Microvascular determinants of cognitive decline and brain volume change in elderly patients with type 2 diabetes.
OBJECTIVE
The present study examined the relationship between microvascular complications and cognitive decline and the development of structural brain abnormalities over a period of 4 years in patients with type 2 diabetes mellitus (T2DM).


METHODS
Sixty-eight elderly patients with T2DM had 2 cognitive assessments with a 4-year interval. Two MRI scans, performed at the same time as the cognitive assessments, were available from 55 patients. Changes in cognitive performance over time were expressed as a regression-based index (RBI). Automated volumetric measurements of total brain, lateral ventricles and white matter hyperintensities were performed. The relationship between baseline microvascular complications [diabetic retinopathy, peripheral neuropathy or albuminuria (micro- or macroalbuminuria)] and cognition and brain volumes was examined with linear regression analyses adjusted for age and sex (for cognition also for IQ).


RESULTS
At baseline, diabetic retinopathy was present in 18% of patients, peripheral neuropathy in 36%, albuminuria in 15%. Retinopathy or neuropathy were not significantly associated with baseline cognition or brain volumes, or changes in these measures over time. Albuminuria was associated with a lower composite RBI score, indicating accelerated cognitive decline (adjusted mean difference between patients with or without albuminuria: -0.58, 95% CI -0.85 to -0.31, p < 0.001).


CONCLUSIONS
Albuminuria predicted accelerated cognitive decline in patients with T2DM, but other microvascular complications were unrelated to accelerated cognitive decline or brain MRI abnormalities.
de Bresser
Jeroen
J
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. J.deBresser@umcutrecht.nl
Reijmer
Yael D
YD
van den Berg
Esther
E
Breedijk
Marja A
MA
Kappelle
L Jaap
LJ
Viergever
Max A
MA
Biessels
Geert Jan
GJ
D000368:Aged; D000369:Aged, 80 and over; D000419:Albuminuria; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D002196:Capillaries / Q000473:pathology*; D002544:Cerebral Infarction / Q000473:pathology; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology*; D003929:Diabetic Neuropathies / Q000150:complications / Q000473:pathology; D003930:Diabetic Retinopathy / Q000150:complications / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests