title: Cognitive dysfunction and its clinical and radiological determinants in patients with symptomatic arterial disease and diabetes.
abstract: OBJECTIVE
  Both vascular disease and diabetes type 2 (DM2) decrease cognitive functioning in elderly people. It is uncertain if DM2 affects cognition independent of vascular disease. In patients with symptomatic arterial disease, we studied the effect of DM2 on cognition and identified clinical and radiological determinants for impaired cognition in patients with DM2.
  
  
  METHODS
  766 patients (mean age 58.8+/-9.5 years; 108 DM2) with symptomatic arterial disease underwent neuropsychological testing. In 542 patients (77 DM2), volumes of brain tissue, ventricles and white matter lesions were obtained by segmentation of brain MR images. Infarcts were distinguished into small (lacunar) or large (cortical or subcortical).
  
  
  RESULTS
  Patients with arterial disease and DM2 performed worse on neuropsychological tests compared to similar patients without DM2 (adjusted composite z-score: beta -0.14 [-0.25 to -0.02]). Insulin treatment, systolic and diastolic blood pressures were significantly associated with cognition in patients with DM2. Large infarcts, global and cortical atrophy on MRI were independently associated with cognition in patients with DM2.
  
  
  CONCLUSIONS
  The presence of DM2 in patients with symptomatic arterial disease is associated with decreased cognitive functioning. Insulin treatment, high blood pressure, brain atrophy and large infarcts were determinants for cognitive dysfunction in patients with DM2 and arterial disease.
authors.affiliation: Department of Radiology, University Medical Center Utrecht, The Netherlands. a.m.tiehuis@umcutrecht.nl
authors.forename: A M
authors.initials: AM
authors.lastname: Tiehuis
authors.forename: W P Th M
authors.initials: WP
authors.lastname: Mali
authors.forename: A F
authors.initials: AF
authors.lastname: van Raamt
authors.forename: F L J
authors.initials: FL
authors.lastname: Visseren
authors.forename: G J
authors.initials: GJ
authors.lastname: Biessels
authors.forename: M J E
authors.initials: MJ
authors.lastname: van Zandvoort
authors.forename: L J
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Y
authors.initials: Y
authors.lastname: van der Graaf
mesh_terms: D001794:Blood Pressure; D001921:Brain / Q000473:pathology; D020520:Brain Infarction / Q000473:pathology / Q000523:psychology; D002561:Cerebrovascular Disorders / Q000473:pathology* / Q000523:psychology*; D003071:Cognition; D003072:Cognition Disorders / Q000473:pathology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000473:pathology* / Q000523:psychology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology; D009483:Neuropsychological Tests; D009929:Organ Size
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin