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Global and Regional Effects of Type 2 Diabetes on Brain Tissue Volumes and Cerebral Vasoreactivity

¹ Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
² Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
³ Department of Radiology, Ohio State University, Columbus, Ohio
⁴ Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts

Address correspondence and reprint requests to Vera Novak, MD, PhD, Division of Gerontology, Beth Israel Deaconess Medical Center, 110 Francis St., Boston, MA 02215. E-mail: vnovak{at}bidmc.harvard.edu

OBJECTIVE—The aim of this study was to evaluate the regional effects of type 2 diabetes and associated conditions on cerebral tissue volumes and cerebral blood flow (CBF) regulation.

RESEARCH DESIGN AND METHODS—CBF was examined in 26 diabetic (aged 61.6 ± 6.6 years) and 25 control (aged 60.4 ± 8.6 years) subjects using continuous arterial spin labeling (CASL) imaging during baseline, hyperventilation, and CO₂ rebreathing. Regional gray and white matter, cerebrospinal fluid (CSF), and white matter hyperintensity (WMH) volumes were measured on a T1-weighted inversion recovery fast-gradient echo and a fluid attenuation inversion recovery magnetic resonance imaging at 3 Tesla.

RESULTS—The diabetic group had smaller global white (P = 0.006) and gray (P = 0.001) matter and larger CSF (36.3%, P < 0.0001) volumes than the control group. Regional differences were observed for white matter (–13.1%, P = 0.0008) and CSF (36.3%, P < 0.0001) in the frontal region, for CSF (20.9%, P = 0.0002) in the temporal region, and for gray matter (–3.0%, P = 0.04) and CSF (17.6%, P = 0.01) in the parieto-occipital region. Baseline regional CBF (P = 0.006) and CO₂ reactivity (P = 0.005) were reduced in the diabetic group. Hypoperfusion in the frontal region was associated with gray matter atrophy (P < 0.0001). Higher A1C was associated with lower CBF (P < 0.0001) and greater CSF (P = 0.002) within the temporal region.

CONCLUSIONS—Type 2 diabetes is associated with cortical and subcortical atrophy involving several brain regions and with diminished regional cerebral perfusion and vasoreactivity. Uncontrolled diabetes may further contribute to hypoperfusion and atrophy. Diabetic metabolic disturbance and blood flow dysregulation that affects preferentially frontal and temporal regions may have implications for cognition and balance in elderly subjects with diabetes.

Abbreviations: CASL, continuous arterial spin labeling • CBF, cerebral blood flow • CSF, cerebrospinal fluid • FLAIR, fluid-attenuated inversion recovery • IR-FGE, inversion recovery fast-gradient echo • MRI, magnetic resonance imaging • ROI, region of interest • SPECT, single proton emission computed tomography • WMH, white matter hyperintensity

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