Cerebral Blood Flow Velocity and Periventricular White Matter Hyperintensities in Type 2 Diabetes

  1. Vera Novak, MD, PHD1,
  2. David Last, PHD1,
  3. David C. Alsop, PHD2,
  4. Amir M. Abduljalil, PHD3,
  5. Kun Hu, PHD1,
  6. Lukas Lepicovsky1,
  7. Jerry Cavallerano, OD, PHD4 and
  8. Lewis A. Lipsitz, MD15
  1. 1Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  2. 2Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
  3. 3Department of Radiology, The Ohio State University, Columbus, Ohio
  4. 4Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
  5. 5Hebrew SeniorLife, Boston, Massachusetts
  1. Address correspondence and reprint requests to Vera Novak, Division of Gerontology, Beth Israel Deaconess Medical Center, 110 Francis St., Boston, MA 02215. E-mail: vnovak{at}bidmc.harvard.edu


OBJECTIVE—Diabetes increases the risk for cerebromicrovascular disease, possibly through its effects on blood flow regulation. The aim of this study was to assess the effects of type 2 diabetes on blood flow velocities (BFVs) in the middle cerebral arteries and to determine the relationship between white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) and BFVs.

RESEARCH DESIGN AND METHODS—We measured BFVs in 28 type 2 diabetic and 22 control subjects (aged 62.3 ± 7.2 years) using transcranial Doppler ultrasound during baseline, hyperventilation, and CO2 rebreathing. WMHs were graded, and their volume was quantified from fluid-attenuated inversion recovery images on a 3.0 Tesla MRI.

RESULTS—The diabetic group demonstrated decreased mean BFVs and increased cerebrovascular resistance during baseline, hypo- and hypercapnia (P < 0.0001), and impaired CO2 reactivity (P = 0.05). WMH volume was negatively correlated with baseline BFV (P < 0.0001). A regression model revealed that baseline BFVs were negatively associated with periventricular WMHs, HbA1c (A1C), and inflammatory markers and positively associated with systolic blood pressure (R2 = 0.86, P < 0.0001).

CONCLUSIONS—Microvascular disease in type 2 diabetes, which manifests as white matter abnormalities on MRI, is associated with reduced cerebral BFVs, increased resistance in middle cerebral arteries, and inflammation. These findings are clinically relevant as a potential mechanism for cerebrovascular disease in elderly with type 2 diabetes.


  • D.C.A. has received research grant support from General Electric Healthcare Technologies.

    A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted March 27, 2006.
    • Received January 31, 2006.
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