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Wagner CA, Massy ZA, Capasso G, Mattace-Raso F, Pepin M, Bobot M, Zoccali C, Ferreira AC, Hoorn EJ, Imenez Silva PH, Unwin RJ, Pesic V. Translational research on cognitive impairment in chronic kidney disease. Nephrol Dial Transplant 2025; 40:621-631. [PMID: 39400744 DOI: 10.1093/ndt/gfae229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Indexed: 10/15/2024] Open
Abstract
Cognitive decline is common in patients with acute or chronic kidney disease. Several areas of brain function can be affected, including short- and long-term memory, attention and inhibitory control, sleep, mood, eating control and motor function. Cognitive decline in kidney disease shares risk factors with cognitive dysfunction in people without kidney disease, such as diabetes, high blood pressure, sedentary lifestyle and unhealthy diet. However, additional kidney-specific risk factors may contribute, such as uremic toxins, electrolyte imbalances, chronic inflammation, acid-base disorders or endocrine dysregulation. Traditional and kidney-specific risk factors may interact to cause damage to the blood-brain barrier, induce vascular damage in the brain and cause neurotoxicity or neuroinflammation. Here, we discuss recent insights into the pathomechanisms of cognitive decline from animal models and novel avenues for prevention and therapy. We focus on a several areas that influence cognition: blood-brain barrier disruption, the role of skeletal muscle, physical activity and the endocrine factor irisin, and the emerging therapeutic role of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide 1 (GLP-1) receptor agonists. Taken together, these studies demonstrate the importance of animal models in providing a mechanistic understanding of this complex condition and their potential to explain the mechanisms of novel therapies.
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Affiliation(s)
- Carsten A Wagner
- Department of Physiology and Zurich Kidney Center (ZKC), University of Zurich, Zurich, Switzerland
| | - Ziad A Massy
- Clinical Epidemiology, Inserm Unit 1018, CESP, Hôpital Paul Brousse, Paris-Sud University (UPS) Villejuif, France
- Association pour l'Utilisation du Rein Artificiel dans la région parisienne (AURA), Paris, France and Ambroise Paré University Hospital, APHP, Department of Nephrology Boulogne-Billancourt/Paris, France
| | - Giovambattista Capasso
- Biogem, Research Institute for Biology and Molecular Genetics, Ariano Irpino, Italy
- Department of Translational Medical Sciences, University of Campania, Luigi Vanvitelli, Napoli, Italy
| | - Francesco Mattace-Raso
- Department of Internal Medicine, Division of Geriatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marion Pepin
- Clinical Epidemiology, Inserm Unit 1018, CESP, Hôpital Paul Brousse, Paris-Sud University (UPS) Villejuif, France
- Geriatric Department, Ambroise Paré University Hospital, APHP, Versailles Saint-Quentin-en-Yvelines University (UVSQ), Boulogne-Billancourt, France
| | - Mickaël Bobot
- Aix-Marseille Univ, C2VN, INSERM 1263, INRAE 1260, CERIMED, Marseille, France
| | - Carmine Zoccali
- Institute of Molecular Biology and Genetics, Ariano Irpino, Italy
- Associazione Ipertensione Nefrologia Trapianto Renale, Grande Ospedale Metropolitano, c/o Nefrologia, Reggio Calabria, Italy
| | - Ana C Ferreira
- Unidade Local de Saúde de São José - Hospital Curry Cabral, Nephrology Department, Lisbon, Portugal
- Nova Medical School - Nephrology, Lisbon, Portugal
| | - Ewout J Hoorn
- Department of Internal Medicine, Division of Nephrology and Hypertension, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Pedro H Imenez Silva
- Department of Internal Medicine, Division of Nephrology and Hypertension, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert J Unwin
- Department of Renal Medicine, Royal Free Hospital Trust, University College London (UCL), London, UK
| | - Vesna Pesic
- Department of Physiology, Faculty of Pharmacy, University of Belgrade, Belgrade, Serbia
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Bolignano D, Simeoni M, Hafez G, Pepin M, Gallo A, Altieri M, Liabeuf S, Giannakou K, De A, Capasso G. Cognitive impairment in CKD patients: a guidance document by the CONNECT network. Clin Kidney J 2025; 18:sfae294. [PMID: 40235626 PMCID: PMC11997768 DOI: 10.1093/ckj/sfae294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Indexed: 04/17/2025] Open
Abstract
Cognitive impairment is a prevalent and debilitating complication in patients with chronic kidney disease (CKD). This position paper, developed by the Cognitive Decline in Nephro-Neurology: European Cooperative Target network, provides guidance on the epidemiology, risk factors, pathophysiology, diagnosis and clinical management of CKD-related cognitive impairment. Cognitive impairment is significantly more common in CKD patients compared with the general population, particularly those undergoing haemodialysis. The development of cognitive impairment is influenced by a complex interplay of factors, including uraemic neurotoxins, electrolytes and acid-base disorders, anaemia, vascular damage, metabolic disturbances and comorbidities like diabetes and hypertension. Effective screening and diagnostic strategies are essential for early identification of cognitive impairment utilizing cognitive assessment tools, neuroimaging and circulating biomarkers. The impact of various drug classes, including antiplatelet therapy, oral anticoagulants, lipid-lowering treatments and antihypertensive drugs, on cognitive function is evaluated. Management strategies encompass pharmacological and non-pharmacological interventions, with recommendations for optimizing cognitive function while managing CKD-related complications. This guidance highlights the importance of addressing cognitive impairment in CKD patients through early detection, careful medication management and tailored therapeutic strategies to improve patient outcomes.
