title: Brain changes underlying cognitive dysfunction in diabetes: what can we learn from MRI?
abstract: Diabetes is associated with cognitive dysfunction and an increased risk of dementia. This article addresses findings with brain MRI that may underlie cognitive dysfunction in diabetes. Studies in adults with type 1 diabetes show regional reductions in brain volume. In those with a diabetes onset in childhood, these volume reductions are likely to reflect the sum of changes that occur during brain development and changes that occur later in life due to exposure to diabetes-related factors. Type 2 diabetes is associated with global brain atrophy and an increased burden of small-vessel disease. These brain changes occur in the context of aging and often also in relation to an adverse vascular risk factor profile. Advanced imaging techniques detect microstructural lesions in the cerebral gray and white matter of patients with diabetes that affect structural and functional connectivity. Challenges are to further unravel the etiology of these cerebral complications by integrating findings from different imaging modalities and detailed clinical phenotyping and by linking structural MRI abnormalities to histology. A better understanding of the underlying mechanisms is necessary to establish interventions that will improve long-term cognitive outcomes for patients with type 1 and type 2 diabetes.
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center, Utrecht, the Netherlands g.j.biessels@umcutrecht.nl.
authors.forename: Geert Jan
authors.initials: GJ
authors.lastname: Biessels
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center, Utrecht, the NetherlandsJ. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Yael D
authors.initials: YD
authors.lastname: Reijmer
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology*; D002648:Child; D003072:Cognition Disorders / Q000209:etiology / Q000473:pathology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009415:Nerve Net / Q000503:physiopathology; D009929:Organ Size