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Liu B, Wang Z, Lin L, Yang H, Gao F, Gong T, Edden RAE, Wang G. Brain GABA+ changes in primary hypothyroidism patients before and after levothyroxine treatment: A longitudinal magnetic resonance spectroscopy study. Neuroimage Clin 2020; 28:102473. [PMID: 33395967 PMCID: PMC7663215 DOI: 10.1016/j.nicl.2020.102473] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Increasing evidence indicates the involvement of the GABAergic system in the pathophysiology of hypothyroidism. We aimed to investigate longitudinal changes of brain GABA in primary hypothyroidism before and after levothyroxine (L-T4) treatment. MATERIAL AND METHODS In 18 patients with hypothyroidism, we used the MEGA-PRESS (Mescher-Garwood point-resolved spectroscopy) editing sequence to measure brain GABA levels from medial prefrontal cortex (mPFC) and posterior cingulate cortex (PCC) at baseline and after 6-months of L-T4 treatment. Sex- and age-matched healthy controls (n = 18) were scanned at baseline. Thyroid function and neuropsychological tests were also performed. RESULTS GABA signals were successfully quantified from all participants with fitting errors lower than 15%. GABA signal was labeled as GABA+ due to contamination from co-edited macromoleculars and homocarnosine. In hypothyroid patients, mean GABA+ was significantly lower in the mPFC region compared with controls (p = 0.031), and the mPFC GABA+ measurements were significantly correlated with depressive symptoms and memory function (r = -0.558, p = 0.016; r = 0.522, p = 0.026, respectively). After adequate L-T4 treatment, the mPFC GABA+ in hypothyroid patients increased to normal level, along with relieved neuropsychological impairments. CONCLUSION The study suggested the decrease of GABA+ may be an important neurobiological factor in the pathophysiology of hypothyroidism. Treatment of L-T4 may reverse the abnormal GABA+ and hypothyroidism-induced neuropsychiatric impairments, indicating the action mode of L-T4 in adjunctive treatment of affective disorders.
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Affiliation(s)
- Bo Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhensong Wang
- Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Liangjie Lin
- MSC Clinical & Technical Solutions, Philips Healthcare, Beijing, China
| | - Huan Yang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Fei Gao
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Tao Gong
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China
| | - Richard A E Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA; FM Kirby Center for Functional Brain Imaging, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Guangbin Wang
- Shandong Medical Imaging Research Institute, Shandong University, Jinan, China.
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Gunbey HP, Has AC, Aslan K, Saglam D, Avcı U, Sayıt AT, Incesu L. Microstructural white matter abnormalities in hypothyroidism evaluation with diffusion tensor imaging tract-based spatial statistical analysis. Radiol Med 2020; 126:283-290. [PMID: 32524282 DOI: 10.1007/s11547-020-01234-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/25/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Hypothyroidism is presented in a wide range from neuropsychiatric problems including depression, memory and cognitive disorders to poor motor coordination. Against the background of morphologic, functional and molecular changes on the white and grey matter of the brain, we aimed to investigate the effects of hypothyroidism on white matter (WM) integrity using tract-based spatial statistics (TBSS). METHODS Eighteen patients with hyperthyroidism and 14 age-sex-matched healthy control subjects were included in this study. TBSS was used in the diffusion tensor imaging study for whole-brain voxel wise analysis of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) of WM. RESULTS When compared to the control group, the whole brain TBSS revealed extensive reductions of FA in the supratentorial WM including corticospinal tract, posterior limb of the internal capsule (PLIC), uncinate fasciculus, inferior longitudinal fasciculus (p < 0.005). The ROI analyses showed RD increment of superior longitudinal fasciculus, AD decrement of cingulum (CIN), external capsule, PLIC and corpus callosum (CC) in patients with hypothyroidism (p < 0.005). Autoimmune and non-autoimmune hypothyroidism patient subgroups showed a significant difference in terms of hippocampus FA, CIN MD, CC MD, CC AD, CIN RD, SLF RD, CC RD (p < 0.005). CIN FA values showed a negative correlation with the Beck Depression Inventory (p = 0.007, r = - 852). CONCLUSIONS These preliminary results of TBSS analyses represented FA and AD decrement, and RD increment in several WM tracts and indicates the demyelination process underlying pathophysiology of clinical aspects of hypothyroidism.