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Affiliation(s)
- Davide Bolignano
- Department of Medical and Surgical Sciences, “Magna-Graecia” University of Catanzaro, Catanzaro, Italy
| | - Mariadelina Simeoni
- Division of Nephrology and Dialysis, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gaye Hafez
- Department of Pharmacology, Faculty of Pharmacy, Altinbas University, Istanbul, Turkey
| | - Marion Pepin
- Ambroise Paré University Hospital, APHP, Geriatric Department, Versailles St Quentin University, Boulogne Billancourt, France
- Inserm Unit 1018, CESP, Clinical Epidemiology Team, Paris Saclay University, Villejuif, France
| | - Antonio Gallo
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Manuela Altieri
- I Division of Neurology, Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Sophie Liabeuf
- Pharmacoepidemiology Unit, Department of Clinical Pharmacology, Amiens University Medical Center, Amiens, France
- MP3CV Laboratory, EA7517, Jules Verne University of Picardie, Amiens, France
| | - Konstantinos Giannakou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus
| | - Ananya De
- Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Bai X, Song L, Liu X, Yang W, Li M, Xu B, Yang Z, Wang Z, Wang H. Cognitive Impairment in Chronic Kidney Disease Across Different Stages: The Role of Structural and Perfusion-Driven Functional Connectivity Changes. Brain Behav 2025; 15:e70330. [PMID: 39957426 PMCID: PMC11830999 DOI: 10.1002/brb3.70330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2024] [Revised: 01/13/2025] [Accepted: 01/20/2025] [Indexed: 02/18/2025] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) is associated with cognitive impairment (CI), yet the exact pathophysiological mechanisms remain unclear. This study aims to investigate the alterations in gray matter volume (GMV) and cerebral blood flow (CBF) across CKD stages, identify co-changed brain regions, explore abnormal seed-based functional connectivity (FC) in patients with CKD, and investigate the correlation between the abnormal brain regions and neuropsychological test scores. METHODS Two hundred and eight participants (66 healthy controls, 70 CKD Stages 1-3a, and 72 CKD Stages 3b-5) were consecutively recruited and underwent high-resolution T1-weighted imaging, arterial spin labeling, and functional MR imaging. The imaging parameters were compared among three groups, and correlations with MoCA scores were analyzed. RESULTS Compared to CKD 1-3a group, the bilateral fusiform gyrus (FFG.L and FFG.R) exhibited reduced GMV, increased CBF, and decreased FFG.L-FC with bilateral inferior frontal gyrus, triangular part (IFGtriang.L and IFGtriang.R), left middle occipital gyrus (MOG.L), and left hippocampus (HIP.L), as well as decreased FFG.R-FC with bilateral median cingulate and paracingulate gyri (DCG.L and DCG.R), left superior frontal gyrus, medial (SFGmed.L), IFGtriang.L, and right middle temporal gyrus (MTG.R) in CKD 3b-5 group. A negative correlation was observed between the MoCA scores and FFG.L-FC with right middle frontal gyrus (MFG.R), IFGtriang.L, IFGtriang.R, HIP.L, and left putamen in patients with CKD 1-3a. CONCLUSION Brain structural and perfusion alterations may underlie the reduced FC between fusiform gyrus and cognitive-related regions, providing potential neuroimaging evidence for the neuropathological mechanisms of CI in patients with different stages CKD.
