title: Ventral striatum, but not cortical volume loss, is related to cognitive dysfunction in type 1 diabetic patients with and without microangiopathy.
abstract: OBJECTIVE
  Patients with longstanding type 1 diabetes may develop microangiopathy due to high cumulative glucose exposure. Also, chronic hyperglycemia is related to cerebral alterations and cognitive dysfunction. Whether the presence of microangiopathy is conditional to the development of hyperglycemia-related cerebral compromise is unclear. Since subcortical, rather than cortical, volume loss was previously related to cognitive dysfunction in other populations, we measured these brain correlates and cognitive functions in patients with longstanding type 1 diabetes with and without microangiopathy.
  
  
  METHODS
  We evaluated differences in subcortical volume and cortical thickness and volume in type 1 diabetic patients with (n = 51) and without (n = 53) proliferative retinopathy and 49 control subjects and related volume differences to cognitive dysfunction. Analyses were corrected for age, sex, systolic blood pressure, and A1C.
  
  
  RESULTS
  Putamen and right thalamic volume loss was noted in both patients with and without proliferative retinopathy compared with control subjects (all P < 0.05). Additionally, in patients with proliferative retinopathy relative to control subjects, volume loss of the bilateral nucleus accumbens was found (all P < 0.05). No differences were observed between the two patient groups. Cortical thickness and volume were not different between groups. In pooled analyses, lower left nucleus accumbens volume was associated with cognitive dysfunction (P < 0.035).
  
  
  CONCLUSIONS
  This study shows subcortical, but not cortical, volume loss in relation to cognitive dysfunction in patients with longstanding type 1 diabetes, irrespective of microangiopathy. The time course, pathophysiology, and clinical relevance of these findings need to be established in longitudinal and mechanistic studies.
authors: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands e.vanduinkerken@vumc.nl.
authors: Eelco
authors: E
authors: van Duinkerken
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands Department of Anatomy and Neuroscience, VU University Medical Center, Amsterdam, the Netherlands.
authors: Menno M
authors: MM
authors: Schoonheim
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors: Martijn D
authors: MD
authors: Steenwijk
authors: Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands.
authors: Martin
authors: M
authors: Klein
authors: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors: Richard G
authors: RG
authors: IJzerman
authors: Department of Ophthalmology, VU University Medical Center, Amsterdam, the Netherlands.
authors: Annette C
authors: AC
authors: Moll
authors: Department of Epidemiology and Biostatistics, EMGO+ Institute, VU University Medical Center, Amsterdam, the Netherlands.
authors: Martijn W
authors: MW
authors: Heymans
authors: Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands.
authors: Frank J
authors: FJ
authors: Snoek
authors: Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors: Frederik
authors: F
authors: Barkhof
authors: Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.
authors: Michaela
authors: M
authors: Diamant
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology*; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D048909:Diabetes Complications / Q000209:etiology* / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D003925:Diabetic Angiopathies / Q000209:etiology* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D066328:Ventral Striatum / Q000473:pathology*; D055815:Young Adult