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Yoon S, Kim J, Musen G, Renshaw PF, Hwang J, Bolo NR, Kim JE, Simonson DC, Weinger K, Ryan CM, Lyoo IK, Jacobson AM. Prefronto-temporal white matter microstructural alterations 20 years after the diagnosis of type 1 diabetes mellitus. Pediatr Diabetes 2018; 19:478-485. [PMID: 28929564 PMCID: PMC5860922 DOI: 10.1111/pedi.12574] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/05/2017] [Accepted: 08/06/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Microvascular pathophysiology that uniquely manifests as white matter (WM) abnormalities is often implicated in type 1 diabetes mellitus (T1DM)-related central nervous system (CNS) complications. This study sought to identify regional WM abnormalities in young adults diagnosed with T1DM and further examine their association with cognitive and emotional dysfunction. RESEARCH DESIGN AND METHODS Diffusion tensor images (DTI) obtained from 34 young adults with T1DM for ≥15 years (mean duration, 20.9 years), and 16 age- and sex-matched healthy control subjects were analyzed using tract-based spatial statistics. Fractional anisotropy (FA) values of the whole brain were analyzed, and their associations with memory function and depressive symptoms were assessed. RESULTS Whole brain voxel-wise analyses showed that T1DM-related FA reductions were most prominent within the fronto-temporo-parietal regions of the brain. Reduced FA values in the bilateral superior longitudinal fasciculi, at which group differences were most prominent, correlated with lower working memory performance in young adults with T1DM (left, P < .001; right, P = .009). Subsyndromal depressive symptoms were also associated with lower FA values in the right inferior fronto-occipital fasciculus (P = .004). CONCLUSION Widespread WM microstructural abnormalities in the fronto-temporo-parietal brain regions, which are associated with emotional and cognitive dysfunction, may be a contributing factor to the neural mechanisms underlying T1DM-related CNS complications, thus affecting the quality of life in young adults with T1DM.
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Affiliation(s)
- Sujung Yoon
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Jungyoon Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Gail Musen
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Research Division, Joslin Diabetes Center, Boston, MA, USA
| | - Perry F Renshaw
- The Brain Institute and the Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Jaeuk Hwang
- Department of Psychiatry, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Nicolas R Bolo
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jieun E. Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea
| | - Donald C Simonson
- Department of Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
| | - Katie Weinger
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA,Research Division, Joslin Diabetes Center, Boston, MA, USA
| | - Christopher M Ryan
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - In Kyoon Lyoo
- Ewha Brain Institute, Ewha Womans University, Seoul, South Korea,Department of Brain and Cognitive Sciences, Ewha Womans University, Seoul, South Korea,College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, South Korea
| | - Alan M Jacobson
- Research Division, Joslin Diabetes Center, Boston, MA, USA,Research Institute, Winthrop University Hospital, Mineola, NY, USA
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Guàrdia-Olmos J, Gallardo-Moreno GB, Gudayol-Ferré E, Peró-Cebollero M, González-Garrido AA. Effect of verbal task complexity in a working memory paradigm in patients with type 1 diabetes. A fMRI study. PLoS One 2017; 12:e0178172. [PMID: 28582399 PMCID: PMC5459425 DOI: 10.1371/journal.pone.0178172] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 05/08/2017] [Indexed: 12/12/2022] Open
Abstract
Type 1 diabetes (T1D) is commonly diagnosed in childhood and adolescence, and the developing brain has to cope with its deleterious effects. Although brain adaptation to the disease may not result in evident cognitive dysfunction, the effects of T1D on neurodevelopment could alter the pattern of BOLD fMRI activation. The aim of this study was to explore the neural BOLD activation pattern in patients with T1D versus that of healthy matched controls while performing two visuospatial working memory tasks, which included a pair of assignments administered through a block design. In the first task (condition A), the subjects were shown a trial sequence of 3 or 4 white squares positioned pseudorandomly around a fixation point on a black background. After a fixed delay, a second corresponding sequence of 3 or 4 red squares was shown that either resembled (direct, 50%) or differed from (50%) the previous stimulation order. The subjects were required to press one button if the two spatial sequences were identical or a second button if they were not. In condition B, the participants had to determine whether the second sequence of red squares appeared in inverse order (inverse, 50%) or not (50%) and respond by pressing a button. If the latter sequence followed an order distinct from the inverse sequence, the subjects were instructed to press a different button. Sixteen patients with normal IQ and without diabetes complications and 16 healthy control subjects participated in the study. In the behavioral analysis, there were no significant differences between the groups in the pure visuo-spatial task, but the patients with diabetes exhibited poorer performance in the task with verbal stimuli (p < .001). However, fMRI analyses revealed that the patients with T1D showed significantly increased activation in the prefrontal inferior cortex, subcortical regions and the cerebellum (in general p < .001). These different activation patterns could be due to adaptive compensation mechanisms that are devoted to improving efficiency while solving more complex cognitive tasks.
