Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics

Havenon, Adam de; Majersik, Jennifer J.; Tirschwell, David; McNally, J. Scott; Stoddard, Gregory J.; Rost, Natalia S.

doi:10.1212/wnl.0000000000007093

Cited by 60 publications

(68 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…CSVD is a broad term that refers to pathologies of the cerebral arteries, arterioles, capillaries, and venules [20]. WMH are widely supported to be markers of CSVD associated with aging and CVD [10–17]. Yet, our sensitivity analyses showed that the effects of WMH remained after controlling for CVD risk factors (i.e., systolic blood pressure, diagnostic history of hypertension, diabetes, and hypercholesterolemia).…”

Section: Discussionmentioning

confidence: 82%

Independent effects of white matter hyperintensities on cognitive, neuropsychiatric, and functional decline: a longitudinal investigation using the National Alzheimer’s Coordinating Center Uniform Data Set

et al. 2019

View full text Add to dashboard Cite

Background Longitudinal investigations are needed to improve understanding of the contributions of cerebral small vessel disease to the clinical manifestation of Alzheimer’s disease, particularly in the early disease stages. This study leveraged the National Alzheimer’s Coordinating Center Uniform Data Set to longitudinally examine the association between white matter hyperintensities and neuropsychological, neuropsychiatric, and functional decline among participants with normal cognition. Methods The sample included 465 participants from the National Alzheimer’s Coordinating Center Uniform Data Set who had quantitated volume of white matter hyperintensities from fluid-attenuated inversion recovery MRI, had normal cognition at the time of their MRI, and were administered the National Alzheimer’s Coordinating Center Uniform Data Set neuropsychological test battery within 1 year of study evaluation and had at least two post-MRI time points of clinical data. Neuropsychiatric status was assessed by the Geriatric Depression Scale-15 and Neuropsychiatric Inventory-Questionnaire. Clinical Dementia Rating Sum of Boxes defined functional status. For participants subsequently diagnosed with mild cognitive impairment (MCI) or dementia, their impairment must have been attributed to Alzheimer’s disease (AD) to evaluate the relationships between WMH and the clinical presentation of AD. Results Of the 465 participants, 56 converted to MCI or AD dementia (average follow-up = 5 years). Among the 465 participants, generalized estimating equations controlling for age, sex, race, education, APOE ε4 , and total brain and hippocampal volume showed that higher baseline log-white matter hyperintensities predicted accelerated decline on the following neuropsychological tests in rank order of effect size: Trails B ( p < 0.01), Digit Symbol Coding ( p < 0.01), Logical Memory Immediate Recall ( p = 0.02), Trail Making A ( p < 0.01), and Semantic Fluency ( p < 0.01). White matter hyperintensities predicted increases in Clinical Dementia Rating Sum of Boxes ( p < 0.01) and Geriatric Depression Scale-15 scores ( p = 0.01). Effect sizes were comparable to total brain and hippocampal volume. White matter hyperintensities did not predict diagnostic conversion. All effects also remained after including individuals with non-AD suspected etiologies for those who converted to MCI or dementia. Conclusions In this baseline cognitively normal sample, greater white matter hyperintensities were associated with accelerated cognitive, neuropsychiatric, and functional decline independent of traditional risk factors and MRI biomarkers for Alzheimer’s disease.

show abstract

Section: Discussionmentioning

confidence: 82%

Independent effects of white matter hyperintensities on cognitive, neuropsychiatric, and functional decline: a longitudinal investigation using the National Alzheimer’s Coordinating Center Uniform Data Set

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Four studies examined the association of duration of DM ( 32 , 33 , 46 , 57 ) and HbA1c values ( 32 , 47 , 50 , 56 ) with WMH, respectively. Christiane Reitz et al ( 56 ) used HbA1c as a continuous variable to define the clinical type of dysglycemia.…”

Section: Resultsmentioning

confidence: 99%

Relationship Between Type 2 Diabetes and White Matter Hyperintensity: A Systematic Review

Wang

Wei

et al. 2020

Front. Endocrinol.

