Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes
Open Access
- 2 September 2007
- journal article
- Published by Springer Science and Business Media LLC in Diabetologia
- Vol. 50 (11), 2388-2397
- https://doi.org/10.1007/s00125-007-0792-z
Abstract
The determinants of cerebral complications of type 2 diabetes are unclear. The present study aimed to identify metabolic and vascular factors that are associated with impaired cognitive performance and abnormalities on brain MRI in patients with type 2 diabetes. The study included 122 patients and 56 controls. Neuropsychological test scores were divided into five cognitive domains and expressed as standardised z values. Brain MRI scans were rated for white matter lesions (WML), cortical and subcortical atrophy, and infarcts. Data on glucose metabolism, vascular risk factors and micro- and macrovascular disease were collected. Patients with type 2 diabetes had more cortical (p < 0.001) and subcortical (p < 0.01) atrophy and deep WML (p = 0.02) than the control group and their cognitive performance was worse. In multivariate regression analyses within the type 2 diabetes group, hypertension (p < 0.05) and a history of vascular events (p < 0.01) were associated with worse cognitive performance, while statin use was associated (p < 0.05) with better performance. Retinopathy and brain infarcts on MRI were associated with more severe cortical atrophy (both p < 0.01) and statin use with less atrophy (p < 0.05). Insulin level and brain infarcts were associated with more severe WML and statin use with less severe WML (all p < 0.05). Type 2 diabetes is associated with modest impairments in cognition, as well as atrophy and vascular lesions on MRI. This ‘diabetic encephalopathy’ is a multifactorial condition, for which atherosclerotic (macroangiopathic) vascular disease is an important determinant. Chronic hyperglycaemia, hyperinsulinaemia and hypertension may play additional roles.This publication has 49 references indexed in Scilit:
- Brain Imaging in Patients With DiabetesDiabetes Care, 2006
- Brain Magnetic Resonance Imaging Correlates of Impaired Cognition in Patients With Type 2 DiabetesDiabetes, 2006
- Vascular Risk Factors and Diabetic NeuropathyThe New England Journal of Medicine, 2005
- Prevalence of macrovascular disease amongst type 2 diabetic patients detected by targeted screening and patients newly diagnosed in general practice: the Hoorn Screening StudyJournal of Internal Medicine, 2004
- The relationship between type 2 diabetes and cognitive dysfunction: longitudinal studies and their methodological limitationsEuropean Journal of Pharmacology, 2004
- Comorbid type 2 diabetes mellitus and hypertension exacerbates cognitive decline: evidence from a longitudinal studyAge and Ageing, 2004
- Cognitive Decline Following Stroke: A Comprehensive Study of Cognitive Decline Following Stroke*Journal of Clinical and Experimental Neuropsychology, 1998
- NIDDM and Blood Pressure as Risk Factors for Poor Cognitive Performance: The Framingham StudyDiabetes Care, 1997
- Cerebral white matter lesions, vascular risk factors, and cognitive function in a population‐based studyNeurology, 1994
- A semiquantative rating scale for the assessment of signal hyperintensities on magnetic resonance imagingJournal of the Neurological Sciences, 1993