title: Relation of Dysglycemia to Structural Brain Changes in a Multiethnic Elderly Cohort.
abstract: OBJECTIVE
  Abnormally high glucose levels (dysglycemia) increase with age. Epidemiological studies suggest that dysglycemia is a risk factor for cognitive impairment but the underlying pathophysiological mechanisms remain unclear. The objective of this study was to examine the relation of dysglycemia clinical categories (normal glucose tolerance (NGT), pre-diabetes, undiagnosed diabetes, known diabetes) with brain structure in older adults. We also assessed the relation between dysglycemia and cognitive performance.
  
  
  METHODS
  Cross-sectional and longitudinal cohort study.
  
  
  METHODS
  Northern Manhattan (Washington Heights, Hamilton Heights, and Inwood).
  
  
  METHODS
  Medicare recipients 65 years and older.
  
  
  METHODS
  Dysglycemia categories were based on HBA1c or history of type 2 diabetes (diabetes). Brain structure (brain infarcts, white matter hyperintensities (WMH) volume, total gray matter volume, total white matter volume, total hippocampus volume) was assessed with brain magnetic resonance imaging; cognitive function (memory, language and visuospatial function, speed) was assessed with a validated neuropsychological battery.
  
  
  RESULTS
  Dysglycemia, defined with HbA1c as a continuous variable or categorically as pre-diabetes and diabetes, was associated with a higher number of brain infarcts, WMH volume and decreased total white matter, gray matter and hippocampus volumes cross-sectionally, and a significant decline in gray matter volume longitudinally. Dysglycemia was also associated with lower performance in language, speed and visuospatial function although these associations were attenuated when adjusted for education, APOE-ε4, ethnic group and vascular risk factors.
  
  
  CONCLUSIONS
  Our results suggest that dysglycemia affects brain structure and cognition even in elderly survivors, evidenced by higher cerebrovascular disease, lower white and gray matter volume, and worse language and visuospatial function and cognitive speed.
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York City, New York.|Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York.|Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York City, New York.|Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York.
authors.forename: Christiane
authors.initials: C
authors.lastname: Reitz
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York City, New York.
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Guzman
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York City, New York.
authors.forename: Atul
authors.initials: A
authors.lastname: Narkhede
authors.affiliation: Department of Neurology, Center for Neuroscience, University of California at Davis, Sacramento, California.|Imaging of Dementia and Aging Laboratory, Center for Neuroscience, University of California at Davis, Sacramento, California.
authors.forename: Charles
authors.initials: C
authors.lastname: DeCarli
authors.affiliation: Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, New York City, New York.|Department of Neurology, College of Physicians and Surgeons, Columbia University, New York City, New York.|Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York City, New York.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Brickman
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York.|Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, New York.
authors.forename: José A
authors.initials: JA
authors.lastname: Luchsinger
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D060825:Cognitive Dysfunction / Q000209:etiology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: cognition; dysglycemia; structural brain changes