View full text Add to dashboard Cite

White matter (WM) disease is recognized as an important cause of cognitive decline and dementia. White matter lesions (WMLs) appear as white matter hyperintensities (WMH) on T2-weighted magnetic resonance imaging (MRI) scans of the brain. Previous studies have shown that type 2 diabetes (T2DM) is associated with WMH. In this review, we reviewed the literature on the relationship between T2DM and WMH in PubMed and Cochrane over the past five years and explored the possible links among the presence of T2DM, the course or complications of diabetes, and WMH. We found that: (1) Both from a macro- and micro-scopic point of view, most studies support the relationship of a larger WMH and a decrease in the integrity of WMH in T2DM; (2) From the relationship between brain structural changes and cognition in T2DM, the poor performance in memory, attention, and executive function tests associated with abnormal brain structure is consistent; (3) Diabetic microangiopathy or peripheral neuropathy may be associated with WMH, suggesting that the brain may be a target organ for T2DM microangiopathy; (4) Laboratory markers such as insulin resistance and fasting insulin levels were significantly associated with WMH. High HbA1c and high glucose variability were associated with WMH but not glycemic control.

show abstract

“…Therefore, BP control is crucial for the prevention of WMH. Despite the presence of a few conflicting voice, in recent years, emerging evidence has shown the benefit of more intensive BP control in terms of cerebrovascular events and WMH 8‐14 …”

Section: Introductionmentioning

confidence: 99%

Effect of intensive blood pressure control on the prevention of white matter hyperintensity: Systematic review and meta‐analysis of randomized trials

Lai

Jiang

et al. 2020

J of Clinical Hypertension

View full text Add to dashboard Cite

Hypertension is an important cause of cerebral small vessel disease, especially of white matter hyperintensity (WMH). The ability of intensive blood pressure (BP) control in preventing this pathological progression remains unclear. The authors systematically searched PubMed, EMBASE, SCOPUS, and Cochrane library for publications until July 20, 2020. Studies included were clinical trials with random allocation to an antihypertensive medication against placebo, or different treatment targets. The primary outcome was intergroup differences in the change of WMH volume. A random‐effect model was applied for pooling effect measures. Subgroup analysis and meta‐regression were conducted to explore heterogeneity. Seven studies with 2693 patients were identified. Compared with the control group, patients in the intensive BP control group had a slower progression of WMH, with a pooled intergroup standard mean difference (SMD) for WMH change of −0.22 (95% CI: −0.35 ~ −0.09, I2 = 63%). For studies comparing intensive and standard BP target, the pooled SMD is −0.37 (95% CI:‐0.50~‐0.24, I2 = 0%), while the pooled SMD of studies comparing active antihypertensive medication and placebo was only −0.08 (95% CI: −0.17 ~ 0.01, I2 = 0%). Meta‐regression analysis showed that the reduction in WMH progression is proportional to the magnitude of intensive BP control (β = −0.028, P < .001). In conclusion, intensive BP control prevents WMH progression, and its effect is associated with the magnitude of intensive BP control.

show abstract

Blood pressure, glycemic control, and white matter hyperintensity progression in type 2 diabetics

Cited by 60 publications

References 49 publications

Independent effects of white matter hyperintensities on cognitive, neuropsychiatric, and functional decline: a longitudinal investigation using the National Alzheimer’s Coordinating Center Uniform Data Set

Independent effects of white matter hyperintensities on cognitive, neuropsychiatric, and functional decline: a longitudinal investigation using the National Alzheimer’s Coordinating Center Uniform Data Set

Relationship Between Type 2 Diabetes and White Matter Hyperintensity: A Systematic Review

Effect of intensive blood pressure control on the prevention of white matter hyperintensity: Systematic review and meta‐analysis of randomized trials

Contact Info

Product

Resources

About