Prospectively Determined Impact of Type 1 Diabetes on Brain Volume During Development

Perantie, Dana C.; Koller, Jonathan M.; Weaver, Patrick; Lugar, Heather M.; Black, Kevin J.; White, Neil H.; Hershey, Tamara

doi:10.2337/db11-0589

Cited by 87 publications

(82 citation statements)

References 48 publications

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“…Given the alteration in conscious state that accompanies severe episodes, the focus traditionally has been on hypoglycemia as the explanation for cognitive deficits in children with type 1 diabetes. However, neuroimaging findings are inconsistent, with some studies finding no association between hypoglycemia history and structural brain changes (4,12) while others report positive correlations, but with little consistency between the brain regions affected (5,7,(9)(10)(11). Metaanalytic cognitive studies also provide contrasting findings, with one reporting positive association between hypoglycemia history and cognitive deficit (23) and another finding no association (14).…”

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confidence: 65%

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Risk Factors for Decline in IQ in Youth With Type 1 Diabetes Over the 12 Years From Diagnosis/Illness Onset

et al. 2014

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OBJECTIVEThis study examined illness-related change in intelligence quotient (IQ) in a cohort of youth with type 1 diabetes studied prospectively from disease onset in childhood to follow-up 12 years later in late adolescence/early adulthood. RESEARCH DESIGN AND METHODSParticipants included type 1 diabetes patients (n = 95; mean age at follow-up 21.3 years) and healthy control participants (HCs; n = 67; mean age at follow-up 21.0 years) from a cohort followed prospectively. Measures included Wechsler Preschool and Primary Scale of Intelligence-Revised, Wechsler Intelligence Scale for ChildrenRevised, and Wechsler Abbreviated Scale of Intelligence and prospective collection of data on metabolic control history. RESULTSYoung people with type 1 diabetes showed greater decline in verbal IQ (VIQ) and full-scale IQ (FSIQ), but not performance IQ (PIQ), than HCs. Within the diabetes group, a younger age at diabetes onset was associated with a decline in PIQ and FSIQ (P £ 0.001). A history of hypoglycemic seizures was associated with a decline in VIQ (P = 0.002). Long-term metabolic control was not associated with changes in IQ. Interaction terms were not significant, suggesting no moderating effect of one diabetes-related variable over another. CONCLUSIONSThe presence of diabetes may negatively influence some aspects of IQ over time. Specific illness risk factors, such as an earlier age of disease onset and a history of hypoglycemic seizures, appear to put the young person at greater risk. Academic progress of children identified as at risk should be monitored and educational supports provided if necessary.A constant supply of glucose is critical for normal cerebral metabolism (1,2). Thus the brain is one of the major organ systems affected in type 1 diabetes, as glucose homeostasis is frequently disrupted, even in well-controlled diabetes (3). Developing brains have high cerebral energy needs associated with brain growth and neural pruning and may be more sensitive than adults to glucose fluctuations (3). It is important to document specific illness-related risk factors for brain changes in young people with type 1 diabetes. Better understanding of the impact of childhood-onset disease on the central nervous system (CNS) will facilitate evidence-based pediatric management A slide set summarizing this article is available online.

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confidence: 65%

“…There is a growing literature documenting pathophysiological CNS changes (4)(5)(6)(7)(8)(9)(10)(11)(12)(13) and neurocognitive deficits (14)(15)(16)(17)(18)(19)(20)(21)(22)(23) in youth with type 1 diabetes. However, attempts to identify specific diabetes-related risk factors for CNS compromise have produced inconclusive findings.…”

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confidence: 99%

Risk Factors for Decline in IQ in Youth With Type 1 Diabetes Over the 12 Years From Diagnosis/Illness Onset

et al. 2014

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“…One possible explanation for our finding of later age of onset being associated with lower connectivity is that the onset of T1DM and the associated changes in glycemic control may have coincided with this period. Several studies of children with T1DM have detected differences in regional brain volumes (46)(47)(48) and a study of young T1DM patients (< 10 years) found a negative association between age of onset and radial diffusivity, suggesting that earlier age of onset was associated with less myelin integrity (6). We are unaware of any published studies that have investigated functional connectivity in children with T1DM and such studies will be necessary to more fully understand the functional implications of the structural alterations that are being documented.…”

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confidence: 99%

Age of Childhood Onset in Type 1 Diabetes and Functional Brain Connectivity in Midlife: Erratum

2016

Psychosom Med

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Objective-The development of type 1 diabetes (T1DM) within the first 7 years of life has been linked to poorer cognitive performance. Adults with T1DM have altered functional brain connectivity, but no studies have examined whether earlier age of T1DM onset is associated with functional connectivity later in life. Accordingly, we tested the relationship between age of onset and resting state functional connectivity in a cohort of middle-aged adults with childhood-onset T1DM.Methods-Subjects were from a subsample of the Pittsburgh Epidemiology of Diabetes Complications cohort and included 66 adults (mean age = 47.54 years; 32 Male). Resting state blood oxygen level dependent activity was used to calculate mean connectivity for eight functional brain networks. A multivariate analysis of variance examined associations between age of onset and network connectivity. Diffusion tensor and fluid attenuated inversion recovery images were analyzed to identify microstructural alterations and white matter hyperintensity volumes.Results-Later childhood onset of T1DM was associated with lower connectivity (F (8,57) = 2.40, p = .026). A significant interaction was present for current age such that an inverse association with age of onset for functional connectivity was present in older individuals (F (8,55) = 2.88, p = .035). Lower connectivity was associated with older age, increased white matter hyperintensity volume, and lower microstructural integrity.Conclusions-Diagnosis of T1DM later in childhood may be associated with lower brain functional connectivity, particularly in those surviving into older ages. These alterations may be an Corresponding author: John Ryan, PhD, University of Pittsburgh School of Medicine, Department of Psychiatry, 3811 O'Hara St., Pittsburgh, Pennsylvania 15213, Phone: 412-246-5765, Fax: 412-586-9111, ryanjp@upmc.edu. Conflicts of Interest:The authors declare no conflicts of interest HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript early marker for subsequent cognitive decrements. Future studies are warranted to understand the pathways underlying these associations.

