title: Cerebral perfusion and aortic stiffness are independent predictors of white matter brain atrophy in type 1 diabetic patients assessed with magnetic resonance imaging.
abstract: OBJECTIVE
  To identify vascular mechanisms of brain atrophy in type 1 diabetes mellitus (DM) patients by investigating the relationship between brain volumes and cerebral perfusion and aortic stiffness using magnetic resonance imaging (MRI).
  
  
  METHODS
  Approval from the local institutional review board was obtained, and patients gave informed consent. Fifty-one type 1 DM patients (30 men; mean age 44 ± 11 years; mean DM duration 23 ± 12 years) and 34 age- and sex-matched healthy control subjects were prospectively enrolled. Exclusion criteria comprised hypertension, stroke, aortic disease, and standard MRI contraindications. White matter (WM) and gray matter (GM) brain volumes, total cerebral blood flow (tCBF), total brain perfusion, and aortic pulse wave velocity (PWV) were assessed using MRI. Multivariable linear regression analysis was used for statistics, with covariates age, sex, mean arterial pressure, BMI, smoking, heart rate, DM duration, and HbA(1c).
  
  
  RESULTS
  Both WM and GM brain volumes were decreased in type 1 DM patients compared with control subjects (WM P = 0.04; respective GM P = 0.03). Total brain perfusion was increased in type 1 DM compared with control subjects (β = -0.219, P < 0.05). Total CBF and aortic PWV predicted WM brain volume (β = 0.352, P = 0.024 for tCBF; respective β = -0.458, P = 0.016 for aortic PWV) in type 1 DM. Age was the independent predictor of GM brain volume (β = -0.695, P < 0.001).
  
  
  CONCLUSIONS
  Type 1 DM patients without hypertension showed WM and GM volume loss compared with control subjects concomitant with a relative increased brain perfusion. Total CBF and stiffness of the aorta independently predicted WM brain atrophy in type 1 DM. Only age predicted GM brain atrophy.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. s.g.c.van_elderen@lumc.nl
authors.forename: Saskia G C
authors.initials: SG
authors.lastname: van Elderen
authors.forename: Anne
authors.initials: A
authors.lastname: Brandts
authors.forename: Jeroen
authors.initials: J
authors.lastname: van der Grond
authors.forename: Jos J M
authors.initials: JJ
authors.lastname: Westenberg
authors.forename: Lucia J M
authors.initials: LJ
authors.lastname: Kroft
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.forename: Johannes W A
authors.initials: JW
authors.lastname: Smit
authors.forename: Albert
authors.initials: A
authors.lastname: de Roos
mesh_terms: D000328:Adult; D001018:Aortic Diseases / Q000473:pathology*; D001284:Atrophy; D001927:Brain Diseases / Q000473:pathology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology*; D003925:Diabetic Angiopathies / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D056784:Leukoencephalopathies / Q000473:pathology* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012720:Severity of Illness Index