老年2型糖尿病患者运动功能障碍的中枢-外周互作机制研究进展OA

With the accelerating global population aging,motor dysfunction in elderly patients with type 2 diabetes mellitus(T2DM)has emerged as a critical factor impairing quality of life and elevating fall risk.Traditional research has predominantly attributed motor dysfunction to isolated system damage;however,accumulating evidence demonstrates that impairments in the central nervous system(CNS)and peripheral neuromuscular system are not independent but interact through complex bidirectional pathways that mutually amplify pathological processes.This review systematically summarizes recent advances in understanding motor dysfunction in elderly T2DM patients,with a focus on dysregulated central-peripheral interactions in the context of T2DM and their pathophysiological mechanisms mediating the impariment of motor dysfunction.At the central level,hyperglycemia and insulin resistance trigger brain atrophy,white matter lesions,basal ganglia and cerebellar dysfunction,and brain network dysregulation,leading to impaired motor control precision and balance deficits.At the peripheral level,diabetic peripheral neuropathy(DPN),sarcopenia,neuromuscular junction dysfunction(NMJ),and microvascular disease collectively contribute to muscle weakness and proprioceptive loss.Critically,the CNS and peripheral systems interact through four key pathways:the inflammation-metabolism-neural axis,neurotrophic factor network dysregulation,neurovascular unit(NVU)injury,and oxidative stress-mitochondrial dysfunction,forming an intricate pathological network that constitutes the integrative basis for comprehensive motor decline.This paper underscores the need to shift from a"single-system"to a"cross-system"research and intervention paradigm,thereby providing the rationale and empirical support for multi-target integrated strategies.