Cognition and brain imaging in type 1 diabetes
Type 1 diabetes has mild effects on cognition that are influenced by age of onset, hyperglycemia, and hypoglycemic episodes. Some of these changes occur quite early in the disease course. Studies using relatively new brain imaging techniques have also shown brain changes in adults and children that appear to be influenced by metabolic abnormalities present in diabetes. Early detections of brain changes may be early indicators of subsequent cognitive abnormalities.
[Show abstract] [Hide abstract] ABSTRACT: In recent years, increasing attention has been paid to the effects of Type 1 Diabetes (T1D) on cognitive functions. T1D onset usually occurs during childhood, so it is possible that the brain could be affected during neurodevelopment. We selected young patients of normal intelligence with T1D onset during neurodevelopment, no complications from diabetes, and adequate glycemic control. The purpose of this study was to compare the neural BOLD activation pattern in a group of patients with T1D versus healthy control subjects while performing a visuospatial working memory task. Sixteen patients and 16 matched healthy control subjects participated. There was no significant statistical difference in behavioral performance between the groups, but, in accordance with our hypothesis, results showed distinct brain activation patterns. Control subjects presented the expected activations related to the task, whereas the patients had greater activation in the prefrontal inferior cortex, basal ganglia, posterior cerebellum, and substantia nigra. These different patterns could be due to compensation mechanisms that allow them to maintain a behavioral performance similar to that of control subjects.0Comments 2Citations
- "This notion leads to questioning whether early clinical emergence of T1D might subtly disturb brain function resulting in an evolutionary stage in which abnormal neural processing could, at least temporarily, successfully meet daily cognitive demands. It appears that T1D has a negative impact on brain function that begins to take effect shortly after diagnosis [13, 14], such that in cases of early onset it might alter neurodevelopment, as various authors have suggested [10, 18, 19] . In this context, brain disturbances in adults with earlyonset T1D are likely to reflect adaptive changes during brain development, which would make the brain more vulnerable to later deleterious effects due to exposure to diabetesrelated factors [1, 20, 21]. "
[Show abstract] [Hide abstract] ABSTRACT: Type 1 diabetes mellitus (T1DM) usually begins in childhood and adolescence and causes lifelong damage to several major organs including the brain. Despite increasing evidence of T1DM-induced structural deficits in cortical regions implicated in higher cognitive and emotional functions, little is known whether and how the structural connectivity between these regions is altered in the T1DM brain. Using inter-regional covariance of cortical thickness measurements from high-resolution T1-weighted magnetic resonance data, we examined the topological organizations of cortical structural networks in 81 T1DM patients and 38 healthy subjects. We found a relative absence of hierarchically high-level hubs in the prefrontal lobe of T1DM patients, which suggests ineffective top-down control of the prefrontal cortex in T1DM. Furthermore, inter-network connections between the strategic/executive control system and systems subserving other cortical functions including language and mnemonic/emotional processing were also less integrated in T1DM patients than in healthy individuals. The current results provide structural evidence for T1DM-related dysfunctional cortical organization, which specifically underlie the top-down cognitive control of language, memory, and emotion.0Comments 4Citations
- "T1DM may lead to several neurobehavioral abnormalities, as the CNS manifestations of T1DM include impaired performances on several cognitive domains as well as a wide range of emotional problems such as depression and anxiety [5,646566. An increasing number of neuroimaging studies suggest that the frontal and temporal brain regions may be the neuroanatomical correlates of these neurobehavioral abnormalities [24,454647484950676869, in that these regions, which are known to have high insulin-receptor density and require high levels of cerebral energy, are particularly vulnerable to abnormal brain glucose metabolism707172. The current findings suggest that altered inter-network connectivity between these key regions may play an important role in T1DM-associated neurobehavioral abnormalities, in addition to T1DM-related volume or thickness reductions with a similar regional pattern. "
[Show abstract] [Hide abstract] ABSTRACT: Symptom control in chronic illnesses like diabetes type 1 and asthma may be related to children's self-regulation both negatively and positively. We show how quality of symptom control is related to parents' and children's assessments of their self-regulatory skills (eg. behavioral inhibition, shifting, planning, monitoring and emotional control). Children with both chronic illnesses are compared with healthy peers and children with ADHD. According to parent's reports patients with diabetes with a history of acute hipo-or hyperglycemia and higher glycated hemoglobin as well as patients with poorly controlled asthma symptoms, more intensive treatment and acute attacks manifest more problems in self-regulation than their healthy peers but less than children with ADHD. Children with diabetes with low-glycated hemoglobin assess their behavior regulation better than their healthy peers.0Comments 0Citations
- "Neuroimaging studies indicate that acute hypo - or hyperglycemia is related to neu - robiological changes ( Wootton - Gorges & Glaser , 2007 ; Musen , 2008 ) . However , some authors question the negative impact of hypoglycemia , especially when diabetes is controlled restric - tively ( Musen et al , 2008 ) . Research shows that frequent hyperglycemia is related to externaliz - ing problems ( McDonnel et al , 2007 ) , whereas sustained improvement in behavior control is observed after commencement of insulin pump therapy ( Knight et al , 2009 , 2011 ) . "