the underlying mechanism and the risk factors that may lead to the development of more severe cognitive dysfunction like dementia in some, but not all diabetic patients are not clear. Diabetic autonomic neuropathy (DAN) represents a particular aspect of diabetic neuropathy, which may lead to impairment of several organs, including the heart, both in type 1 and type 2 diabetic patients. The pathogenesis of DAN is not entirely clear, but metabolic, genetic, and hormonal factors may be involved; however, the final pathway probably involves oxidative stress and inflammation caused by hyperglycemia. Since no therapy was demonstrated to effectively reverse DAN, prevention with close glycemic control, multifactorial intervention, and lifestyle modification remain crucial.