Microstructural White Matter Abnormalities and Cognitive Functioning in Type 2 Diabetes
A diffusion tensor imaging study
- Yael D. Reijmer, PHD1⇓,
- Manon Brundel, MD1,
- Jeroen de Bresser, MD1,2,
- L. Jaap Kappelle, MD1,
- Alexander Leemans, PHD2,
- Geert Jan Biessels, MD1,
- on behalf of the Utrecht Vascular Cognitive Impairment Study Group*
- 1Department of Neurology, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, the Netherlands
- 2Image Sciences Institute, University Medical Center Utrecht, Utrecht, the Netherlands
- Corresponding author: Yael D. Reijmer, .
OBJECTIVE To examine whether type 2 diabetes is associated with microstructural abnormalities in specific cerebral white matter tracts and to relate these microstructural abnormalities to cognitive functioning.
RESEARCH DESIGN AND METHODS Thirty-five nondemented older individuals with type 2 diabetes (mean age 71 ± 5 years) and 35 age-, sex-, and education-matched control subjects underwent a 3 Tesla diffusion-weighted MRI scan and a detailed cognitive assessment. Tractography was performed to reconstruct several white matter tracts. Diffusion tensor imaging measures, including fractional anisotropy (FA) and mean diffusivity (MD), were compared between groups and related to cognitive performance.
RESULTS MD was significantly increased in all tracts in both hemispheres in patients compared with control subjects (P < 0.05), reflecting microstructural white matter abnormalities in the diabetes group. Increased MD was associated with slowing of information-processing speed and worse memory performance in the diabetes but not in the control group after adjustment for age, sex, and estimated IQ (group × MD interaction, all P < 0.05). These associations were independent of total white matter hyperintensity load and presence of cerebral infarcts.
CONCLUSIONS Individuals with type 2 diabetes showed microstructural abnormalities in various white matter pathways. These abnormalities were related to worse cognitive functioning.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc12-0493/-/DC1.
A slide set summarizing this article is available online.
↵* A complete list of members of the Utrecht Vascular Cognitive Impairment Study Group involved in the Utrecht Diabetic Encephalopathy Study can be found in the appendix.
- Received March 14, 2012.
- Accepted July 5, 2012.
- © 2013 by the American Diabetes Association.
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