Decreased Plasma Endothelin-1 Levels in Asymptomatic Type I Diabetic Patients with Regional Cerebral Hypoperfusion Assessed by Spect

Vázquez, Luis Alberto; Amado, J. A.; García‐Unzueta, María Teresa; Quirce, R.; Jiménez-Bonilla, J.; Pazos, Fernando; Pesquera, C.; Carril, J.M.

doi:10.1016/s1056-8727(99)00064-1

Cited by 14 publications

(9 citation statements)

References 27 publications

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“…Furthermore, the increased intercellular adhesion molecule and vascular cell adhesion molecule concentrations suggests a vascularly mediated metabolic injury. This is supported by the single photon emission computed tomography and single photon emission tomography studies that have shown impaired cerebral blood flow in patients with type 1 diabetes without a history or evidence of cerebral disease (Keymulen et al, 1996;Vázquez et al, 1999).…”

Section: Figmentioning

confidence: 74%

Brain Metabolic Alterations in Patients with Type 1 Diabetes–Hyperglycemia-Induced Injury

Mäkimattila

Malmberg-Cèder

Häkkinen

et al. 2004

J Cereb Blood Flow Metab

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Summary:Microangiopathic end-organ injury is common in type 1 diabetes. However, the pathophysiology of diabetic encephalopathy is poorly understood. The authors studied 10 normotensive patients with type 1 diabetes with retinopathy, autonomic neuropathy, but without nephropathy, and 10 healthy subjects. Proton magnetic resonance spectroscopy was performed at 1.5 T in the frontal cortex, thalamus, and posterior frontal white matter. There was no change in N-acetyl-containing compounds (NA), but choline-containing compounds (Cho) were increased in the white matter and in the thalamus; myoinositol was increased in the white matter, glucose excess was found in all brain, and water intensity was increased in the cortical voxel in the patients. Calculated lifetime glycemic exposure correlated inversely with Cho and NA in white matter and with Cho in thalamus. Concentrations of soluble intercellular adhesion molecules and vascular cell adhesion molecules were increased in the patients. In conclusion, in patients with type 1 diabetes, the increase in adhesion molecules and an association between altered brain metabolites and glycemic exposure suggest the presence of a vascularly mediated, progressive metabolic disturbance in the brain.

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Section: Figmentioning

confidence: 74%

Brain Metabolic Alterations in Patients with Type 1 Diabetes–Hyperglycemia-Induced Injury

Mäkimattila

Malmberg-Cèder

Häkkinen

et al. 2004

J Cereb Blood Flow Metab

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“…Semiquantitative assessments of regional CBF using SPECT detected the lower ratio between regions with normal CBF versus areas of reduced CBF in type 1 diabetic subjects (4,5). The ratio was inversely correlated with systolic blood pressure, total cholesterol, and the atherogenic index, and it was positively correlated with HDL and cholesterol.…”

Section: Regional Perfusion and Brain Volumes In Diabetesmentioning

confidence: 94%

“…Single proton emission computed tomography (SPECT) studies suggest that chronic hyperglycemia alters cerebral blood flow (CBF) in the frontal, temporal, parietal, occipital, and cerebellar regions of interest (ROIs) (4,5). Vasoreactivity to acetazolamide is not homogeneous, with a majority of hypoperfused and some hyperperfused ROIs (6).…”

mentioning

confidence: 99%

Global and Regional Effects of Type 2 Diabetes on Brain Tissue Volumes and Cerebral Vasoreactivity