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“…Морфологическим субстратом КН может быть диффузное двустороннее поражение белого ве-щества больших полушарий (лейкоареоз), которое связано с микроангиопатией [62]. При нейровизуализации головно-го мозга (особенно в стадии манифестации) встречались случаи выраженной церебральной атрофии, отдельные и множественные очаги пониженной плотности в коре полу-шарий и подкорковых субстанциях в сочетании с расшире-нием ликворопроводящих путей, эти изменения были ме-нее выражены, чем у пациентов с СД 2-го типа (р<0,01) [63, 64]. Установлено, что у пациентов с СД 1-го типа КН более выражены при ранней манифестации заболевания, что под-тверждается в экспериментах [65].…”

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Cognitive impairments in some cardiovascular and somatic diseases

Пизова

2015

RJTAO

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Нервная система часто вовлекается в патологиче-ский процесс при различных по этиологии заболеваниях. В последнее время существенно изменились представле-ния о когнитивных нарушениях (КН). И если раньше счи-талось, что КН -удел лиц пожилого и старческого возрас-та, то в настоящее время они наблюдаются в более моло-дом возрасте. Это связано с тем, что отмечается «омоло-жение» многих заболеваний. Основными факторами рис-ка возникновения КН являются артериальная гипертен-зия (АГ), поражение церебральных артерий (атероскле-роз, васкулит), сахарный диабет (СД), гиперхолестерине-мия, гипергомоцистеинемия (ГГЦ), курение, а также на-следственная отягощенность по сосудистым и нейродеге-неративным заболеваниям. Нередко имеется несколько факторов риска. При этом происходит усиление их небла-гоприятного воздействия.АГ -важный предиктор возникновения КН вплоть до развития деменции [1][2][3][4][5][6][7][8][9]. У пациентов с АГ отмечаются бо- Neurology, Neuropsychiatry, Psychosomatics. 2015;7(2):93-100. DOI: http://dx.doi.org/10.14412/20747(2):93-100. DOI: http://dx.doi.org/10.14412/ -27117(2):93-100. DOI: http://dx.doi.org/10.14412/ -2015 Когнитивные нарушения при некоторых сердечно-сосудистых и соматических заболеваниях 94 лее низкие результаты всех нейропсихологических тестов. КН выявляются у 73% пациентов среднего и пожилого воз-раста с длительностью АГ более 5 лет [10]. Важно понимать, что у пациентов с АГ, уже на самых ранних этапах развития нарушения кровообращения в головном мозге в молодом и среднем возрасте, почти всегда отмечаются КН различной степени выраженности [11].Негативное влияние АГ на когнитивные функции было продемонстрировано в роттердамском и гетенберг-ском исследованиях [12] , а также в других работах [13]. На основании обследования почти 600 пожилых больных АГ показано, что чем выше систолическое артериальное дав-ление (АД), тем ниже показатель когнитивных функций, оцениваемый по краткой шкале оценки психического ста-туса [8]. Исследование почти 6 тыс. больных АГ выявило наличие небольшой, но статистически значимой отрица-тельной обратной связи между уровнем систолического АД, диастолического АД и показателями когнитивных функций независимо от уровня образования, наличия СД, цереброваскулярных заболеваний и курения [7]. Особенно значительной эта ассоциация была в отношении исполни-тельных функций у женщин: анализ информации, реше-ние задач, выявление сходств и различий, обобщение, ак-тивность, мотивация, построение программы, умозаклю-чение, произвольное внимание. Наиболее высокий риск КН отмечается у больных АГ, перенесших инсульт. 7-лет-нее наблюдение за 10 тыс. женщин в возрасте 65 лет и стар-ше показало, что АГ -независимый фактор риска разви-тия КН [14]. В исследовании, проведенном в Швеции [2], в течение 20 лет наблюдали почти 1 тыс. больных, страда-ющих АГ. Показано, что повышение диастолического АД в 50 лет представляет фактор риска развития КН в 70 лет. Высокий уровень среднесуточного АД, отсутствие его сни-жения ночью при суточном мониторировании ассоцииру-ются с более низкими показателям...

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Prospectively Determined Impact of Type 1 Diabetes on Brain Volume During Development

Cited by 87 publications

References 48 publications

Risk Factors for Decline in IQ in Youth With Type 1 Diabetes Over the 12 Years From Diagnosis/Illness Onset

Risk Factors for Decline in IQ in Youth With Type 1 Diabetes Over the 12 Years From Diagnosis/Illness Onset

Age of Childhood Onset in Type 1 Diabetes and Functional Brain Connectivity in Midlife: Erratum

Cognitive impairments in some cardiovascular and somatic diseases

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