Diabetes mellitus and progression of vascular brain lesions and brain atrophy in patients with symptomatic atherosclerotic disease. The SMART-MR study

JOURNAL OF THE NEUROLOGICAL SCIENCES

卷:332

Article

Kooistra, Minke^1,4  Geerlings, Mirjam I.¹  Mali, Willem P. T. M.²  Vincken, Koen L.³  van der Graaf, Yolanda¹  Biessels, Geert Jan⁴ 

[1] UMC Utrecht, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands

[2] UMC Utrecht, Dept Radiol, NL-3508 GA Utrecht, Netherlands

[3] UMC Utrecht, Image Sci Inst, NL-3508 GA Utrecht, Netherlands

[4] UMC Utrecht, Rudolf Magnus Inst Neurosci, Dept Neurol, NL-3508 GA Utrecht, Netherlands

关键词: Diabetes mellitus;    Vascular disease;    White matter lesion;    Brain infarct;    Brain atrophy;    Cognitive decline;    Longitudinal;   

DOI  :  10.1016/j.jns.2013.06.019

来源: Elsevier

【 摘 要 】

Aim: Diabetes mellitus (DM) is associated with brain atrophy and vascular brain lesions. Cardiovascular disease is a key determinant in this association. We assessed whether DM increased the rate of progression of brain atrophy, vascular brain lesions, and cognitive decline in patients with symptomatic atherosclerotic disease. Methods: In 663 patients (58 +/- 10 years) from the SMART-MR study (n = 89 with DM), 1.5 T MRI and neuropsychological examination were performed at baseline and after 3.9 +/- 0.4 years follow-up. Results: Repeated measures ANCOVA (adjusted for age, sex, and vascular risk factors) showed that patients with DM had smaller total brain volume (mean differences as percentage of intracranial volume (ICV) [95% CI]: -1.36% [-1.81; -0.91]), smaller gray matter volume (-1.23% [-1.85; -0.61]), larger ventricular volume (0.32% [0.14; 0.49]), and larger white matter lesion volume (0.31% [0.09; 0.53]) than patients without DM. Patients with DM had accelerated increase in ventricular volume over time compared with patients without DM (mean differences ventricular volume as percentage of ICV: 032% [0.25; 0.39] vs. 0.17% [0.15; 0.19]; p-interaction DM x time < 0.01). Poisson regression showed that patients with DM had an increased risk for incident brain infarcts (relative risk [95% Cl]: 1.62 [1.04; 2.53]). Patients with and without DM had similar performance on cognition. Conclusions: DM on top of existing symptomatic atherosclerotic disease is associated with increased brain atrophy and vascular brain lesion load that proceed at a slightly higher rate than in patients without DM. (C) 2013 Elsevier B.V. All rights reserved.

【 授权许可】

Free