Differential impact of subclinical carotid artery disease on cerebral structure and functioning in type 1 diabetes patients with versus those without proliferative retinopathy

Cardiovascular Diabetology

Original Investigation

Martin Klein¹  Frank J Snoek¹  Alette M Wessels²  Annette C Moll³  Petra JW Pouwels⁴  Frederik Barkhof⁵  Menno M Schoonheim⁶  Jeannette Boerop⁷  Nynke J van der Zijl⁷  Michaela Diamant⁷  Richard G IJzerman⁷  Eelco van Duinkerken⁸ 

[1] Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands;Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands;Eli Lilly and Company, Indianapolis, IN, USA;Department of Ophthalmology, VU University Medical Center, Amsterdam, The Netherlands;Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands;Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands;Department of Anatomy and Neuroscience, VU University Medical Center, Amsterdam, The Netherlands;Diabetes Center/Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117 – Room MF-G417, 1081 HV, Amsterdam, The Netherlands;Diabetes Center/Department of Internal Medicine, VU University Medical Center, De Boelelaan 1117 – Room MF-G417, 1081 HV, Amsterdam, The Netherlands;Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands;

关键词: Type 1 diabetes;    Cognition;    Subclinical macroangiopathy;    Microangiopathy;    Neuroimaging;    Cognition;   

DOI  :  10.1186/1475-2840-13-58

 received in 2014-01-14, accepted in 2014-03-07,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundType 1 diabetes mellitus (T1DM) is associated with cerebral compromise, typically found in patients with microangiopathy. Associations between subclinical macroangiopathy and the brain, whether or not in the presence of microangiopathy, have not been fully explored in T1DM. We hypothesized that subclinical macroangiopathy in adult T1DM may affect the brain and interacts with microangiopathy.MethodsIn 51 asymptomatic T1DM patients with, 53 without proliferative retinopathy and 51 controls, right common carotid artery ultrasound was used to assess intima media thickness (cIMT) and distensibility (cD). Neuropsychological tests for cognitive functions, and magnetic resonance imagining for white matter integrity and functional connectivity, i.e. neuronal communication, were used.ResultsAfter correction for confounders, cIMT was borderline significantly increased in all T1DM patients (P = 0.071), whereas cD was not statistically significantly altered (P = 0.45). Patients with proliferative retinopathy showed the largest increase in cIMT and decrease in cD. In all participants, after adjustment for confounders, increased cIMT was related to decreased white matter integrity (β = −0.198 P = 0.041) and decreased functional connectivity in visual areas (β = −0.195 P = 0.046). For cognition, there was a significant interaction between cIMT and the presence of proliferative retinopathy after adjustment for confounding factors (all P < 0.05). Increased cIMT was associated with lower general cognitive ability (β = −0.334; P = 0.018), information processing speed (β = −0.361; P = 0.010) and attention (β = −0.394; P = 0.005) scores in patients without, but not in patients with proliferative retinopathy.ConclusionsThese findings suggest that subclinical macroangiopathy may be a factor in the development of diabetes-related cognitive changes in uncomplicated T1DM, whereas in patients with advanced T1DM, proliferative retinopathy may rather be the driving force of cerebral compromise.

【 授权许可】

CC BY   
© van Duinkerken et al.; licensee BioMed Central Ltd. 2014