Non-enzymatic glycosylation of proteins, also called Maillard reaction, which occurs at an accelerated rate in diabetes, can lead to the formation of advanced glycosylation endproducts (AGEs). Tenilsetam (CAS 997: (+/-)-3-(2-thienyl)-2-piperazinone), a cognition-enhancing drug successfully used for treatment of patients suffering from Alzheimer's disease, when included in the Maillard reaction apparently inhibits protein crosslinking by AGEs in vitro. According to the mechanism proposed, Tenilsetam acts via covalent attachment to glycated proteins, thus blocking the reactive sites for further polymerisation reactions. A beneficial effect of Tenilsetam in Alzheimer's disease could come from the interference with AGE-derived crosslinking of amyloid plaques and a decreased inflammatory response by diminished activation of phagocytosing microglia.
Despite intense efforts, it has not yet been possible to clarify the etiopathogenesis of Alzheimer's dementia. There are, however, hypotheses which focus on certain aspects of this type of dementia, characterized by particular neuropathological alterations and clinical correlates. Recently, evidence has accumulated that advanced glycation endproducts (AGEs) could play an important role in the etiology of the Alzheimer's syndrome. AGEs are generated by an irreversible reaction through the non-enzymatic, long-term glycosylation of proteins. They are strongly resistant to proteolytic processes and induce protein crosslinking. They could thus inhibit the physiological functions of many proteins. Moreover, it is suggested that they contribute to the transformation of the soluble form of beta-amyloid into its unsoluble version. AGEs are also demonstrable in neurofibrillary tangles (NFTs). A further mechanism by which AGEs might be pathogenic is via their induction of oxidative stress. AGEs probably exert their pathological effects not only directly because of their chemical properties, but also by indirect receptor-mediated mechanisms. Further investigation of AGE-mediated mechanisms should reveal their role in the etiopathogenesis of the Alzheimer's syndrome and, finally, lead to the development of new pharmacological strategies aimed at inhibiting protein cross-linking.
ÖZET Amaç: Birçok araştırma obezitesi olan çocuk ve ergenlerde psikopatolojinin daha sık ortaya çıktığını ortaya koymasına rağmen, psikopatolojinin doğası ve boyutu ile ilgili anlaşmazlıklar sürmektedir. Bu araştırma 9 ve 18 yaş arası obezitesi olan çocuk ve ergenlerde kendilik algısı ve psikiyatrik belirtileri araştırmayı amaçlamaktadır. Yöntemler: Çalışmanın örneklemini, Uludağ Üniversitesi Tıp Fakültesi Pediatrik Endokrinoloji Bölümü polikliniğine başvuran 47 obezitesi olan çocuk ve ergen oluşturdu. Psikiyatrik değerlendirme; yarı-yapılandırılmış psikiyatrik görüşme, Piers-Harris Çocuklarda Öz-Kavramı Ölçeği, Çocuklar İçin Kovacs Depresyon Ölçeği, Durumluk-Sürekli Kaygı Ölçeği ve Çok Yönlü Beden-Self İlişkisi Ölçeği ile yapıldı. Bulgular: Çalışmaya 47 hasta (26 kız, 21 erkek) alındı. Ortalama yaş 13.1±2.63 tü (9-18). Durumluk anksiyete ortalama puanları daha obez olan grupta yüksekti (BKI>30; p<0,05), ancak cinsiyete ya da çocuk-ergen olmaya göre değişmedi (p>0.05). Sürekli anksiyete ve depresyon ortalama puanları ise obezite derecesi, cinsiyet ya da çocuk-ergen farkı gözetmedi (p>0.05). Patolojik düzeydeki depresyon, durumluk ve sürekli kaygı oranları obezite derecesi arttıkça, cinsiyete ve çocuk-ergen olmaya göre değişmedi (p>0.05). Kendilik algısı sonuçları daha obez (BKI>30; p<0.05) olanların ve ergenlerin (p<0.01) kendilerini 'daha popüler' gördüklerini gösterdi, kızlar akademik alanda daha pozitif bir kendilik algısına sahipti (p<0.01). Beden-self ilişkisi obezite derecesinin artmasıyla değişmedi (p>0.05), ancak kızlar (p<0.01) ve ergenler (p<0.05) görünüşleriyle daha fazla ilgiliydi, ek olarak kızlar (p<0.05) sağlık durumlarıyla daha fazla ilgiliydi. Sonuç: Sonuçlar obezite ile psikopatoloji (depresyon, davranış problemleri, düşük öz-saygı) arasında yüksek ilişki gösteren önceki araştırmalarla uyumlu değildi. Anahtar kelimeler: Obezite; Kendilik algısı; Depresyon; Anksiyete; Beden-self ilişkisi ABSTRACT Objectıve: Although several studies have documented the existence of psychopathology in obese children and adolescents, disagreement remains regarding the extent and nature of this psychopathology. This study aimed to investigate self perception and psychiatric symptoms in obese children and adolescents aged between 9 and 18 years old. Methods: The study sample consisted of 47 patients admitted to the pediatric endocrinology outpatient clinic at Uludag University School of Medicine. Psychological assessment was performed using a semi-structured psychiatric interview, The Piers-Harris Children's Self-Concept Scale, Kovacs Depression Scale for Children, State-Trait Anxiety Scale, and Multi-Dimensional Body-Self Relations Questionaire. Results: Fortyseven patients (26 girls and 21 boys) were enrolled in the study. Mean age was 13.1±2.63 years (9-18 years). Mean results showed that state anxiety was higher in the more obese (BMI>30; p<0.05) but did not differ with sex or being a child or adolescent (p>0.05); and that trait anxiety and depression did not differ for degree of obesity, sex or being a child or ...
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