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Affiliation(s)
- Xiaoyan Bai
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Lijun Song
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Xu Liu
- Department of NephrologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Wenbo Yang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Mingan Li
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Boyan Xu
- MR ResearchGE HealthcareBeijingChina
| | - Zhenghan Yang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Zhen‐Chang Wang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
| | - Hao Wang
- Department of RadiologyBeijing Friendship Hospital, Capital Medical UniversityBeijingChina
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Zhang Y, Liao X, Xu J, Yin J, Li S, Li M, Shi X, Zhang S, Li C, Xu W, Yu X, Yang Y. The Promising Potency of Sodium-Glucose Cotransporter 2 Inhibitors in the Prevention of and as Treatment for Cognitive Impairment Among Type 2 Diabetes Patients. Biomedicines 2024; 12:2783. [PMID: 39767690 PMCID: PMC11673520 DOI: 10.3390/biomedicines12122783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Revised: 11/28/2024] [Accepted: 12/04/2024] [Indexed: 01/03/2025] Open
Abstract
Type 2 diabetes mellitus (T2DM), accounting for the majority of diabetes mellitus prevalence, is associated with an increased risk of cognition decline and deterioration of cognition function in diabetic patients. The sodium-glucose cotransporter 2 (SGLT2), located in the renal proximal tubule, plays a role in urine glucose reabsorption. SGLT2 inhibitors (SGLT2i), have shown potential benefits beyond cardiac and renal improvement in preventing and treating cognitive impairment (CI), including mild cognitive impairment, Alzheimer's disease and vascular dementia in T2DM patients. Studies suggest that SGLT2i may ameliorate diabetic CI through metabolism pathways, inflammation, oxidative stress, neurotrophic factors and AChE inhibition. Clinical trials and meta-analyses have reported significant and insignificant results. Given their vascular effects, SGLT2i may offer unique protection against vascular CI. This review compiles mechanisms and clinical evidence, emphasizing the need for future analysis, evaluation, trials and meta-analyses to verify and recommend optimal SGLT2i selection and dosage for specific patients.
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Affiliation(s)
- Yibin Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaobin Liao
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Second Clinical College, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Jialu Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Jiaxin Yin
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Shan Li
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Mengni Li
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Xiaoli Shi
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Shujun Zhang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Chunyu Li
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Weijie Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Xuefeng Yu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
| | - Yan Yang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.Z.); (X.L.); (J.X.); (J.Y.); (S.L.); (M.L.); (X.S.); (S.Z.); (C.L.); (W.X.); (X.Y.)
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan 430030, China
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Kim HK, Biessels GJ, Yu MH, Hong N, Lee YH, Lee BW, Kang ES, Cha BS, Lee EJ, Lee M. SGLT2 Inhibitor Use and Risk of Dementia and Parkinson Disease Among Patients With Type 2 Diabetes. Neurology 2024; 103:e209805. [PMID: 39292986 DOI: 10.1212/wnl.0000000000209805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Despite the mechanistic potential of sodium-glucose cotransporter 2 inhibitor (SGLT2i) to improve neurologic outcomes, the efficacy of SGLT2i in neurodegenerative disorders among patients with type 2 diabetes is not well established. This population-based cohort study aimed to investigate the association of SGLT2i use with risks of incident dementia and Parkinson disease (PD) in patients with type 2 diabetes. METHODS This was a retrospective examination of data from a cohort of 1,348,362 participants with type 2 diabetes (≥40 years), who started antidiabetic drugs from 2014 to 2019, evaluated using the Korean National Health Insurance Service Database. Propensity score matching (1:1; SGLT2i to other oral antidiabetic drugs [OADs]) produced a cohort of 358,862 participants. Primary outcomes were the individual incidence of Alzheimer disease (AD), vascular dementia (VaD), and PD. Secondary outcomes were all-cause dementia (AD, VaD, and other dementia) and a composite of all-cause dementia and PD. Cox proportional hazards models were used to investigate the association between SGLT2i use and the risks of dementia and PD. RESULTS From the 358,862 participants analyzed (mean [SD] age, 57.8 [9.6] years; 58.0% male), 6,837 incident dementia or PD events occurred. Regarding the individual endpoints, SGLT2i use was associated with reduced risks of AD (adjusted hazard ratio [aHR] 0.81, 95% CI 0.76-0.87), VaD (aHR 0.69, 95% CI 0.60-0.78), and PD (aHR 0.80, 95% CI 0.69-0.91) with a 6-month drug use lag period. In addition, use of SGLT2i was associated with a 21% lower risk of all-cause dementia (aHR 0.79, 95% CI 0.69-0.90) and a 22% lower risk of all-cause dementia and PD than use of other OADs (aHR 0.78, 95% CI 0.73-0.83). The association between the use of SGLT2i and the lowered risk of these neurodegenerative disorders was not affected by sex, Charlson Comorbidity Index, diabetic complications, comorbidities, and medications. Sensitivity analysis further adjusting for bioclinical variables from health screening tests, including blood pressure, glucose, lipid profiles, and kidney function, yielded generally consistent results. DISCUSSION In this nationwide population-based study, SGLT2i use significantly reduced the risks of neurodegenerative disorders in patients with type 2 diabetes independent of various factors including comorbidities and bioclinical parameters. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that SGLT2 antidiabetic drugs decrease the risk of dementia and PD in people with diabetes.
