The review focuses on the problem of nervous system dysfunction in patients with type 2 diabetes mellitus (DM), which can be manifested by neuropsychological stress (NPN), cognitive impairment and dementia, which negatively affect both metabolic processes and feelings of well-being and quality of life. The gradual development of neurovascular disorders, as well as chronic systemic inflammation associated with atherosclerosis and immune disorders are the causes of neuropsychological and neurophysiological disarrays. Cholinergic mechanisms and hyperactivation of the sympathetic-adrenal and hypothalamic-pituitary systems contribute to the secretion of stress hormones, increase mental stress against the background of chronic metabolic stress. Therefore, the assessment of the degree of NPN can be useful for characterizing the state of neuropsychological, neurophysiological processes and determining the treatment strategy for patients with type 2 DM. In general, current studies of neuropsychological parameters in patients with DM have shown that the disease adversely affects the neurocognitive characteristics of these patients. This is due to the main pathogenetic mechanisms (indicators of insulin resistance, markers of inflammation, atherogenesis and vascular dysfunction, changes in the secretion of stress hormones and neurotransmitters). Both type 2 DM and aging, can affect the development of neuropsychiatric abnormalities in patients with mental stress, memory, ability to concentrate, and cognition. Investigation of these effects and the development of methods for monitoring, prevention and pharmacotherapy of these disorders can be useful for improving the health of the elderly people, especially of patients with type 2 DM. Modern antidiabetic drugs can have a protective effect on the peripheral and central nervous system due to their hypoglycemic effects. Mechanisms of neuroprotective effect include antioxidant and anti-inflammatory action, antiapoptotic effect, enhanced neuronal differentiation. Agents for correction of intestinal microbiota also provide positive effects.