Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes
The determinants of cerebral complications of type 2 diabetes are unclear. The present study aimed to identify metabolic and vascular factors that are associated with impaired cognitive performance and abnormalities on brain MRI in patients with type 2 diabetes.
The study included 122 patients and 56 controls. Neuropsychological test scores were divided into five cognitive domains and expressed as standardised z values. Brain MRI scans were rated for white matter lesions (WML), cortical and subcortical atrophy, and infarcts. Data on glucose metabolism, vascular risk factors and micro- and macrovascular disease were collected.
Patients with type 2 diabetes had more cortical (p < 0.001) and subcortical (p < 0.01) atrophy and deep WML (p = 0.02) than the control group and their cognitive performance was worse. In multivariate regression analyses within the type 2 diabetes group, hypertension (p < 0.05) and a history of vascular events (p < 0.01) were associated with worse cognitive performance, while statin use was associated (p < 0.05) with better performance. Retinopathy and brain infarcts on MRI were associated with more severe cortical atrophy (both p < 0.01) and statin use with less atrophy (p < 0.05). Insulin level and brain infarcts were associated with more severe WML and statin use with less severe WML (all p < 0.05).
Type 2 diabetes is associated with modest impairments in cognition, as well as atrophy and vascular lesions on MRI. This ‘diabetic encephalopathy’ is a multifactorial condition, for which atherosclerotic (macroangiopathic) vascular disease is an important determinant. Chronic hyperglycaemia, hyperinsulinaemia and hypertension may play additional roles.
- Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes
- Open Access
- Available under Open Access This content is freely available online to anyone, anywhere at any time.
Volume 50, Issue 11 , pp 2388-2397
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Brain atrophy
- Brain MRI
- Cerebral complications
- Cognitive performance
- Diabetic encephalopathy
- Metabolic risk factors
- Neuropsychological investigation
- Type 2 diabetes mellitus
- Vascular risk factors
- White matter lesions
- Industry Sectors
- Author Affiliations
- 1. Rudolf Magnus Institute of Neuroscience, Department of Neurology, G03.228, University Medical Center, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
- 2. Department of Internal Medicine, University Medical Center, Utrecht, The Netherlands
- 3. Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
- 4. Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands