Influence of Type 2 Diabetes on Brain Volumes and Changes in Brain Volumes
Results from the Women’s Health Initiative Magnetic Resonance Imaging Studies
- Mark A. Espeland, PHD1⇓,
- R. Nick Bryan, MD, PHD2,
- Joseph S. Goveas, MD3,
- Jennifer G. Robinson, MD, MPH4,
- Mustafa S. Siddiqui, MD5,
- Simin Liu, MD, MPH, SCD6,
- Patricia E. Hogan, MS1,
- Ramon Casanova, PHD1,
- Laura H. Coker, PHD7,
- Kristine Yaffe, MD8,
- Kamal Masaki, MD9,
- Rebecca Rossom, MD, MSCR10,
- Susan M. Resnick, PHD11,
- for the WHIMS-MRI Study Group*
- 1Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
- 2Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
- 3Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- 4Departments of Epidemiology and Medicine, Division of Cardiology, University of Iowa, Iowa City, Iowa
- 5Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
- 6Center for Metabolic Disease Prevention, University of California, Los Angeles, Los Angeles, California
- 7Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
- 8Departments of Epidemiology and Biostatistics, Psychiatry, and Neurology, University of California, San Francisco, San Francisco, California
- 9Department of Geriatric Medicine, University of Hawaii at Manoa, Honolulu, Hawaii;
- 10Health Partners Research Foundation, Bloomington, Minnesota
- 11Laboratory of Behavioral Neuroscience, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, Maryland
- Corresponding author: Mark A. Espeland, .
OBJECTIVE To study how type 2 diabetes adversely affects brain volumes, changes in volume, and cognitive function.
RESEARCH DESIGN AND METHODS Regional brain volumes and ischemic lesion volumes in 1,366 women, aged 72–89 years, were measured with structural brain magnetic resonance imaging (MRI). Repeat scans were collected an average of 4.7 years later in 698 women. Cross-sectional differences and changes with time between women with and without diabetes were compared. Relationships that cognitive function test scores had with these measures and diabetes were examined.
RESULTS The 145 women with diabetes (10.6%) at the first MRI had smaller total brain volumes (0.6% less; P = 0.05) and smaller gray matter volumes (1.5% less; P = 0.01) but not white matter volumes, both overall and within major lobes. They also had larger ischemic lesion volumes (21.8% greater; P = 0.02), both overall and in gray matter (27.5% greater; P = 0.06), in white matter (18.8% greater; P = 0.02), and across major lobes. Overall, women with diabetes had slightly (nonsignificant) greater loss of total brain volumes (3.02 cc; P = 0.11) and significant increases in total ischemic lesion volumes (9.7% more; P = 0.05) with time relative to those without diabetes. Diabetes was associated with lower scores in global cognitive function and its subdomains. These relative deficits were only partially accounted for by brain volumes and risk factors for cognitive deficits.
CONCLUSIONS Diabetes is associated with smaller brain volumes in gray but not white matter and increasing ischemic lesion volumes throughout the brain. These markers are associated with but do not fully account for diabetes-related deficits in cognitive function.
A slide set summarizing this article is available online.
↵* A list of participants in the WHIMS-MRI Study Group can be found in the Appendix.
- Received March 22, 2012.
- Accepted July 3, 2012.
- © 2013 by the American Diabetes Association.
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