tailieunhanh - Diabetes Chronic Complications - part 7

Các tác dụng cấp tính của bệnh mạch máu não xơ vữa động mạch có thể được sâu sắc, và nếu sống sót, khuyết tật sản xuất lâu dài trong chức năng não có khả năng mất độc lập, kết quả là một gánh nặng cá nhân, xã hội và tài chính to lớn. | 146 DIABETES AND THE BRAIN Figure Complex interplay of some of the factors determining cerebral performance type 2 diabetes in particular. This review will deal primarily with these areas most closely associated with our day-to-day clinical understanding of diabetes touching additionally on other areas of association between diabetes and its potential effects on the brain and its function. Cerebrovascular Disease and Diabetes The acute effects of atherosclerotic cerebrovascular disease can be profound and if survived produce long-term defects in cerebral function with potential loss of independence resulting in an immense personal social and financial burden. Worldwide there are approximately million deaths from stroke each year making it the second most common cause of In the Western world between 2 and 5 in 100 adults die each year from stroke and in the UK approximately CEREBROVASCULAR DISEASE AND DIABETES 147 5 per cent of the total national health budget is consumed by stroke disease million per 100000 population per annum .2 Epidemiologic studies of the prevalence of stroke reliably identify diabetes predominantly type 2 as a risk factor for ischaemic stroke alongside others such as smoking and hypertension and although the strength of its association is variable across studies possibly dependant upon the degree of co-factor analysis undertaken most suggest a risk between two and three times that for the non-diabetic population. Whilst co-factor analysis attempts to separate risk attributable to single aspects of pathogenesis this may actually underestimate the role of diabetes in stroke disease as so many of the recognized risk factors co-exist in the population with type 2 diabetes. Pathological examination of brain tissue from stroke victims with diabetes reveals a much higher rate of small vessel disease of the penetrating vessels supplying the thalamic and sub-thalamic areas with increased rates of lacunar infarction as a