Objective: The aim of this prospective study was to investigate the relationships between inflammation, cerebral vasoregulation, and cognitive decline in type 2 diabetes mellitus (T2DM) over a 2-year span.Methods: Sixty-five participants (aged 66 6 9.2 years, 35 with T2DM, 33 women) were enrolled for this 2-year prospective study. Continuous arterial spin labeling at 3-tesla MRI was used to measure global and regional cerebral perfusion and vasoreactivity. Neuropsychological measures were evaluated at the beginning and completion of the study. The associations between serum inflammatory markers, regional cerebral vasoreactivity, and cognitive functions were examined using least squares models.Results: After 2 years of follow-up, participants with T2DM had diminished global and regional cerebral vasoreactivity and a decline in multiple cognitive tasks compared with baseline (p , 0.0001-0.012). In the T2DM group, lower cerebral vasoreactivity was associated with a greater decrease in daily living activities score (r Type 2 diabetes mellitus (T2DM) has been recognized as an independent risk for development of cognitive impairment and dementia.1,2 Endothelial dysfunction and impaired cerebral vasoregulation associated with hyperglycemia and elevated proinflammatory cytokine levels have been linked to functional decline in T2DM.3-5 The aim of this study was to prospectively determine the associations between inflammation, cerebral vasoregulation, and cognitive performance over a 2-year span in older adults with and without T2DM. We hypothesized that (1) inflammation and hyperglycemia are associated with impaired vasoregulation in the brain, and (2) impaired vasoregulation is associated with cognitive decline in T2DM.

Treatment options for stroke remain limited. Neuroprotective therapies, in particular, have invariably failed to yield the expected benefit in stroke patients, despite robust theoretical and mechanistic background and promising animal data. Insulin and insulin-like growth factor 1 (IGF-1) play a pivotal role in critical brain functions, such as energy homeostasis, neuronal growth, and differentiation. They may exhibit neuroprotective properties in acute ischemic stroke based upon their vasodilatory, anti-inflammatory and antithrombotic effects, as well as improvements of functional connectivity, neuronal metabolism, neurotransmitter regulation, and remyelination. Intranasally administered insulin has demonstrated a benefit for prevention of cognitive decline in older people, and IGF-1 has shown potential benefit to improve functional outcomes in animal models of acute ischemic stroke. The intranasal route presents a feasible, tolerable, safe, and particularly effective administration route, bypassing the blood–brain barrier and maximizing distribution to the central nervous system (CNS), without the disadvantages of systemic side effects and first-pass metabolism. This review summarizes the neuroprotective potential of intranasally administered insulin and IGF-1 in stroke patients. We present the theoretical background and pathophysiologic mechanisms, animal and human studies of intranasal insulin and IGF-1, and the safety and feasibility of intranasal route for medication administration to the CNS.

RESUMOEste artigo apresenta, de forma simples, a definição e fundamentos da pesquisa qualitativa, de forma a introduzir a temática da importância desta metodologia de investigação, para as ciências da nutrição e alimentação e os nutricionistas. Ao contrário da metodologia quantitativa, a pesquisa qualitativa é realizada através de uma abordagem interpretativa e naturalística do tema de estudo. Com o foco nos significados atribuídos pelos indivíduos ao objeto de estudo, a investigação qualitativa oferece um percurso científico propício à compreensão de um fenómeno tão complexo como o alimentar e nutricional. Não obstante o atual reconhecimento científico da importância da evidência qualitativa, a utilização desta metodologia é ainda muito reduzida e/ou pouco valorizada. O estabelecimento de mecanismos de educação e formação nesta temática e a elaboração de processos de colaboração interdisciplinar na realização de estudos científicos tornam-se assim vitais para o desenvolvimento da utilização desta metodologia, na área das ciências da nutrição e alimentação. ABSTRACTThis article presents, in a simple way, the definition and foundations of the qualitative research in order to introduce the thematic of the importance of this research methodology for the nutritional sciences and nutritionists. Unlike the quantitative methodology, qualitative research is realized through an interpretative and naturalistic approach of the subject of study. Qualitative research offers a scientific pathway conducive to the understanding of a phenomenon as complex as food and nutrition, however the use of this methodology is still very reduced or little valued. The establishment of education / training mechanisms in this area and processes of interdisciplinary collaboration in the conduct of scientific studies thus becomes vital for the development of the use of this methodology in the area of nutrition and food sciences. KEYWORDS Methodology, Food and Nutrition, Qualitative research A pesquisa qualitativa originária das ciências humanas e sociais, ganhou, nas últimas décadas, no seio das ciências da saúde, força e valor, através do reconhecimento da sua contribuição para uma mais profunda compreensão da complexidade do comportamento humano e da interação entre doença e sociedade, levando alguns autores a anunciar "uma revolução qualitativa", na investigação científica em saúde (1-3). Na verdade, esta abordagem metodológica, anteriormente posicionada nos lugares inferiores da hierarquia de produção de evidência científica, é, atualmente, cada vez mais considerada como parte importante dos processos de tomada de decisão, que direcionam o desenvolvimento de políticas e práticas de saúde (2). Os resultados produzidos por este tipo de metodologia não envolvem procedimentos estatísticos. A pesquisa qualitativa tende a colocar questões utilizando "o quê", "como" e "porquê", e a analisar as respostas no contexto da vida quotidiana e dos significados e explicações atribuídos por cada indivíduo ao fenómeno estudado (4). Das inúmeras áreas de valor...

