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Open Access 01-11-2007 | Article

Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes

Authors: S. M. Manschot, G. J. Biessels, H. de Valk, A. Algra, G. E. H. M. Rutten, J. van der Grond, L. J. Kappelle, on behalf of the Utrecht Diabetic Encephalopathy Study Group

Published in: Diabetologia | Issue 11/2007

Abstract

Aims/hypothesis

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.

Methods

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.

Results

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).

Conclusions/interpretation

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.

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Title: Metabolic and vascular determinants of impaired cognitive performance and abnormalities on brain magnetic resonance imaging in patients with type 2 diabetes
Authors: S. M. Manschot
G. J. Biessels
H. de Valk
A. Algra
G. E. H. M. Rutten
J. van der Grond
L. J. Kappelle
on behalf of the Utrecht Diabetic Encephalopathy Study Group
Publication date: 01-11-2007
Publisher: Springer Berlin Heidelberg
Published in: Diabetologia / Issue 11/2007
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-007-0792-z

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Conclusions/interpretation

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Abstract

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