Diabetes increases atrophy and vascular lesions on brain MRI in patients with symptomatic arterial disease

Stroke. 2008 May;39(5):1600-3. doi: 10.1161/STROKEAHA.107.506089. Epub 2008 Mar 27.

Abstract

Background and purpose: Diabetes type 2 (DM2) is associated with accelerated cognitive decline and structural brain abnormalities. Macrovascular disease has been described as a determinant for brain MRI changes in DM2, but little is known about the involvement of other DM2-related factors.

Methods: Brain MRI was performed in 1043 participants (151 DM2) with symptomatic arterial disease. Brain volumes were obtained through automated segmentation.

Results: Patients with arterial disease and DM2 had more global and subcortical brain atrophy (-1.20% brain/intracranial volume [95%CI -1.58 to -0.82], P<0.0005 and 0.20% ventricular/intracranial volume [0.05 to 0.34], P<0.01), larger WMH volumes (0.22 logtransformed volume [0.07 to 0.38], P<0.005), and more lacunar infarcts (OR 1.75 [1.13 to 2.69], P<0.01) than identical patients without DM2. In patients with DM2, high glucose levels (B-0.12% per mmol/L [-0.23 to -0.01], P<0.05) and diabetes duration (B-0.05% per year [-0.10 to -0.001], P<0.05) were associated with global brain atrophy.

Conclusions: In patients with symptomatic arterial disease, DM2 has an added detrimental effect on the brain. In patients with DM2, hyperglycemia and diabetes duration contribute to brain atrophy.

Publication types

  • Letter

MeSH terms

  • Aged
  • Atrophy / etiology
  • Atrophy / pathology*
  • Atrophy / physiopathology
  • Brain / blood supply
  • Brain / pathology*
  • Brain / physiopathology
  • Cerebral Arteries / pathology*
  • Cerebral Arteries / physiopathology
  • Cerebrovascular Disorders / etiology
  • Cerebrovascular Disorders / pathology*
  • Cerebrovascular Disorders / physiopathology
  • Cognition Disorders / etiology
  • Cognition Disorders / pathology
  • Cognition Disorders / physiopathology
  • Cohort Studies
  • Dementia / etiology
  • Dementia / pathology
  • Dementia / physiopathology
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / physiopathology
  • Disease Progression
  • Female
  • Humans
  • Hyperglycemia / complications
  • Hyperglycemia / physiopathology
  • Intracranial Arteriosclerosis / complications
  • Intracranial Arteriosclerosis / pathology
  • Intracranial Arteriosclerosis / physiopathology
  • Leukoaraiosis / etiology
  • Leukoaraiosis / pathology
  • Leukoaraiosis / physiopathology
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Risk Factors