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Affiliation(s)
- Hae Kyung Kim
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Geert Jan Biessels
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Heui Yu
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Namki Hong
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Yong-Ho Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung-Wan Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Seok Kang
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Bong-Soo Cha
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Jig Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Minyoung Lee
- From the Department of Internal Medicine (H.K.K., M.H.Y., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Institute of Endocrine Research (H.K.K., N.H., Y.-h.L., B.-W.L., E.S.K., B.-S.C., E.J.L., M.L.), Yonsei University College of Medicine, Seoul, South Korea; Department of Neurology (G.J.B.), University Medical Center (UMC) Utrecht Brain Center, UMC Utrecht, the Netherlands; and SENTINEL Team (M.H.Y.), Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
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Mei J, Li Y, Niu L, Liang R, Tang M, Cai Q, Xu J, Zhang D, Yin X, Liu X, Shen Y, Liu J, Xu M, Xia P, Ling J, Wu Y, Liang J, Zhang J, Yu P. SGLT2 inhibitors: a novel therapy for cognitive impairment via multifaceted effects on the nervous system. Transl Neurodegener 2024; 13:41. [PMID: 39123214 PMCID: PMC11312905 DOI: 10.1186/s40035-024-00431-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/11/2024] [Indexed: 08/12/2024] Open
Abstract
The rising prevalence of diabetes mellitus has casted a spotlight on one of its significant sequelae: cognitive impairment. Sodium-glucose cotransporter-2 (SGLT2) inhibitors, originally developed for diabetes management, are increasingly studied for their cognitive benefits. These benefits may include reduction of oxidative stress and neuroinflammation, decrease of amyloid burdens, enhancement of neuronal plasticity, and improved cerebral glucose utilization. The multifaceted effects and the relatively favorable side-effect profile of SGLT2 inhibitors render them a promising therapeutic candidate for cognitive disorders. Nonetheless, the application of SGLT2 inhibitors for cognitive impairment is not without its limitations, necessitating more comprehensive research to fully determine their therapeutic potential for cognitive treatment. In this review, we discuss the role of SGLT2 in neural function, elucidate the diabetes-cognition nexus, and synthesize current knowledge on the cognitive effects of SGLT2 inhibitors based on animal studies and clinical evidence. Research gaps are proposed to spur further investigation.
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Affiliation(s)
- Jiaqi Mei
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Huan Kui College of Nanchang University, Nanchang, China
| | - Yi Li
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Huan Kui College of Nanchang University, Nanchang, China
| | - Liyan Niu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Huan Kui College of Nanchang University, Nanchang, China
| | - Ruikai Liang
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mingyue Tang
- Queen Mary College of Nanchang University, Nanchang, China
| | - Qi Cai
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingdong Xu
- Queen Mary College of Nanchang University, Nanchang, China
| | - Deju Zhang
- Food and Nutritional Sciences, School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Xiaoping Yin
- Department of Neurology, Affiliated Hospital of Jiujiang University, Jiujiang, China
| | - Xiao Liu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianping Liu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Minxuan Xu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Panpan Xia
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jitao Ling
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuting Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jianqi Liang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jing Zhang
- Department of Anesthesiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
| | - Peng Yu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China.
