Structural brain imaging in diabetes: a methodological perspective.
ABSTRACT Brain imaging provides information on brain anatomy and function and progression of cerebral abnormalities can be monitored. This may provide insight into the aetiology of diabetes related cerebral disorders. This paper focuses on the methods for the assessment of white matter hyperintensities and brain atrophy on structural brain images, mostly magnetic resonance imaging, in diabetes. These methods range from visual rating scales to advanced semi-automated and automated image processing techniques such as volumetry and voxel-based morphometry. The findings of previous imaging studies in diabetes are discussed from a methodological perspective and recommendations for future research are given.
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ABSTRACT: Diabetes mellitus is an important vascular risk factor for cerebrovascular disease. This occurs through pathophysiologic changes to the microcirculation as arteriolosclerosis and to the macrocirculation as large artery atherosclerosis. Imaging techniques can provide detailed visualization of the cerebrovasculature using CT (computed tomography) angiography and MR (magnetic resonance) angiography. Newer techniques focused on advanced parenchymal imaging include CT perfusion, quantitative MRI, and diffusion tensor imaging; each identifies brain lesion burden due to diabetes mellitus. These imaging approaches have provided insights into the diabetes mellitus brain and cerebral circulation pathophysiology. Imaging has taught us that diabetics develop cerebral atrophy, silent infarcts, and white matter disease more rapidly than other patient populations. Longitudinal studies are needed to quantify the rate and extent of such structural brain and blood vessel changes and how they relate to cognitive decline. Diabetes prevention and treatment strategies will then be possible to slow the development of such changes.Handbook of Clinical Neurology 01/2014; 126:291-315. DOI:10.1016/B978-0-444-53480-4.00021-7
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ABSTRACT: Diabetes mellitus is associated with an increase in the risk of dementia and the proportion of patients who convert from mild cognitive impairment (MCI) to dementia. In addition to MCI and dementia, the stages of diabetes-associated cognitive dysfunction include subtle cognitive changes that are unlikely to affect activities of daily life or diabetes self-management. These diabetes-associated cognitive decrements have structural brain correlates detectable with brain MRI, but usually show little progression over time. Although cognitive decrements do not generally represent a pre-dementia stage in patients below the age of 60-65 years, in older individuals these subtle cognitive changes might represent the earliest stages of a dementia process. Acknowledgment of diabetes-associated cognitive decrements can help to improve understanding of patients' symptoms and guide management. Future challenges are to establish the importance of screening for cognitive impairment in people with diabetes, to identify those at increased risk of accelerated cognitive decline at an early stage, and to develop effective treatments. Copyright © 2015 Elsevier Ltd. All rights reserved.The Lancet Neurology 03/2015; 14(3):329-40. DOI:10.1016/S1474-4422(14)70249-2 · 21.82 Impact Factor
Article: INSIDE THE DIABETIC BRAIN[Show abstract] [Hide abstract]
ABSTRACT: A b s t r a c t CNS complications resulting from diabetes mellitus (DM) are a problem gaining more acceptance and attention in the recent years. Both types 1 and 2 DM represent an significant risk factor for decreased cognitive functions, memory and learning deficits as well as development of Alzheimer's disease. Chronic hyperglycemia through protein glycation and increased oxidative stress contributes to brain dysfunction, however increasing evidences suggest that the pathology of DM in the brain involves a progressive and coordinated disruption of insulin signaling, with profound consequences for brain function and plasticity. Since many of the CNS changes observed in diabetic patients and animal models of DM are reminiscent of the changes seen in aging, the theory of advanced brain aging in DM has been proposed. This review summarizes the findings of the literature regarding the effects of DM on the brain in the terms of diabetes-related metabolic derangements and intracellular signaling.