title: Cognitive dysfunctions in middle-aged type 2 diabetic patients and neuroimaging correlations: a cross-sectional study.
abstract: OBJECTIVE
  The aim was to assess the neuropsychological performance of a group of middle-aged patients with well-controlled type 2 diabetes mellitus (T2DM) and to examine whether the neuropsychological deficits correlate with structural and functional brain alterations.
  
  
  METHODS
  We compared 25 subjects with T2DM aged 45-65 years with 25 control participants matched for age, gender, and educational level. The neuropsychological battery was designed to examine executive functions, attention, information processing speed, and verbal memory. Severity of depression was assessed using the Hamilton Depression Rating Scale and cardiovascular risk factors were assessed using the Framingham Cardiovascular Risk Profile Score. The presence of at least one APOEε4 allele was determined. Reduced gray matter density was analyzed using voxel-based morphometry and brain glucose metabolic changes were assessed by 18FDG-PET.
  
  
  RESULTS
  T2DM subjects had significantly lower scores than subjects without T2DM in the Trail-making Test B (p < 0.004), Color-Word Stroop test (p < 0.005), Semantic Fluency (p < 0.006), Digit-Symbol modalities test (p < 0.02), Text Recall from the Wechsler Memory Scale (p < 0.0001), Rey-Osterrieth Complex Figure-copy (p < 0.004), and delayed reproduction (p < 0.03). Worse executive functions and memory functioning correlated predominantly with less gray matter density and reduced glucose metabolism in the orbital and prefrontal cortex, temporal (middle gyrus, parahippocampus and uncus), and cerebellum regions (p < 0.001).
  
  
  CONCLUSIONS
  T2DM subjects presented cognitive dysfunctions compared with controls. Clinical-neuroimaging correlations corresponded to brain changes (reduced gray matter density and glucose metabolism) mainly in fronto-temporal areas.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaga, Malaga, Spain Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), General Foundation University of Malaga, Malaga, Spain.
authors.forename: Natalia
authors.initials: N
authors.lastname: García-Casares
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Ricardo E
authors.initials: RE
authors.lastname: Jorge
authors.affiliation: Department of Endocrinology, Carlos Haya Hospital, Malaga, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: García-Arnés
authors.affiliation: The Iowa Consortium for Substance Abuse Research and Evaluation, University of Iowa, Iowa City, IA, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Acion
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaga, Malaga, Spain Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), General Foundation University of Malaga, Malaga, Spain.
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Berthier
authors.affiliation: Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.
authors.forename: Pedro
authors.initials: P
authors.lastname: Gonzalez-Alegre
authors.affiliation: Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), General Foundation University of Malaga, Malaga, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Nabrozidis
authors.affiliation: Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), General Foundation University of Malaga, Malaga, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Gutiérrez
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaga, Malaga, Spain Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), General Foundation University of Malaga, Malaga, Spain.
authors.forename: María José
authors.initials: MJ
authors.lastname: Ariza
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaga, Malaga, Spain Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), General Foundation University of Malaga, Malaga, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rioja
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Malaga, Malaga, Spain Centro de Investigaciones Médico-Sanitarias (C.I.M.E.S), General Foundation University of Malaga, Malaga, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: González-Santos
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D003072:Cognition Disorders / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology* / Q000523:psychology; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D005947:Glucose
keywords: Cognition; dementia; magnetic resonance imaging; mild cognitive impairment; neuropsychology; positron emission tomography; type 2 diabetes mellitus