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Lardaro A, Quarta L, Pagnotta S, Sodero G, Mariani S, Del Ben M, Desideri G, Ettorre E, Baratta F. Impact of Sodium Glucose Cotransporter 2 Inhibitors (SGLT2i) Therapy on Dementia and Cognitive Decline. Biomedicines 2024; 12:1750. [PMID: 39200215 PMCID: PMC11351143 DOI: 10.3390/biomedicines12081750] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 07/28/2024] [Accepted: 07/29/2024] [Indexed: 09/02/2024] Open
Abstract
Dementia is an age-related syndrome characterized by the progressive deterioration of cognition and capacity for independent living. Diabetes is often associated with cognitive decline and shares similar pathophysiological mechanisms with dementia, such as systemic inflammation, oxidative stress, insulin resistance, and advanced glycation end-products formation. Therefore, adequate diabetes management may reduce the risk of cognitive decline, especially in patients with other comorbidities and risk factors. The sodium glucose cotransporter inhibitors (SGLT2i) regulate renal glucose reabsorption by blocking the SGLT2 cotransporters located in the proximal tubules, causing glycosuria and intraglomerular pressure reduction. Their use helps to lower blood pressure by modifying sodium and water homeostasis; these drugs are also commonly used in the treatment of heart failure and chronic kidney disease, while recently, a potential neuroprotective role in the central nervous system has been suggested. The aim of our scoping review is to analyze current evidence about the potential neuroprotective effects of SGLT2i in adult patients. We performed a scoping literature review to evaluate the effect of SGLT2i on dementia, mild cognitive impairment (MCI) and Alzheimer's disease incidence and progression. The screening process was performed through different searches on PubMed and EMBASE, evaluating original works published up to January 2024. In conclusion, the use of SGLT2i could be associated with a neuroprotective effect in patients with diabetes, reducing the incidence or the progression of MCI and dementia. Further prospective studies are needed to validate this hypothesis and to evaluate the effectiveness of this class of drugs in normal glycemic profile patients.
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Affiliation(s)
- Antonio Lardaro
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (A.L.); (L.Q.); (S.P.); (M.D.B.); (G.D.); (E.E.)
| | - Ludovica Quarta
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (A.L.); (L.Q.); (S.P.); (M.D.B.); (G.D.); (E.E.)
| | - Stefania Pagnotta
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (A.L.); (L.Q.); (S.P.); (M.D.B.); (G.D.); (E.E.)
| | - Giorgio Sodero
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| | - Sandro Mariani
- Department of Internal Medicine and Medical Specialties, Policlinico Umberto I University Hospital, 00161 Rome, Italy;
| | - Maria Del Ben
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (A.L.); (L.Q.); (S.P.); (M.D.B.); (G.D.); (E.E.)
| | - Giovambattista Desideri
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (A.L.); (L.Q.); (S.P.); (M.D.B.); (G.D.); (E.E.)
| | - Evaristo Ettorre
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (A.L.); (L.Q.); (S.P.); (M.D.B.); (G.D.); (E.E.)
| | - Francesco Baratta
- Department of Clinical Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy; (A.L.); (L.Q.); (S.P.); (M.D.B.); (G.D.); (E.E.)
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Złotek M, Kurowska A, Herbet M, Piątkowska-Chmiel I. GLP-1 Analogs, SGLT-2, and DPP-4 Inhibitors: A Triad of Hope for Alzheimer's Disease Therapy. Biomedicines 2023; 11:3035. [PMID: 38002034 PMCID: PMC10669527 DOI: 10.3390/biomedicines11113035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Alzheimer's is a prevalent, progressive neurodegenerative disease marked by cognitive decline and memory loss. The disease's development involves various pathomechanisms, including amyloid-beta accumulation, neurofibrillary tangles, oxidative stress, inflammation, and mitochondrial dysfunction. Recent research suggests that antidiabetic drugs may enhance neuronal survival and cognitive function in diabetes. Given the well-documented correlation between diabetes and Alzheimer's disease and the potential shared mechanisms, this review aimed to comprehensively assess the potential of new-generation anti-diabetic drugs, such as GLP-1 analogs, SGLT-2 inhibitors, and DPP-4 inhibitors, as promising therapeutic approaches for Alzheimer's disease. This review aims to comprehensively assess the potential therapeutic applications of novel-generation antidiabetic drugs, including GLP-1 analogs, SGLT-2 inhibitors, and DPP-4 inhibitors, in the context of Alzheimer's disease. In our considered opinion, antidiabetic drugs offer a promising avenue for groundbreaking developments and have the potential to revolutionize the landscape of Alzheimer's disease treatment.
