Diffusion tensor imaging in type 1 diabetes: decreased white matter integrity relates to cognitive functions

Duinkerken, Eelco van; Schoonheim, Menno M.; IJzerman, Richard G.; Klein, Martin; Ryan, Christopher M.; Moll, Annette C.; Snoek, Frank J.; Barkhof, Frederik; Diamant, Michaëla; Pouwels, Petra J. W.

doi:10.1007/s00125-012-2488-2

Cited by 59 publications

(60 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More widespread reductions in FA throughout the brain were found in patients with diabetes and microangiopathy (38). In these studies, lower FA in patients was associated with longer diabetes duration (37) and decreased information processing speed and executive functioning (37,38).…”

Section: Type 1 Diabetesmentioning

confidence: 81%

See 1 more Smart Citation

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

2014

View full text Add to dashboard Cite

Diabetes is associated with cognitive dysfunction and an increased risk of dementia. This article addresses findings with brain MRI that may underlie cognitive dysfunction in diabetes. Studies in adults with type 1 diabetes show regional reductions in brain volume. In those with a diabetes onset in childhood, these volume reductions are likely to reflect the sum of changes that occur during brain development and changes that occur later in life due to exposure to diabetes-related factors. Type 2 diabetes is associated with global brain atrophy and an increased burden of small-vessel disease. These brain changes occur in the context of aging and often also in relation to an adverse vascular risk factor profile. Advanced imaging techniques detect microstructural lesions in the cerebral gray and white matter of patients with diabetes that affect structural and functional connectivity. Challenges are to further unravel the etiology of these cerebral complications by integrating findings from different imaging modalities and detailed clinical phenotyping and by linking structural MRI abnormalities to histology. A better understanding of the underlying mechanisms is necessary to establish interventions that will improve long-term cognitive outcomes for patients with type 1 and type 2 diabetes.Interest in the effect of diabetes on the brain is growing. It is now clear that type 1 diabetes is associated with modest decrements in cognitive functioning, which are most marked in patients with an early childhood diabetes onset (1). These decrements in adults with type 1 diabetes are most evident in the domains of general intelligence, psychomotor speed, and mental flexibility (2). On these domains, the magnitude of the decrements is ;0.3 to 0.7 SD units relative to people without diabetes (2). This implies that, on average, the performance of people with diabetes on these domains is at the 30th to the 40th percentile of control values. The progression of cognitive decrements in adults with type 1 diabetes, relative to people without diabetes, is generally slow, except in subgroups of patients with marked microvascular complications, who may show more marked decline (1).Modest decrements in cognitive functioning, evident on the domains of verbal and visual memory, information processing speed, and executive functioning, have also been noted in people with type 2 diabetes across all age groups (3). Similar to type 1 diabetes, effect sizes are small to moderate (0.3 to 0.4 SD units) (4) and follow a slow progression over time, only modestly exceeding the rate of normal aging-related cognitive decline (3). In older people, however, particularly older than the age of 65, type 2 diabetes is also associated with more severe forms of cognitive impairment. Data from large epidemiological surveys link diabetes to an increased dementia risk. A meta-analysis estimated that people with type 2 diabetes have a relative risk of vascular dementia of 2.5 (95% CI 2.1-3.0) and that of Alzheimer disease is 1.5 (95% CI 1.2-1.8) relative to indiv...

show abstract

Section: Type 1 Diabetesmentioning

confidence: 81%

“…Two studies examined microstructural white matter alterations with DTI in middle-aged adults with type 1 diabetes (37,38). Results showed decreased FA in posterior brain regions compared with control subjects (37).…”

Section: Type 1 Diabetesmentioning

confidence: 99%

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

2014

View full text Add to dashboard Cite

show abstract

“…This could indicate that other pathophysiological processes are related to cognitive dysfunction. In previous studies, it was shown that integrity of white matter and functional connectivity are related to cognitive dysfunction (7,8,10). Indeed, processing speed, the hallmark of type 1 diabetes-related decrements, may rely on the integration of activity in multiple brain regions and their interconnections.…”

Section: Discussionmentioning

confidence: 99%

“…in type 1 diabetes (4)(5)(6)(7)(8), has been identified as a surrogate marker for cumulative hyperglycemic exposure (9).…”

mentioning

confidence: 99%

“…It has been shown that alterations in neuronal communication (i.e., functional connectivity) and white matter integrity (i.e., structural connectivity) were most pronounced in type 1 diabetic patients with proliferative retinopathy, but were also noted in those without microvascular complications (6)(7)(8)10). These cerebral alterations were directly associated with type 1 diabetes-related cognitive decrements (6)(7)(8)10).…”

mentioning

confidence: 99%

See 1 more Smart Citation

Ventral Striatum, but Not Cortical Volume Loss, Is Related to Cognitive Dysfunction in Type 1 Diabetic Patients With and Without Microangiopathy

et al. 2014

View full text Add to dashboard Cite

OBJECTIVEPatients with longstanding type 1 diabetes may develop microangiopathy due to high cumulative glucose exposure. Also, chronic hyperglycemia is related to cerebral alterations and cognitive dysfunction. Whether the presence of microangiopathy is conditional to the development of hyperglycemia-related cerebral compromise is unclear. Since subcortical, rather than cortical, volume loss was previously related to cognitive dysfunction in other populations, we measured these brain correlates and cognitive functions in patients with longstanding type 1 diabetes with and without microangiopathy. RESEARCH DESIGN AND METHODSWe evaluated differences in subcortical volume and cortical thickness and volume in type 1 diabetic patients with (n = 51) and without (n = 53) proliferative retinopathy and 49 control subjects and related volume differences to cognitive dysfunction. Analyses were corrected for age, sex, systolic blood pressure, and A1C. RESULTSPutamen and right thalamic volume loss was noted in both patients with and without proliferative retinopathy compared with control subjects (all P < 0.05). Additionally, in patients with proliferative retinopathy relative to control subjects, volume loss of the bilateral nucleus accumbens was found (all P < 0.05). No differences were observed between the two patient groups. Cortical thickness and volume were not different between groups. In pooled analyses, lower left nucleus accumbens volume was associated with cognitive dysfunction (P < 0.035). CONCLUSIONSThis study shows subcortical, but not cortical, volume loss in relation to cognitive dysfunction in patients with longstanding type 1 diabetes, irrespective of microangiopathy. The time course, pathophysiology, and clinical relevance of these findings need to be established in longitudinal and mechanistic studies.Longstanding type 1 diabetes mellitus may lead to development of microangiopathy, mediated by cumulative hyperglycemic exposure (1). Cognitive dysfunction is also related to prolonged hyperglycemia (2,3). Proliferative retinopathy, the presence of which has been found to be independently related to cognition and cerebral alterations

show abstract

Introduction

Giustina¹,

Frara²

2020

Microvascular Disease in Diabetes

View full text Add to dashboard Cite

Diffusion tensor imaging in type 1 diabetes: decreased white matter integrity relates to cognitive functions

Cited by 59 publications

References 8 publications

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

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

Ventral Striatum, but Not Cortical Volume Loss, Is Related to Cognitive Dysfunction in Type 1 Diabetic Patients With and Without Microangiopathy

Introduction

Contact Info

Product

Resources

About