Global and regional effects of type 2 diabetes on brain tissue volumes and cerebral vasoreactivity.
OBJECTIVE
The aim of this study was to evaluate the regional effects of type 2 diabetes and associated conditions on cerebral tissue volumes and cerebral blood flow (CBF) regulation.


METHODS
CBF was examined in 26 diabetic (aged 61.6 +/- 6.6 years) and 25 control (aged 60.4 +/- 8.6 years) subjects using continuous arterial spin labeling (CASL) imaging during baseline, hyperventilation, and CO2 rebreathing. Regional gray and white matter, cerebrospinal fluid (CSF), and white matter hyperintensity (WMH) volumes were measured on a T1-weighted inversion recovery fast-gradient echo and a fluid attenuation inversion recovery magnetic resonance imaging at 3 Tesla.


RESULTS
The diabetic group had smaller global white (P = 0.006) and gray (P = 0.001) matter and larger CSF (36.3%, P < 0.0001) volumes than the control group. Regional differences were observed for white matter (-13.1%, P = 0.0008) and CSF (36.3%, P < 0.0001) in the frontal region, for CSF (20.9%, P = 0.0002) in the temporal region, and for gray matter (-3.0%, P = 0.04) and CSF (17.6%, P = 0.01) in the parieto-occipital region. Baseline regional CBF (P = 0.006) and CO2 reactivity (P = 0.005) were reduced in the diabetic group. Hypoperfusion in the frontal region was associated with gray matter atrophy (P < 0.0001). Higher A1C was associated with lower CBF (P < 0.0001) and greater CSF (P = 0.002) within the temporal region.


CONCLUSIONS
Type 2 diabetes is associated with cortical and subcortical atrophy involving several brain regions and with diminished regional cerebral perfusion and vasoreactivity. Uncontrolled diabetes may further contribute to hypoperfusion and atrophy. Diabetic metabolic disturbance and blood flow dysregulation that affects preferentially frontal and temporal regions may have implications for cognition and balance in elderly subjects with diabetes.
Last
David
D
Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St., Boston, MA 02215, USA.
Alsop
David C
DC
Abduljalil
Amir M
AM
Marquis
Robert P
RP
de Bazelaire
Cedric
C
Hu
Kun
K
Cavallerano
Jerry
J
Novak
Vera
V
D000368:Aged; D001794:Blood Pressure; D001921:Brain / Q000033:anatomy & histology* / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003924:Diabetes Mellitus, Type 2 / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006985:Hyperventilation; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010487:Periaqueductal Gray / Q000033:anatomy & histology; D012039:Regional Blood Flow
D007004:Hypoglycemic Agents