Brain Atrophy in Type 2 Diabetes Regional distribution and influence on cognition

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  • Chris Moran, M.B., B.C.H., Thanh G. Phan, P.H.D., Jian Chen, M.E., Leigh Blizzard, P.H.D., Richard Beare, P.H.D, Alison Venn, P.H.D., Gerald Mnch, P.H.D., Amanda G. Wood, P.H.D., Josephine Forbes, P.H.D., Timothy M. Greenaway, P.H.D., Susan Pearson, P.H.D., Velandai Srikanth, P.H.D.Diabetes Care Volume 36: 4036-4042December, 2013

  • STUDY OBJECTIVEType 2 diabetes (T2DM) is associated with brain atrophy and cerebrovascular disease

    We define the regional distribution of brain atrophy in T2DM and examine if atrophy or cerebrovascular lesions are links between T2DM and cognitive function

    Moran C. et al. Diabetes Care 2013;36:4036-4042

  • STUDY DESIGN AND METHODSMagnetic resonance imaging (MRI) scans and cognitive tests were used in 350 participants with T2DM and 363 participants without T2DM

    With voxel-based morphometry, regional distribution of atrophy in T2DM was studied

    Cerebrovascular lesions and atrophy were measured while blinded to T2DM statusMoran C. et al. Diabetes Care 2013;36:4036-4042

  • RESULTST2DM was associated with more cerebral infarcts and lower total gray, white, andhippocampal volumes but not with microbleeds or white matter hyperintensity

    T2DM-related gray matter loss was distributed mainly in medial temporal, anterior cingulate, and medial frontal lobes

    White matter loss was distributed in frontal and temporal regions

    T2DM was associated with poorer visuospatial construction, planning, visual memory, and speed independent of age, sex, education, and vascular risk factorsMoran C. et al. Diabetes Care 2013;36:4036-4042

  • Moran C. et al. Diabetes Care 2013;36:4036-4042

  • Moran C. et al. Diabetes Care 2013;36:4036-4042

  • CONCLUSIONSCortical atrophy in T2DM resembles patterns seen in preclinical Alzheimer disease

    Neurodegeneration rather than cerebrovascular lesions may play a key role in T2DM-related cognitive impairmentMoran C. et al. Diabetes Care 2013;36:4036-4042

  • Moran C. et al. Diabetes Care 2013;36:4036-4042

  • Moran C. et al. Diabetes Care 2013;36:4036-4042

    **Table 1- Sample characteristics

    Data are mean (SD) or n (%) unless otherwise indicated. TIA, transient ischemic attack. *Cognitive score comparisons are unadjusted for age, sex, education, or mood.*Table 2- Associations between T2DM and MRI measures

    Data are mean (SD) and b (95% CI). 1Adjusted for age, sex, and total intracranial volume. aNot adjusted for total intracranial volume. bNot adjusted for stroke history.**Figure 1- Probability map of location of gray matter atrophy attributable to T2DM. VBM was used to create a probability map of areas of gray matter atrophy attributable to T2DM when adjusted for age, sex, education, and total intracranial volume. Voxels highlighted are those areas most likely to have gray matter atrophy attributable to T2DM, with a false discovery rate P , 0.001 (orange) to P , 0.0001 (yellow). These areas are detailed in Supplementary Table 2. A: Inferior region. B: Temporal region. C: Medial region. D: Superior region.**