title: Endothelial and inflammatory markers in relation to progression of ischaemic cerebral small-vessel disease and cognitive impairment: a 6-year longitudinal study in patients with type 2 diabetes mellitus.
abstract: BACKGROUND
  Progression of silent brain infarctions (SBIs) and white-matter lesions (WMLs) seen on brain MRI is associated with an increased risk of cognitive impairment, but their relation to endothelial and inflammatory markers is unknown in type 2 diabetes mellitus.
  
  
  METHODS
  In 190 type 2 diabetic outpatients (mean age 62.7&emsp14;years), the authors related baseline levels of soluble intercellular adhesion molecule-1 (sICAM-1) and high-sensitivity C-reactive protein (hs-CRP) to subsequent brain MRI findings and cognitive function. The authors assessed incident SBIs and changes in periventricular and subcortical WMLs (PVWMLs and SCWMLs) on MRI performed at baseline and 3 and 6 years. Neuropsychological tests were administered to 83 patients older than 65 years at 6 years. This present study represents an extension of the authors' previously published study.
  
  
  RESULTS
  SBIs were observed in 46 patients (24.2%), PVWMLs in 93 (48.9%) and SCWMLs in 87 (45.8%) on baseline MRI. After adjustment for age, gender, hypertension, duration of diabetes, baseline MRI findings and medication use, the relative odds associated with a 1SD increase in sICAM-1 levels at baseline were 1.67 (95% CI 1.02 to 3.05) for SBI progression and 2.17 (95% CI 1.29 to 3.62) for PVWML progression at 6 years. In contrast, baseline hs-CRP levels were significantly associated with SBI progression only at 3 years. Significant trends were observed between quartiles of sICAM-1 at baseline and scores in Digit Symbol substitution (p for trend=0.01).
  
  
  CONCLUSIONS
  The findings suggest that higher sICAM-1 levels are associated with SBI and PVWML progression, and may predict impairment in psychomotor function in type 2 diabetes.
authors.affiliation: Department of Neurology, Chubu Rosai Hospital, 1-10-6 Komei, Minato-ku, Nagoya City, Aichi 455-8530, Japan. t.umemura@bg7.so-net.ne.jp
authors.forename: T
authors.initials: T
authors.lastname: Umemura
authors.forename: T
authors.initials: T
authors.lastname: Kawamura
authors.forename: H
authors.initials: H
authors.lastname: Umegaki
authors.forename: S
authors.initials: S
authors.lastname: Mashita
authors.forename: A
authors.initials: A
authors.lastname: Kanai
authors.forename: T
authors.initials: T
authors.lastname: Sakakibara
authors.forename: N
authors.initials: N
authors.lastname: Hotta
authors.forename: G
authors.initials: G
authors.lastname: Sobue
mesh_terms: D000368:Aged; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000473:pathology*; D059345:Cerebral Small Vessel Diseases / Q000150:complications / Q000473:pathology*; D003072:Cognition Disorders / Q000473:pathology; D048909:Diabetes Complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology; D018450:Disease Progression; D004730:Endothelium, Vascular / Q000473:pathology*; D005260:Female; D006801:Humans; D007249:Inflammation; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged