White Matter Integrity Disruptions Associated With Cognitive Impairments in Type 2 Diabetic Patients

Zhang, Junying; Wang, Jun; Zhou, Xiaoqing; Shu, Ni; Wang, Yongyan; Zhang, Zhanjun

doi:10.2337/db14-0342

Cited by 110 publications

(120 citation statements)

References 47 publications

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“…We found similar results from Reijmer et al's study that WMN parameters were associated with worse cognitive performances in patients with T2DM [12]. Besides, studies in T2DM patients showed that executive function impairment was related to WM integrity decline including internal and external capsules [7]. These findings also support the idea that the decreased nodal efficiency of ROL connects with executive function impairment in T2DM patients.…”

Section: Discussionsupporting

confidence: 80%

“…These abnormal phenomena maybe attributed to reduced WM integrity and increased disconnection; some microvascular lesions and enlarged perivascular spaces would induce possible neuropathology changes in T2DM [30]. Previous studies provide direct evidence for disrupted structural integrity in various WM tracts in diabetic patients, such as the corpus callosum [7,31]. Overall, our findings provide additional evidence for the imbalanced topological organizations and reduced efficiency for signal propagation in patients with diabetes.…”

Section: Discussionsupporting

confidence: 60%

“…Cerebral atrophy and WM lesions, which were commonly observed structural anomalies, are believed to be modestly associated with diabetes-related cognitive dysfunction [4,5]. Recent studies have shown that T2DM patients exhibited reduced WM integrity in the whole brain [4] and that specific tracts such as the cingulum bundle and the uncinate fasciculus exhibited lower fractional anisotropy (FA) in T2DM patients [6,7]. These studies suggest that WM structural disconnections play a potential part in the cognitive decline of diabetic patients.…”

Section: Introductionmentioning

confidence: 99%

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Disrupted White Matter Network and Cognitive Decline in Type 2 Diabetes Patients

Zhang

Liu

et al. 2016

JAD

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Abstract. Type 2 diabetes mellitus is accompanied by cognitive impairment and is associated with an increased risk of dementia. Damage to brain structures such as white matter network disruption may underlie this cognitive disturbance. In the present study, 886 non-diabetic and 163 type 2 diabetic participants completed a battery of neuropsychological tests. Among them, 38 diabetic patients and 34 non-diabetic participants that matched the patients for age/sex/education received a magnetic resonance imaging-based diffusion tensor imaging. Then we calculated the topological properties of the white matter network using a graph theoretical method to investigate network efficiency differences between groups. We found that type 2 diabetic patients had inferior performances compared to the non-diabetic controls, in several cognitive domains involving executive function, spatial processing, memory, and attention. We also found that diabetic patients exhibited a disrupted topological organization of the white matter network (including the global network properties, i.e., network strength, global efficiency, local efficiency and shortest path length, and the nodal efficiency of the right rolandic operculum) in the brain. Moreover, those global network properties and the nodal efficiency of the right rolandic operculum both had positive correlations with executive function in the patient group. The results suggest that type 2 diabetes mellitus leads to an alteration in the topological organization of the cortical white matter network and this alteration may account for the observed cognitive decline.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 99%

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Disrupted White Matter Network and Cognitive Decline in Type 2 Diabetes Patients

Zhang

Liu

et al. 2016

JAD

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“…Studies on middleaged adults with cognitive complaints also have shown that lower activation in the SFG is related to poorer WM performance (42). Moreover, in light of recent white matter studies, increased impairments in the frontal fiber tracts were associated with reduced executive function (43) and information processing speed (16) in T2DM patients. Demyelination of axons, loss of glial cells, expanded microvascular lesions, enlarged perivascular spaces, and even bloodbrain barrier disruptions possibly induce neuropathological changes in brain structure and function in T2DM patients (44).…”

