Glycemic status and brain injury in older individuals: the age gene/environment susceptibility-Reykjavik study.
OBJECTIVE
To examine the association of glycemic status to magnetic resonance imaging indicators of brain pathological changes.


METHODS
This was a cross-sectional, population-based study of 4,415 men and women without dementia (mean age 76 years) participating in the Age Gene/Environment Susceptibility-Reykjavik Study. Glycemic status groups included the following: type 2 diabetes (self-report of diabetes, use of diabetes medications, or fasting blood glucose > or =7.0 mmol/l [11.1%]); impaired fasting glucose (IFG) (fasting blood glucose 5.6-6.9 mmol/l [36.2%]); and normoglycemic (52.7%). Outcomes were total brain volume, white and gray matter volume, white matter lesion (WML) volume, and presence of cerebral infarcts.


RESULTS
After adjustment for demographic and cardiovascular risk factors, participants with type 2 diabetes had significantly lower total brain volume (72.2 vs. 71.5%; P < 0.001) and lower gray and white matter volumes (45.1 vs. 44.9%, P < 0.01 and 25.7 vs. 25.3%, P < 0.001, respectively) and were more likely to have single (odds ratio 1.45 [95% CI 1.14-1.85]) or multiple (2.27 [1.60-3.23]) cerebral infarcts compared with normoglycemic participants. Longer duration of type 2 diabetes was associated with lower total brain volume and gray and white matter volume, higher WML volume (all P(trend) < 0.05), and a greater likelihood of single and multiple cerebral infarcts (all P(trend) < 0.01).


CONCLUSIONS
Type 2 diabetic participants have more pronounced brain atrophy and are more likely to have cerebral infarcts. Duration of type 2 diabetes is associated with brain changes, suggesting that type 2 diabetes has a cumulative effect on the brain.
Saczynski
Jane S
JS
Division of Geriatric Medicine and Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts, USA. jane.saczynski@umassmed.edu
Siggurdsson
Sigurdur
S
Jonsson
Palmi V
PV
Eiriksdottir
Gudny
G
Olafsdottir
Elin
E
Kjartansson
Olafur
O
Harris
Tamara B
TB
van Buchem
Mark A
MA
Gudnason
Vilmundur
V
Launer
Lenore J
LJ
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000453:epidemiology* / Q000473:pathology; D002544:Cerebral Infarction / Q000453:epidemiology / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000473:pathology; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D008297:Male; D012737:Sex Factors