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Affiliation(s)
- Joan Guàrdia-Olmos
- Facultat de Psicologia, Universitat de Barcelona, Institut de Neurociències. Institute of Complex Systems (UBICS), Passeig de la Vall d’Hebron 171, Barcelona, Spain
| | - Geisa B. Gallardo-Moreno
- Instituto de Neurociencias, Universidad de Guadalajara, Francisco de Quevedo 180, Colonia Arcos Vallarta, Guadalajara, Jalisco, Mexico
| | - Esteve Gudayol-Ferré
- Facultad de Psicología, Universidad Michoacana de San Nicolás de Hidalgo, Morelia, Michoacán, Mexico
| | - Maribel Peró-Cebollero
- Facultat de Psicologia, Universitat de Barcelona, Institut de Neurociències. Institute of Complex Systems (UBICS), Passeig de la Vall d’Hebron 171, Barcelona, Spain
| | - Andrés A. González-Garrido
- Instituto de Neurociencias, Universidad de Guadalajara, Francisco de Quevedo 180, Colonia Arcos Vallarta, Guadalajara, Jalisco, Mexico
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Gallardo-Moreno GB, González-Garrido AA, Gudayol-Ferré E, Guàrdia-Olmos J. Type 1 Diabetes Modifies Brain Activation in Young Patients While Performing Visuospatial Working Memory Tasks. J Diabetes Res 2015; 2015:703512. [PMID: 26266268 PMCID: PMC4525461 DOI: 10.1155/2015/703512] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 06/30/2015] [Accepted: 07/01/2015] [Indexed: 12/23/2022] Open
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.
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Affiliation(s)
- Geisa B. Gallardo-Moreno
- Instituto de Neurociencias, Universidad de Guadalajara, Francisco de Quevedo 180, Colonia Arcos Vallarta, 44130 Guadalajara, JAL, Mexico
- *Geisa B. Gallardo-Moreno:
| | - Andrés A. González-Garrido
- Instituto de Neurociencias, Universidad de Guadalajara, Francisco de Quevedo 180, Colonia Arcos Vallarta, 44130 Guadalajara, JAL, Mexico
| | - Esteban Gudayol-Ferré
- Facultad de Psicología, Universidad Michoacana de San Nicolás de Hidalgo, Francisco Villa 450, 58120 Morelia, MICH, Mexico
| | - Joan Guàrdia-Olmos
- Facultat de Psicologia, Universitat de Barcelona, Institut de Recerca en Cervell, Cognició i Conducta (IR3C), Passeig de la Vall d'Hebron 171, 08035 Barcelona, Spain
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Tonoli C, Heyman E, Roelands B, Pattyn N, Buyse L, Piacentini MF, Berthoin S, Meeusen R. Type 1 diabetes-associated cognitive decline: a meta-analysis and update of the current literature. J Diabetes 2014; 6:499-513. [PMID: 25042689 DOI: 10.1111/1753-0407.12193] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 05/07/2014] [Accepted: 06/29/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) can have a significant impact on brain structure and function, which is referred to as T1D-associated cognitive decline (T1DACD). Diabetes duration, early onset disease, and diabetes-associated complications are all proposed as factors contributing to T1DACD. However, there have been no comparisons in T1DACD between children and adults with T1D. To obtain a better insight into the occurrence and effects of T1DACD in T1D, the aim of the present meta-analysis was to investigate differences between children and adults and to analyse factors contributing T1DACD. METHODS Two electronic databases were consulted: PubMed and ISI Web of Knowledge. Literature published up until the end of 2013 was included in the analysis. Effect sizes (Cohen's d), which are standardized differences between experimental and control groups, were calculated. RESULTS There was a small to modest decrease in cognitive performance in T1D patients compared with non-diabetic controls. Children with T1D performed worse while testing for executive function, full intelligence quotient (IQ), and motor speed, whereas adults with T1D performed worse while testing the full, verbal and performance IQ, part of the executive function, memory, spatial memory, and motor speed. Episodes of severe hypoglycemia, chronic hyperglycemia, and age of onset can be significant factors influencing cognitive function in T1D. CONCLUSIONS The findings in the literature suggest that T1DACD is more severe in adults than children, indicating that age and diabetes duration contribute to this T1DACD.
