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Progression of Cerebral Atrophy and White Matter Hyperintensities in Patients With Type 2 Diabetes

  1. on behalf of the Utrecht Diabetic Encephalopathy Study Group*
  1. 1Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands;
  2. 2Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands;
  3. 3Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands.
  1. Corresponding author: Jeroen de Bresser, j.debresser{at}umcutrecht.nl.

Abstract

OBJECTIVE Type 2 diabetes is associated with a moderate degree of cerebral atrophy and a higher white matter hyperintensity (WMH) volume. How these brain-imaging abnormalities evolve over time is unknown. The present study aims to quantify cerebral atrophy and WMH progression over 4 years in type 2 diabetes.

RESEARCH DESIGN AND METHODS A total of 55 patients with type 2 diabetes and 28 age-, sex-, and IQ-matched control participants had two 1.5T magnetic resonance imaging scans with a 4-year interval. Volumetric measurements of total brain, peripheral cerebrospinal fluid (CSF), lateral ventricles, and WMH were performed with k-nearest neighbor–based probabilistic segmentation. All volumes were expressed as percentage of intracranial volume. Linear regression analyses, adjusted for age and sex, were performed to compare brain volumes between the groups and to identify determinants of volumetric change within the type 2 diabetic group.

RESULTS At baseline, patients with type 2 diabetes had a significantly smaller total brain volume and larger peripheral CSF volume than control participants. In both groups, all volumes showed a significant change over time. Patients with type 2 diabetes had a greater increase in lateral ventricular volume than control participants (mean adjusted between-group difference in change over time [95% CI]: 0.11% in 4 years [0.00 to 0.22], P = 0.047).

CONCLUSIONS The greater increase in lateral ventricular volume over time in patients with type 2 diabetes compared with control participants shows that type 2 diabetes is associated with a slow increase of cerebral atrophy over the course of years.

Footnotes

  • *Members of the Utrecht Diabetic Encephalopathy Study Group can be found in the appendix.

  • 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.

  • Received October 15, 2009.
  • Accepted March 7, 2010.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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This Article

  1. Diabetes Care vol. 33 no. 6 1309-1314
  1. All Versions of this Article:
    1. dc09-1923v1
    2. 33/6/1309 most recent
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