title: Microvascular disease in type 1 diabetes alters brain activation: a functional magnetic resonance imaging study.
abstract: 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.
authors.affiliation: Department of Medical Psychology, Vrije University (VU) Medical Center, Amsterdam, Netherlands. am.wessels@vumc.nl
authors.forename: Alette M
authors.initials: AM
authors.lastname: Wessels
authors.forename: Serge A R B
authors.initials: SA
authors.lastname: Rombouts
authors.forename: Suat
authors.initials: S
authors.lastname: Simsek
authors.forename: Joost P A
authors.initials: JP
authors.lastname: Kuijer
authors.forename: Piet J
authors.initials: PJ
authors.lastname: Kostense
authors.forename: Frederik
authors.initials: F
authors.lastname: Barkhof
authors.forename: Philip
authors.initials: P
authors.lastname: Scheltens
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Snoek
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Heine
mesh_terms: D000328:Adult; D001786:Blood Glucose; D001921:Brain / Q000098:blood supply* / Q000503:physiopathology*; D003071:Cognition; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology*; D003930:Diabetic Retinopathy / Q000150:complications* / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose