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

  1. David Last, PHD1,
  2. David C. Alsop, PHD2,
  3. Amir M. Abduljalil, PHD3,
  4. Robert P. Marquis, BS2,
  5. Cedric de Bazelaire, MD2,
  6. Kun Hu, PHD1,
  7. Jerry Cavallerano, OD, PHD4 and
  8. Vera Novak, MD, PHD1
  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, Ohio State University, Columbus, Ohio
  4. 4Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
  1. 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

Abstract

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.

Footnotes

  • Published ahead of print at http://care.diabetesjournals.org on 8 February 2007. DOI: 10.2337/dc06-2052.

    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 February 1, 2007.
    • Received October 4, 2006.
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This Article

  1. Published online before print February 8, 2007, doi: 10.2337/dc06-2052 Diabetes Care May 2007 vol. 30 no. 5 1193-1199
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