title: Voxel-based morphometry demonstrates reduced grey matter density on brain MRI in patients with diabetic retinopathy.
abstract: OBJECTIVE
  In addition to nephropathy, retinopathy and peripheral neuropathy, a microvascular complication of type 1 diabetes that may be tentatively referred to as 'diabetic encephalopathy' has gained increasing attention. There is growing evidence that lowered cognitive performance in patients with type 1 diabetes is related to chronic hyperglycaemia rather than recurrent episodes of severe hypoglycaemia, as previously speculated. The aim of our study was to use magnetic resonance imaging (MRI) to establish whether long-term hyperglycaemia, resulting in advanced retinopathy, contributes to structural changes in the brain (reduced grey matter).
  
  
  METHODS
  We applied voxel-based morphometry on magnetic resonance images to compare grey matter density (GMD) between three groups of participants. GMD is used as a marker of cortical atrophy. We compared 13 type 1 diabetic patients with a microvascular complication (i.e. proliferative retinopathy) with 18 type 1 diabetic patients who did not have retinopathy in order to assess the effects of microvascular changes on GMD. Both patient groups were compared with 21 healthy control subjects to assess the effect of diabetes in itself.
  
  
  RESULTS
  Patients with diabetic retinopathy showed reduced GMD in the right inferior frontal gyrus and right occipital lobe compared both with patients without retinopathy and with healthy controls (p<0.05).
  
  
  CONCLUSIONS
  Our data show that patients with type 1 diabetes, who, as a consequence of chronic hyperglycaemia, had developed advanced retinopathy, also showed increased focal cortical atrophy on brain MRI.
authors.affiliation: Department of Medical Psychology, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. am.wessels@vumc.nl
authors.forename: A M
authors.initials: AM
authors.lastname: Wessels
authors.forename: S
authors.initials: S
authors.lastname: Simsek
authors.forename: P L
authors.initials: PL
authors.lastname: Remijnse
authors.forename: D J
authors.initials: DJ
authors.lastname: Veltman
authors.forename: G J
authors.initials: GJ
authors.lastname: Biessels
authors.forename: F
authors.initials: F
authors.lastname: Barkhof
authors.forename: P
authors.initials: P
authors.lastname: Scheltens
authors.forename: F J
authors.initials: FJ
authors.lastname: Snoek
authors.forename: R J
authors.initials: RJ
authors.lastname: Heine
authors.forename: S A R B
authors.initials: SA
authors.lastname: Rombouts
mesh_terms: D000328:Adult; D017668:Age of Onset; D001921:Brain / Q000033:anatomy & histology / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology*; D003930:Diabetic Retinopathy / Q000473:pathology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010487:Periaqueductal Gray / Q000033:anatomy & histology / Q000473:pathology*; D012016:Reference Values
chemical_list: D006442:Glycated Hemoglobin