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ObjectiveTo examine if statins have an effect on small nerve fibers.MethodsThis retrospective study evaluated the effect of statins in pure small-fiber neuropathy (SFN). Outcome measures were symptom scales (numbness, tingling, and autonomic symptoms), skin biopsies assessing epidermal nerve fiber density (ENFD), sweat gland nerve fiber density (SGNFD), and quantitative autonomic testing.ResultsOne hundred and sixty participants with pure SFN were identified. Eighty participants (women/men, age ± SD 33/47, 68.1 ± 11.6 years old) were on statins for 53.5 ± 28.7 months to treat dyslipidemia and they were age and gender matched with 80 participants (33/47, 68.1 ± 9.5) that were off statins. ANOVA showed reduced ENFD/SGNFD at the proximal leg in the statin group [(count/mm) 8.3 ± 3.6/51.3 ± 14.2] compared to the off statin group (10.4 ± 3.8, p = 0.0008/56.4 ± 12.7, p = 0.018). There was no difference in ENFD/SGNFD at the distal leg in the statin group (4.9 ± 3.2/39.8 ± 15.7) compared to the off statin group (5.9 ± 3.4, p = 0.067/41.8 ± 15.9, p = 0.426). Statins did not affect symptom scales and the outcome of autonomic testing.ConclusionStatin use is associated with degeneration of sensory and autonomic fibers. The pattern of abnormalities, e.g., degeneration of proximal while sparing of distal fibers, is consistent with a non-length-dependent process with lesions in the dorsal root and the autonomic ganglia. The statin-associated sensory and autonomic ganglionopathy is mild.

Objective Microalbuminuria (MA), a marker of renal microvascular disease, is associated with brain atrophy and neurovascular changes in older adults with type 2 diabetes mellitus (DM). We evaluated the relationship between urine albumin-to-creatinine ratio (UACR) and regional brain volumes determine whether subclinical albuminuria may indicate early structural brain changes in type 2 DM. Materials/Methods We studied UACR and brain volumes in 85 type 2 DM patients (64.8 ± 8.3 years) and 40 age-matched controls using 3D magnetization prepared rapid acquisition with gradient echo (MP-RAGE) MRI (magnetic resonance imaging) at 3 Tesla. The relationship between UACR and brain volumes was analyzed using the least square models. Results In DM patients, UACR ≥ 5 mg/g, UACR ≥ 10 mg/g and clinically significant MA (UACR ≥ 17 mg/g [males] and 25 mg/g [females]) were associated with lower gray matter (GM) volume in the frontal lobe (r2 adj = 0.2-0.4, P= 0.01-0.05) and UACR ≥ 5mg/g was also related to global GM atrophy (r2 adj= 0.1, P= 0.04), independent of DM duration, glucose levels, HbA1c and hypertension. For UACR ≥ 5mg/g, a lower global GM volume was related to worse executive function (P= 0.04) in the DM group. No associations were found for UACR (< 5 mg/g) and controls. Conclusions Subclinical albuminuria (UACR ≥ 5 mg/g) is associated with lower GM volume that has clinical impact on cognitive function in older diabetic patients, and these relationships are independent of DM control and hypertension. Therefore, UACR levels may serve as an additional marker of DM-related brain structural changes.

The epidemic of type 2 diabetes (T2DM) is spreading around the globe and challenging the unprecedented success of health sciences in increasing longevity. T2DM has been linked to accelerated brain aging, functional decline in older adults and dementia. Brain insulin resistance and glycemic variability are potential mechanisms underlying T2DM-related brain damage and cognitive decline. Intranasal insulin therapy has emerged as a potential new treatment for T2DM-related cognitive impairment. Wearable technologies now allow better monitoring of behaviors and glycemic levels over several days and deliver real time feedback that can be used to improve self-management and lead to new prevention strategies and therapies for T2DM complications.

The epidemic of type 2 diabetes (T2DM) is spreading around the globe and challenging the unprecedented success of health sciences in increasing longevity. T2DM has been linked to accelerated brain aging, functional decline in older adults and dementia. Brain insulin resistance and glycemic variability are potential mechanisms underlying T2DM-related brain damage and cognitive decline. Intranasal insulin therapy has emerged as a potential new treatment for T2DM-related cognitive impairment. Wearable technologies now allow better monitoring of behaviors and glycemic levels over several days and deliver real time feedback that can be used to improve self-management and lead to new prevention strategies and therapies for T2DM complications.