Factors Associated with Changes in Brain Atrophy during a Three-Year Observation in Elderly Diabetic Patients: Effect of Renal Impairment on Hippocampal Atrophy.
OBJECTIVE
We conducted a 3-year longitudinal study concerning factors associated with changes in brain atrophy in elderly diabetic patients.


METHODS
We evaluated hippocampal and global brain atrophy using automatic voxel-based morphometry of structural magnetic resonance images, 4 cognitive function tests, and cerebral small vessel disease (SVD) in 66 diabetic patients.


RESULTS
During the 3-year follow-up, hippocampal and global brain atrophy advanced, and cognitive functions worsened. For changes in hippocampal atrophy, changes in estimated glomerular filtration rate (eGFR), albuminuria, and being an ApoE ε4 carrier were independent factors; change in the number of silent brain infarctions was an independent factor for changes in global brain atrophy. A significant association of changes in eGFR and albuminuria with hippocampal atrophy remained after adjusting for confounders including SVD. Both types of brain atrophy at baseline were significantly correlated with cognitive impairment at baseline and especially associated with changes in delayed word recall during the follow-up after adjusting for confounders.


CONCLUSIONS
Changes in eGFR and albuminuria during follow-up were independent risk factors for hippocampal atrophy, which was associated with decline in delayed word recall, suggesting that management of chronic kidney disease may prevent the progression of hippocampal atrophy.
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan; Center for Preventive Medicine, Chubu Rosai Hospital, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Takahiko
T
Kawamura
Departments of Neurology, Chubu Rosai Hospital, Nagoya, Japan.
Toshitaka
T
Umemura
Departments of Community Health Care and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Hiroyuki
H
Umegaki
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Rui
R
Imamine
Departments of Community Health Care and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Departments of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Naoko
N
Kawano
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Hajime
H
Mase
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Asako
A
Mizoguchi
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Makiko
M
Minatoguchi
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Minoru
M
Kusama
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Yu
Y
Kouchi
Center for Preventive Medicine, Chubu Rosai Hospital, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Atsuko
A
Watarai
Center for Preventive Medicine, Chubu Rosai Hospital, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Akio
A
Kanai
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Eitaro
E
Nakashima
Departments of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.
Nigishi
N
Hotta
Brain atrophy; Cerebral small vessel disease; Cognitive impairment; Diabetes mellitus; Renal impairment