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Affiliation(s)
| | | | | | - Iwona Piątkowska-Chmiel
- Department of Toxicology, Faculty of Pharmacy, Medical University of Lublin, Jaczewskiego 8b Street, 20-090 Lublin, Poland; (M.Z.); (A.K.); (M.H.)
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Scheen AJ, Bonnet F. Efficacy and safety profile of SGLT2 inhibitors in the elderly: How is the benefit/risk balance? DIABETES & METABOLISM 2023; 49:101419. [PMID: 36640828 DOI: 10.1016/j.diabet.2023.101419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is a highly prevalent health condition in the aging population. Older adults with T2DM have higher risks of cardiovascular disease, heart failure (long underestimated) and premature death than those without diabetes. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have proven their ability to improve cardiovascular prognosis and reduce the risk of hospitalization for heart failure (hHF). However, several adverse events have been reported, whose incidence and severity might be increased in the elderly population. The aims of this comprehensive review were to analyze the benefit-risk ratio of SGLT2i therapy in older patients with T2DM by collecting data from (i) large prospective placebo-controlled cardiovascular outcome trials (including those dedicated to heart failure), using both original publications and dedicated post-hoc analyses across different age groups and (ii) observational cohort studies, describing the effects of SGLT2is versus other glucose-lowering agents on cardiovascular outcomes and hHF in elderly patients or these effects in different age groups. Overall, consistent results showed a similar relative risk reduction in cardiovascular mortality and hHF with SGLT2is independently of age. The absolute risk reduction may be greater in elderly because of a higher background risk in older versus younger patients. Similarly, the safety profile of SGLT2is appeared comparable in older versus younger patients. In conclusion, the benefit/risk balance favors the use of SGLT2is in older patients at risk of cardiovascular disease and/or heart failure. Caution may be required in very old frail patients, especially those exposed to an increased risk of volume depletion.
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Affiliation(s)
- André J Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders, Department of Medicine, CHU, Liege, Belgium; Division of Clinical Pharmacology, Centre for Interdisciplinary Research on Medicines (CIRM), Liège University, Liege, Belgium.
| | - Fabrice Bonnet
- Centre Hospitalier Universitaire de Rennes, Université ́ Rennes 1, Rennes, France; INSERM U1018, Villejuif, France
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Lee K, Chen J, Wang C. Association between diabetes mellitus and post-stroke cognitive impairment. J Diabetes Investig 2022; 14:6-11. [PMID: 36181402 PMCID: PMC9807143 DOI: 10.1111/jdi.13914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 08/29/2022] [Accepted: 09/07/2022] [Indexed: 01/07/2023] Open
Abstract
Stroke survivors suffer from various physical, emotional, and cognitive impairments. These changes are dynamic and depend on multiple factors, including underlying diseases, baseline brain function and pathology, the site of the stroke and the post-stroke inflammation, neurogenesis as well as the subsequent remodeling of the neuro-network. First we review the structural and pathological changes of the brain in stroke survivors with diabetes mellitus, which may lead to post-stroke cognitive dysfunction. Second, we provide evidence of hyperglycemia, diabetes mellitus, hypoglycemia, and their relationship with post-stroke cognitive impairment (PSCI) and post-stroke dementia (PSD). In addition to conventional biomarkers, such as HbA1c, we also provide other novel tools to predict PSCI/PSD, such as glycemic variability, receptor for advanced glycation end products, and gut microbiota. Finally, we attempt to provide some modifying methods for glycemic control, focusing on the prevention of PSCI/PSD.
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Affiliation(s)
- Kang‐Po Lee
- College of MedicineI‐Shou UniversityKaohsiungTaiwan,Stroke Center and Department of NeurologyE‐Da HospitalKaohsiungTaiwan
| | | | - Chih‐Yuan Wang
- Division of Endocrinology and Metabolism, Department of Internal MedicineCollege of Medicine, National Taiwan University Hospital, National Taiwan UniversityTaipeiTaiwan
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