* * * * Figure 1 Suggested pathogenesis of cognitive decline in DM2 Insulin resistance and risk factors related to the metabolic syndrome lead to DM2. The adverse effects of the metabolic syndrome and DM2 on the brain are mediated through ischaemic cerebrovascular disease, in concert with other factors from the metabolic syndrome. Hyperglycaemia plays an additional role through ‘toxic’ effects on brain tissue and the development of cerebral microangiopathy. Alterations in insulin metabolism can also directly affect the brain, through involvement in synaptic plasticity and amyloid and tau metab
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