Table 3—

Relation between diabetes and cerebral atrophy

Study (ref.)Study populationSubjects (total/diabetic) (n)Mean age (years)Diabetes typeImagingRating scaleOutcome and resultsP valueAdjustments/matching
General cohorts
    Longstreth et al. (33)Population based3,253/?>652MRIOrd (0–9)Increase in cortical atrophy grade: men 0.6 (0.2–0.9); women 0.2 (0–0.4)?Age, race, edu, BP, PVD, alcohol
    Den Heijer et al. (12)Population based506/41>602MRIIntHippocampal volume: −4% (0–9)*0.04Age, sex, PVD
Amygdalar volume: −7% (−2 to 12)*0.004
    Schmidt et al. (13)Population based1,252/114692MRIOrd (0–15), ventricle-to-brain ratioCortical atrophy: d = 0.3*0.001Sex, age, edu, BP, PVD, smoking, BMI, HL
Subcortical atrophy: d = 0.3*0.03
    Musen et al. (36)Case-control118/82331MRIVolumetryCortical density loss: range 4.3–5.0%<0.001Age, sex, edu,
Subcortical density loss: 5.2%<0.001
Vascular cohorts
    Manolio et al. (10)Stroke and control303/76>652MRIOrd (0–9)Sulcal widening: mean diff −0.30.3No
Ventricular enlargement: mean diff 0.5<0.03
    Padovani et al. (34)Stroke and control100/20>602MRIIntVentricular enlargement: NSNSNo
Outpatient cohorts
    Pirttila et al. (32)CT for any indication416/46>15NDCTDichAny cerebral atrophy: OR 3.4 (1.8–6.5)*?No
    Soininen et al. (35)Elderly volunteers84/25>702CTIntCortical atrophy: d = range −0.2 to 0.7 (right temporal horn)*NSAge, head size
Subcortical atrophy: d = range 0.2–0.4*NS
    Araki et al. (21)MRI for any indication2,725/159602MRIDichAny cerebral atrophy: OR 3.2 (2.3–4.4)*<0.05No
    Biessels et al. (11)Memory clinic347/29732MRIOrdCortical atrophy: mean diff 1.5 (0–2.5)?Age, sex
Subcortical atrophy: mean diff 0 (−1.5 to 2)NS
Medial temporal lobe atrophy: mean diff 0.5 (−0.5 to 0.5)NS
  • Studies are listed in chronological order. Study populations: general cohorts, population-based or case-control studies; vascular cohorts, cohort with stroke or other cardiovascular risk factors; outpatient cohorts, neurological outpatients. Diabetes type: 2 (except for the study by Soininen et al. [35]), population type classified as predominantly type 2 diabetes (see research design and methods). ND, not determined. Rating scales: Dich, dichotomous scale; Int, interval scale; Ord, ordinal scale. Outcome and results: ORs are presented with 95% CIs in parentheses.

  • *

    * Where possible, we calculated ORs or effect sizes (d ) if they were not provided in the original article. Mean differences (diff; with 95% CIs in parentheses), d, β, and t values >0 reflect more severe atrophy in the diabetic group relative to control subjects. P value: NS, not significant; ?, not specified. Adjustments/matching: AF, atrial fibrillation; BP, blood pressure (including hypertension, mean arterial pressure, systolic blood pressure, use of antihypertensive drugs, left ventricular hypertrophy, and ankle-to-arm index); edu, education; HL, hyperlipidemia; ICD, ischemic cerebrovascular disease (including transient ischemic attack, stroke, leukoaraiosis, WMLs, and ultrasound examination of carotids or intracranial arteries); PVD, peripheral vascular disease (including peripheral artery disease, coronary artery disease, cardiac disease, congestive heart failure, and electrocardiogram changes).