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.
Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands. J.deBresser@umcutrecht.nl
Jeroen
J
de Bresser
Yael D
YD
Reijmer
Esther
E
van den Berg
Marja A
MA
Breedijk
L Jaap
LJ
Kappelle
Max A
MA
Viergever
Geert Jan
GJ
Biessels
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