title: Frontal gray matter atrophy in middle aged adults with type 1 diabetes is independent of cardiovascular risk factors and diabetes complications.
abstract: OBJECTIVE
  To determine if regional gray matter volume (GMV) differences in middle-aged adults with and without type-1 diabetes (T1D) are localized in areas most vulnerable to aging, e.g. fronto-subcortical networks; and if these differences are explained by cardiovascular risk factors and diabetes complications.
  
  
  METHODS
  Regional GMV was computed using 3T MRI of 104 adults with a childhood onset of T1D (mean age: 49±7 and duration: 41±6years) and 151 adults without diabetes (mean age: 40±6). A Bonferroni threshold (n=45, p≤0.001) was applied to account for multiple between-group comparisons and analyses were repeated in an age- and gender-matched subset of participants with T1D and controls (n=44 in each group, mean age [SD] and range: 44.0, [4.3], 17.4 and 44.6 [4.3], 17.0, respectively).
  
  
  RESULTS
  Compared to controls, T1D patients had smaller GMV in the frontal lobe (6% to 19% smaller) and adjacent supramarginal and postcentral gyri (8% to 13% smaller). Between-group differences were independent of age, waist circumference, systolic blood pressure, fasting total cholesterol and smoking status and were similar in sensitivity analyses restricted to age- and gender-matched participants. Associations between GMV and diabetes complications were not significant.
  
  
  CONCLUSIONS
  These findings extend the notion of accelerated brain aging in T1D to middle-aged adults. The pathophysiology of frontal gray matter atrophy and its impact on future development of disability and dementia need further study, especially as middle-aged T1D patients progress to older age.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Hughes
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Ryan
authors.forename: Howard J
authors.initials: HJ
authors.lastname: Aizenstein
authors.forename: Karen
authors.initials: K
authors.lastname: Nunley
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gianaros
authors.forename: Rachel
authors.initials: R
authors.lastname: Miller
authors.forename: Tina
authors.initials: T
authors.lastname: Costacou
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Trevor J
authors.initials: TJ
authors.lastname: Orchard
authors.forename: Caterina
authors.initials: C
authors.lastname: Rosano
mesh_terms: D000328:Adult; D001284:Atrophy / Q000150:complications; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
keywords: Brain; Complications; Hypertension; Imaging (MRI); Nephropathy; Retinopathy