Section: Discussionmentioning

confidence: 99%

Altered Brain Activation Patterns Under Different Working Memory Loads in Patients With Type 2 Diabetes

et al. 2014

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OBJECTIVEType 2 diabetes mellitus (T2DM) has important effects on cognition and the risk for Alzheimer disease (AD). Working memory (WM) is a susceptible cognitive domain of mild cognitive impairment and AD. Thus, the identification of brain activation patterns under different WM loads can potentially enhance our understanding of the mechanisms underlying cognitive dysfunction in T2DM. RESEARCH DESIGN AND METHODSThe current study assessed the effects of T2DM on cognitive performance and explored the related neuronal damage through a visual n-back task and functional magnetic resonance imaging. RESULTSWe found that patients with T2DM exhibited worse executive and memory abilities than control subjects. Furthermore, the patterns of brain activation changed under different WM loads in the T2DM patients, who exhibited reduced activation in the left inferior frontal gyrus under low loads and reduced activation in the left middle frontal gyrus and superior frontal gyrus (SFG) under high loads. Thus, more regions of diminished activation were seen in the frontal cortex with increasing task difficulty. Furthermore, we found that lower SFG activation was associated with worse cognitive function. CONCLUSIONSThe findings demonstrate deficient WM in patients with T2DM and the relation between cognitive function and degree of neuronal activity and their relevance to AD risk. Further longitudinal studies are needed to replicate these results and to evaluate the clinical value of brain imaging methods in the prediction of disease progress in these patients.

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“…Structural MRI studies on T2DM have revealed the aberrant hyperintensity in the thalamus associated with impaired speed of mental processes and memory (Akisaki et al 2006). Zhang et al reported decreased fractional anisotropy and increased mean diffusivity in widespread WM tracts in T2DM compared with controls, including the posterior thalamic radiation (Zhang et al 2014). Furthermore, impaired macromolecular protein pools in fronto-striato-thalamic circuits were demonstrated in T2DM using magnetization transfer imaging (Yang et al 2014).…”

Section: Introductionmentioning

confidence: 96%

Thalamic resting-state functional connectivity: disruption in patients with type 2 diabetes

et al. 2015

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To explore the disrupted thalamic functional connectivity and its relationships with cognitive dysfunction in type 2 diabetes mellitus (T2DM) by using resting-state functional magnetic resonance imaging (fMRI). A total of 38 T2DM patients and 39 well-matched healthy controls participated in the resting-state fMRI and T1-weighted imaging scans. The thalamic functional connectivity was characterized by using a seed-based whole-brain correlation method and compared T2DM patients with healthy controls. Pearson correlation analysis was performed between thalamic functional connectivity and clinical data. When compared with healthy controls, T2DM showed significantly decreased functional connectivity of the thalamus mainly in the right middle temporal gyrus (MTG), right precentral gyrus and bilateral occipital cortex; Increased functional connectivity of the thalamus was detected in the left cerebellum, bilateral middle frontal gyrus and middle cingulate gyrus (p < 0.05, corrected for AlphaSim). In T2DM patients, the decreased thalamic functional connectivity of the right MTG was positively associated with the Verbal Fluency Test score (r = 0.438, p = 0.006). Meanwhile, the decreased thalamic functional connectivity of the right cuneus was positively correlated with the Complex Figure Test-delayed score and negatively correlated with the Trail Making Test-B score, respectively (r = 0.492, p = 0.002; r = -0.504, p = 0.001). Moreover, there was no structural damage in the thalamus of T2DM patients. T2DM patients develop disrupted thalamocortical functional connectivity, which is associated with cognitive impairment in selected brain regions. Resting-state thalamocortical connectivity disturbance may play a central role in the underlying neuropathological process of T2DM-related cognitive dysfunction.

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White Matter Integrity Disruptions Associated With Cognitive Impairments in Type 2 Diabetic Patients

Cited by 110 publications

References 47 publications

Disrupted White Matter Network and Cognitive Decline in Type 2 Diabetes Patients

Disrupted White Matter Network and Cognitive Decline in Type 2 Diabetes Patients

Altered Brain Activation Patterns Under Different Working Memory Loads in Patients With Type 2 Diabetes

Thalamic resting-state functional connectivity: disruption in patients with type 2 diabetes

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