Type 2 diabetes mellitus (T2DM) is a complex, chronic and progressive
metabolic disease, which is characterized by relative
insulin deficiency,
insulin resistance, and high
glucose levels in blood. Esteemed published articles and epidemiological data exhibit an increased risk of developing Alzheimer's disease (AD) in diabetic pateints.
Metformin is the most frequently used oral anti-diabetic drug, which apart from hypoglycaemic activity, improves serum
lipid profiles, positively influences the process of haemostasis, and possesses anti-inflammatory properties. Recently, scientists have put their efforts in establishing
metformin's role in the treatment of
neurodegenerative diseases, such as AD, amnestic
mild cognitive impairment and
Parkinson's disease. Results of several clinical studies confirm that long term use of
metformin in diabetic patients contributes to better cognitive function, compared to participants using other anti-diabetic drugs. The exact mechanism of
metformin's advantageous activity in AD is not fully understood, but scientists claim that activation of AMPK-dependent pathways in human neural stem cells might be responsible for the neuroprotective activity of
metformin.
Metformin was also found to markedly decease
Beta-secretase 1 (BACE1)
protein expression and activity in cell culture models and in vivo, thereby reducing BACE1 cleavage products and the production of Aβ (β-
amyloid). Furthermore, there is also some evidence that
metformin decreases the activity of acetylcholinesterase (AChE), which is responsible for the degradation of acetylcholine (Ach), a
neurotransmitter involved in the process of learning and memory. In regard to the beneficial effects of
metformin, its anti-inflammatory and anti-oxidative properties cannot be omitted. Numerous in vitro and in vivo studies have confirmed that
metformin ameliorates oxidative damage.