Diabetes increases atrophy and vascular lesions on brain MRI in patients with symptomatic arterial disease.
OBJECTIVE
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.
Tiehuis
Audrey M
AM
van der Graaf
Yolanda
Y
Visseren
Frank L
FL
Vincken
Koen L
KL
Biessels
Geert Jan
GJ
Appelman
Auke P A
AP
Kappelle
L Jaap
LJ
Mali
Willem P T M
WP
D000368:Aged; D001284:Atrophy / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000473:pathology* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000473:pathology* / Q000503:physiopathology; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000473:pathology* / Q000503:physiopathology; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D015331:Cohort Studies; D003704:Dementia / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000150:complications / Q000503:physiopathology; D002537:Intracranial Arteriosclerosis / Q000150:complications / Q000473:pathology / Q000503:physiopathology; D049292:Leukoaraiosis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors