Mechanisms and Pathogenesis of Diabetic Cognitive Impairment: A Comprehensive Review.

Diabetic cognitive impairment (DCI) is a form of cognitive dysfunction that affects individuals with diabetes, marking it as one of the complications linked to this disease. This condition typically presents as deficits in various cognitive abilities, such as memory, learning, language, motor skills, perception, and attention. Studies show that around 13% of diabetic individuals aged 65 to 74 experience cognitive impairment, with this figure rising to 24% for those over 75. As the global incidence of DCI increases, the economic and caregiving challenges for both individuals and society are also growing. The specific mechanisms underlying DCI remain unclear, and the relationships among various pathological processes are still under investigation. The study of DCI mechanisms continues to present numerous unresolved mysteries, such as unclear causal relationships: does metabolic disorder (e.g., hyperglycemia) directly damage neurons, or does it indirectly affect cognition through vascular lesions? Additionally, the mechanisms of individual heterogeneity pose further questions: why do some diabetic patients experience cognitive decline (CD) while others do not? Therefore, understanding the pathological alterations and the fundamental reason behind DCI is essential for improving early prevention and treatment strategies for individuals exhibiting clinical symptoms of this disorder. Furthermore, DCI represents a significant intersection between metabolic and neurodegenerative diseases, which encourages the integration of cognitive assessments into routine diabetes management. This article not only provides a systematic review of existing research but also serves as a bridge connecting basic science with clinical practice, offering theoretical support for the precise prevention and early diagnosis of DCI in patients.