Diabetes mellitus and progression of vascular brain lesions and brain atrophy in patients with symptomatic atherosclerotic disease. The SMART-MR study

Abstract

DM on top of existing symptomatic atherosclerotic disease is associated with increased brain atrophy and vascular brain lesion load that proceed at a slightly higher rate than in patients without DM.

Brain Changes Underlying Cognitive Dysfunction in Diabetes: What Can We Learn From MRI?

“…The reduction in mean total brain volume is 0.2-0.6 SD units, comparable with 3-5 years of normal aging (16)(17)(18). Longitudinal case-control and population-based studies have demonstrated brain volume loss in patients with diabetes that is similar to or up to three times the atrophy rate of normal aging (16)(17)(18)(19). The loss of brain tissue is most clearly reflected by accelerated expansion of the ventricles (16,17,19).…”

“…Longitudinal case-control and population-based studies have demonstrated brain volume loss in patients with diabetes that is similar to or up to three times the atrophy rate of normal aging (16)(17)(18)(19). The loss of brain tissue is most clearly reflected by accelerated expansion of the ventricles (16,17,19). These findings may indicate that type 2 diabetes-associated atrophy is most pronounced in regions surrounding the ventricles, such as subcortical gray matter or white matter regions.…”

“…Several studies that assessed WMH volumes with (semi)automated methods reported no difference between patients with type 2 diabetes and control subjects in cross-sectional (18,22,32) or longitudinal analyses (18). Other studies reported that WMH volumes were increased in patients with diabetes (7,17,19,33). Importantly, in these latter studies, the relative increase in WMH volumes compared with control subjects was ;20%, which is only a modest difference in light of the marked interindividual variation in WMH volumes in older people.…”

[P4–134]: Insulin Resistance Is Associated With Reductions in Specific Cognitive Domains and Increases in CSF Tau in Cognitively Normal Adults

“…Furthermore, studies of structural magnetic resonance imaging (MRI) show that in T2D cognitive impairment is associated with greater levels of vascular lesions as well as with brain atrophy [6][7][8][9][10] . Prospective MRI studies also show that in T2D brain atrophy occurs at faster rates than in normal ageing 11,12 , suggesting that T2D accelerates neurodegeneration. Animal studies provide additional evidence to show that inducing T2D/insulin resistance (IR) can promote the pathological changes characteristic of Alzheimer's disease (AD), specifically accumulation of amyloid-beta (Aβ) and tau (see review ref.…”

“…C 11 -Pittsburg compound B-PET: PiB-PET) show that reduced neuronal glucose metabolism and increased levels of neocortical Aβ accumulation are features that occur early in the disease (see review ref. 15).…”