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Affiliation(s)
- Cajsa Tonoli
- Department of Human Physiology and Sports Medicine, Faculty of Physical Education and Physical Therapy, Vrije Universiteit Brussel, Brussels, Belgium; Department EA4488, Physical Activity, Muscle, Health, University Lille Nord de France, Lille, France
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Bryan RN, Bilello M, Davatzikos C, Lazar RM, Murray A, Horowitz K, Lovato J, Miller ME, Williamson J, Launer LJ. Effect of diabetes on brain structure: the action to control cardiovascular risk in diabetes MR imaging baseline data. Radiology 2014; 272:210-6. [PMID: 24779562 PMCID: PMC4263658 DOI: 10.1148/radiol.14131494] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To investigate the association of characteristics of type 2 diabetes mellitus (duration and biochemical severity of diabetes) to brain structure measured on magnetic resonance (MR) images, specifically testing whether more severity in metrics of diabetes is inversely correlated with brain volumes and positively correlated with ischemic lesion volumes. MATERIALS AND METHODS This study protocol was approved by the institutional review board of each center and participants provided written informed consent. Baseline severity of diabetes was evaluated by testing fasting plasma glucose levels, hemoglobin A1c levels, and duration of diabetes. MR imaging was performed with fluid-attenuated inversion recovery, proton-density, T2-weighted, and T1-weighted sequences, which were postprocessed with an automated computer algorithm that classified brain tissue as gray or white matter and as normal or ischemic. Separate linear regression models adjusted for potential confounding factors were used to investigate the relationship of the diabetes measures to MR imaging outcomes in 614 participants (mean age, 62 years; mean duration of type 2 diabetes mellitus, 9.9 years). RESULTS The mean volumes of total gray matter (463.9 cm(3)) and total white matter (463.6 cm(3)) were similar. The mean volume of abnormal tissue was 2.5 cm(3), mostly in the white matter (81% white matter, 5% gray matter, 14% deep gray and white matter). Longer duration of diabetes and higher fasting plasma glucose level were associated with lower normal (β = -0.431 and -0.053, respectively; P < .01) and total gray matter volumes (β = -0.428 and -0.053, respectively; P < .01). Fasting plasma glucose was also inversely correlated with ischemic lesion volume (β = -0.006; P < .04). Hemoglobin A1c level was not associated with any MR imaging measure. CONCLUSION Longer duration of diabetes is associated with brain volume loss, particularly in the gray matter, possibly reflecting direct neurologic insult; biochemical measures of glycemia were less consistently related to MR imaging changes. Contrary to common clinical belief, in this sample of patients with type 2 diabetes mellitus, there was no association of diabetes characteristics with small vessel ischemic disease in the brain.
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Affiliation(s)
- R. Nick Bryan
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Michel Bilello
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Christos Davatzikos
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Ronald M. Lazar
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Anne Murray
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Karen Horowitz
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - James Lovato
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Michael E. Miller
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Jeff Williamson
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
| | - Lenore J. Launer
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (R.N.B., M.B., C.D.); Department of Radiology, Columbia University, New York, NY (R.M.L.); Department of Radiology, Hennepin County Medical Center, Minneapolis, Minn (A.M.); Department of Radiology, Case Western Reserve University, Cleveland, Ohio (K.H.); Department of Radiology, Wake Forest University, Winston-Salem, NC (J.L., M.E.M., J.W.); and National Institute on Aging, Bethesda, Md (L.J.L.)
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