Regional cerebral hypoperfusion in long-term Type 1 (insulin-dependent) diabetic patients

Datseris, Ioannis; Sonmezoglu, K.; Siraj, Q. H.; Bomanji, JB; Nimmon, C.C.; Nijran, K. S.; Britton, K. E.

doi:10.1097/00006231-199501000-00004

Cited by 31 publications

(28 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is of note that the glucose level in the brain tissue is determined by its supply via blood flow, transport through the blood-brain barrier and its metabolic rate in the brain tissue. The grey matter has both a higher perfusion rate [4] and a higher oxidation rate of glucose [35,36] than the white matter. Our finding suggests that the supply of glucose in relation to its oxidation is greater in the frontal cortex than in the white matter.…”

Section: Discussionmentioning

confidence: 99%

“…Some individuals with type 1 diabetes develop mild cognitive impairment in executive functions, most notably as reduced mental speed and diminished mental flexibility [3]. Type 1 diabetes is also associated with circulatory alterations that can lead to regional hypo-and hyperperfusion of the brain [4,5] and to increased risk of lacunar infarcts and stroke [6,7]. In addition, structural changes, such as white matter hyperintensities [2] and cortical and subcortical atrophy [8,9], have been reported to be more frequent in individuals with diabetes.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hyperglycaemia is associated with changes in the regional concentrations of glucose and myo-inositol within the brain

et al. 2008

View full text Add to dashboard Cite

Aims/hypothesis The aim of the study was to assess the effect of hyperglycaemia on regional concentrations of glucose and other substrates within the brain in nondiabetic individuals and in patients with type 1 diabetes. Methods The brain metabolites of 17 men with type 1 diabetes and 12 age-matched non-diabetic men (22-43 years old) were studied after an overnight fast (plasma glucose 9.2±3.0 vs 4.8±0.5 mmol/l, respectively). N-Acetylaspartate (NAA), creatine, choline, myo-inositol (mI) and glucose in the frontal cortex, frontal white matter and thalamus were quantified with proton magnetic resonance spectroscopy. Results In the non-diabetic participants, the glucose level was 47% higher (p<0.01) in the frontal cortex than in the frontal white matter. In contrast, this regional variation was not observed in the diabetic participants, in whom the glucose level in the frontal white matter was 64% higher (p<0.001) and in the frontal cortex 25% higher (p=0.033) than that of the non-diabetic participants. In the diabetic participants, the glucose level in each of the three regions studied correlated with fasting plasma glucose (r=0.88-0.67, p<0.01). In addition, in the diabetic participants, mI was 20% higher (p<0.001) and NAA 6% lower (p=0.037) in the frontal white matter, and mI was 8% higher (p= 0.042) in the frontal cortex, than in the non-diabetic participants. Conclusions/interpretation In type 1 diabetes, hyperglycaemia is associated with accumulation of glucose and mI in the cortex and in the white matter.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperglycaemia is associated with changes in the regional concentrations of glucose and myo-inositol within the brain

et al. 2008

View full text Add to dashboard Cite

show abstract

“…Fulesdi et al (36) found that the increase in blood flow after administration of a dilatory stimulus is impaired, and this impairment appeared to be most pronounced in subjects with other complications such as retinopathy and nephropathy. In a single-photon emission tomography study, Keymeulen et al (37) could not find a correlation between the presence of proliferative retinopathy or microalbuminuria and alterations in CBF, but the number of included patients with proliferative retinopathy was very small. Increases in CBF in response to acute hypoglycemia and studies using single-photon emission tomography demonstrated blood flow increases to the frontal lobes (38 -40).…”

Section: Diabetes Vol 55 February 2006mentioning

confidence: 92%

Microvascular Disease in Type 1 Diabetes Alters Brain Activation

et al. 2006

View full text Add to dashboard Cite

Individuals with type 1 diabetes have mild performance deficits on a range of neuropsychological tests compared with nondiabetic control subjects. The mechanisms underlying this cognitive deterioration are still poorly understood, but chronic hyperglycemia is now emerging as a potential determinant, possibly through microvascular changes in the brain. In 24 type 1 diabetic patients, we tested at euglycemia and at acute hypoglycemia whether the presence of proliferative diabetic retinopathy, as a marker of microvascular disease, adversely affects the ability of the brain to respond to standardized hypoglycemia, using functional magnetic resonance imaging with a cognitive task. Patients with retinopathy, compared with patients without, showed less deactivation (hence, an increased response) in the anterior cingulate and the orbital frontal gyrus during hypoglycemia compared with euglycemia (P < 0.05). Task performance and reaction time were not significantly different for either group. We conclude that microvascular damage in the brain of patients with retinopathy caused this increased brain response to compensate for functional loss. Diabetes 55:334 -340, 2006

show abstract

“…The ratio was inversely correlated with systolic blood pressure, total cholesterol, and the atherogenic index, and it was positively correlated with HDL and cholesterol. These observations suggest that the agerelated CBF reduction may be accelerated by a combination of hyperglycemia plus other risk factors for arteriosclerosis (26,27). The regional differences in cerebral metabolic capacity may explain increased sensitivity to hyperglycemia in the cerebral cortex (28).…”

Section: Regional Perfusion and Brain Volumes In Diabetesmentioning

confidence: 93%

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

et al. 2007

View full text Add to dashboard Cite

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,...

show abstract

Regional cerebral hypoperfusion in long-term Type 1 (insulin-dependent) diabetic patients

Cited by 31 publications

References 0 publications

Hyperglycaemia is associated with changes in the regional concentrations of glucose and myo-inositol within the brain

Hyperglycaemia is associated with changes in the regional concentrations of glucose and myo-inositol within the brain

Microvascular Disease in Type 1 Diabetes Alters Brain Activation

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

Contact Info

Product

Resources

About