et al. 2007

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OBJECTIVE -The aim of this study was to evaluate the regional effects of type 2 diabetes and associated conditions on cerebral tissue volumes and cerebral blood flow (CBF) regulation.RESEARCH DESIGN AND METHODS -CBF was examined in 26 diabetic (aged 61.6 Ϯ 6.6 years) and 25 control (aged 60.4 Ϯ 8.6 years) subjects using continuous arterial spin labeling (CASL) imaging during baseline, hyperventilation, and CO 2 rebreathing. Regional gray and white matter, cerebrospinal fluid (CSF), and white matter hyperintensity (WMH) volumes were measured on a T1-weighted inversion recovery fast-gradient echo and a fluid attenuation inversion recovery magnetic resonance imaging at 3 Tesla.RESULTS -The diabetic group had smaller global white (P ϭ 0.006) and gray (P ϭ 0.001) matter and larger CSF (36.3%, P Ͻ 0.0001) volumes than the control group. Regional differences were observed for white matter (Ϫ13.1%, P ϭ 0.0008) and CSF (36.3%, P Ͻ 0.0001) in the frontal region, for CSF (20.9%, P ϭ 0.0002) in the temporal region, and for gray matter (Ϫ3.0%, P ϭ 0.04) and CSF (17.6%, P ϭ 0.01) in the parieto-occipital region. Baseline regional CBF (P ϭ 0.006) and CO 2 reactivity (P ϭ 0.005) were reduced in the diabetic group. Hypoperfusion in the frontal region was associated with gray matter atrophy (P Ͻ 0.0001). Higher A1C was associated with lower CBF (P Ͻ 0.0001) and greater CSF (P ϭ 0.002) within the temporal region.CONCLUSIONS -Type 2 diabetes is associated with cortical and subcortical atrophy involving several brain regions and with diminished regional cerebral perfusion and vasoreactivity. Uncontrolled diabetes may further contribute to hypoperfusion and atrophy. Diabetic metabolic disturbance and blood flow dysregulation that affects preferentially frontal and temporal regions may have implications for cognition and balance in elderly subjects with diabetes. Diabetes Care 30:1193-1199, 2007D iabetes is a prevalent condition associated with substantial morbidity attributed to vascular complications (1). Diabetes alters endothelial function (2) and permeability of the bloodbrain barrier, thus affecting microcirculation and regional metabolism (3).Studies in type 1 diabetes have shown that the fronto-temporal cortex and periventricular white matter (3) are more affected by diabetic metabolic disturbance. Single proton emission computed tomography (SPECT) studies suggest that chronic hyperglycemia alters cerebral blood flow (CBF) in the frontal, temporal, parietal, occipital, and cerebellar regions of interest (ROIs) (4,5). Vasoreactivity to acetazolamide is not homogeneous, with a majority of hypoperfused and some hyperperfused ROIs (6). White matter hyperintensities (WMHs) on T2-weighted magnetic resonance imaging (MRI) (7) have been associated with arteriolosclerosis, arising as consequences of aging, diabetes, and other cardiovascular risk factors (8,9). Vascular and neurodegenerative changes in these structures have consequences for regional perfusion, cognitive impairment, and balance in elderly people with type 2 diabetes (10,...

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“…Adhesion molecules are concomitant with altered endothelial cell motility through nitric oxide dependent pathways [112;113], angiogenic activity and neovascularization [114]. The regional effects of hyperglycemia on neurovascular coupling, metabolism, and neuronal function are dependent on energy demands [115–117] Therefore, cognitive and motor regions with high metabolic rates [118;119] are particularly vulnerable to hyperglycemia and vascular inflammation [120;121]. Recently, it has been shown that serum intercellular adhesion molecules [ICAM] and vascular cell adhesion molecules [VCAM] are associated with altered vasoreactivity and gray matter atrophy in several brain regions in older diabetic but also in non-diabetic hypertensive adults [50], and that cell adhesion molecules were also associated with worsened cognition.…”

Section: Cerebromicrovascular Disease Vasoreactivity and Brain Atrophymentioning

confidence: 99%

Cognition and Hemodynamics

Novak

2012

Curr Cardiovasc Risk Rep

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The relationship between cerebral hemodynamics and cognitive performance has increasingly become recognized as a major challenge in clinical practice for older adults. Both diabetes and hypertension worsen brain perfusion and are major risk factors for cerebrovascular disease, stroke and dementia. Cerebrovascular reserve has emerged as a potential biomarker for monitoring pressure–perfusion–cognition relationships. Endothelial dysfunction and inflammation, microvascular disease, and mascrovascular disease affect cerebral hemodynamics and play an important role in pathohysiology and severity of multiple medical conditions, presenting as cognitive decline in the old age. Therefore, the identification of cerebrovascular vascular reactivity as a new therapeutic target is needed for prevention of cognitive decline late in life.

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Decreased Plasma Endothelin-1 Levels in Asymptomatic Type I Diabetic Patients with Regional Cerebral Hypoperfusion Assessed by Spect

Cited by 14 publications

References 27 publications

Brain Metabolic Alterations in Patients with Type 1 Diabetes–Hyperglycemia-Induced Injury

Brain Metabolic Alterations in Patients with Type 1 Diabetes–Hyperglycemia-Induced Injury

Global and Regional Effects of Type 2 Diabetes on Brain Tissue Volumes and Cerebral Vasoreactivity

Cognition and Hemodynamics

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