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Affiliation(s)
- Hediye Pınar Gunbey
- Department of Radiology, University of Health Sciences Kartal Lutfi Kırdar Training and Research Hospital, 34890, Kartal/Istanbul, Turkey.
| | - Arzu Ceylan Has
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kerim Aslan
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Dilek Saglam
- Departmant of Radiology, University of Health Sciences Malatya Training and Research Hospital, Malatya, Turkey
| | - Ugur Avcı
- Department of Endocrinology, Recep Tayyip Erdogan University, Rize, Turkey
| | | | - Lutfi Incesu
- Department of Radiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey
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Li YM, Zhou HM, Xu XY, Shi HS. Research Progress in MRI of the Visual Pathway in Diabetic Retinopathy. Curr Med Sci 2018; 38:968-975. [DOI: 10.1007/s11596-018-1971-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 10/10/2018] [Indexed: 12/17/2022]
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El-Mewafy ZMH, Razek AAKA, El-Eshmawy MM, El-Eneen NRA, EL-Biaomy AAB. Magnetic resonance spectroscopy of the frontal region in patients with metabolic syndrome: correlation with anthropometric measurement. Pol J Radiol 2018; 83:e215-e219. [PMID: 30627238 PMCID: PMC6323604 DOI: 10.5114/pjr.2018.76024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 07/25/2017] [Indexed: 12/20/2022] Open
Abstract
PURPOSE To demonstrate 1H-MR spectroscopy of the frontal region in patients with metabolic syndrome and to correlate the metabolic ratios with anthropometric measurement. MATERIAL AND METHODS A prospective study was conducted upon 20 patients with metabolic syndrome (10 male, 10 female; mean age 52 years) and 20 age- and sex-matched volunteers. Patients were mild-moderate (n = 14) and marked and morbid obesity (n = 6). Patients and volunteers underwent 1H-MR spectroscopy of the frontal region. The Ch/Cr and NAA/Cr ratio were calculated and correlated with anthropometric measurement. RESULTS The Cho/Cr and NAA/Cr of patients with Mets (1.03 ± 0.08 and 1.62 ± 0.08) were significantly different (p = 0.001) to those of volunteers (0.78 ± 0 and 1.71 ± 0.61, respectively). The Cho/Cr and NAA/Cr cutoffs used to differentiate patients from volunteers were 0.89 and 1.77 with areas under the curve of 0.992 and 0.867 and accuracy of 97% and 93%, respectively. There was a significant difference in Cho/Cr and NAA/Cr between patients with marked-morbid obesity and moderate-mild obesity (p = 0.001 respectively). CONCLUSIONS We concluded that NAA/Cr and Cho/Cr ratios of the frontal region can differentiate patients with metabolic syndrome from volunteers and are well correlated with the anthropometric measurement.
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Wu GY, Zhang Q, Wu JL, Jing L, Tan Y, Qiu TC, Zhao J. Changes in cerebral metabolites in type 2 diabetes mellitus: A meta-analysis of proton magnetic resonance spectroscopy. J Clin Neurosci 2017; 45:9-13. [DOI: 10.1016/j.jocn.2017.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 06/19/2017] [Accepted: 07/11/2017] [Indexed: 01/09/2023]
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Li S, Wang X, Yang J, Lei H, Wang X, Xiang Y. Metabolic profile of visual cortex in diabetic rats measured with in vivo proton MRS. NMR IN BIOMEDICINE 2017; 30:e3783. [PMID: 28915340 DOI: 10.1002/nbm.3783] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 07/09/2017] [Accepted: 07/10/2017] [Indexed: 06/07/2023]
Abstract
The purpose of the present study was to characterize the metabolic profile of the visual cortex in streptozotocin-induced Type 1 diabetic rats by means of in vivo proton MRS. Several metabolite concentration ratios in the visual cortex were calculated. In addition, postmortem histologic analyses for retinal ganglion cell (RGC) loss, optic nerve injury and visual cortex alterations were monitored. The results showed that diabetes induced several changes in visual cortex metabolites, such as reduced N-acetylaspartate, glutamate, γ-aminobutyric acid, taurine and choline-containing compound levels. Nevertheless, myo-inositol levels increased significantly as compared with controls. Remarkable RGC loss and optic nerve degeneration were observed by morphological analysis. Moreover, the results showed significant neuronal loss and glial activation in the visual cortex. These findings indicated that, besides vascular abnormalities, neuronal loss and degeneration in the visual pathway were induced due to disrupted glucose homeostasis in diabetes. Metabolic or functional abnormalities were induced in cerebral neurons of the visual cortex by diabetes.
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Affiliation(s)
- Shuang Li
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xinghua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Junjie Yang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hao Lei
- National Center for Magnetic Resonance in Wuhan, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Xuxia Wang
- National Center for Magnetic Resonance in Wuhan, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, Wuhan Institute of Physics and Mathematics, Chinese Academy of Sciences, Wuhan, 430071, China
| | - Yi Xiang
- Department of Ophthalmology, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
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Liu B, Yang H, Gao F, Wang Q, Zhao B, Gong T, Wang Z, Chen W, Wang G, Edden RA. Investigation of brain GABA+ in primary hypothyroidism using edited proton MR spectroscopy. Clin Endocrinol (Oxf) 2017; 86:256-262. [PMID: 27581339 PMCID: PMC5512100 DOI: 10.1111/cen.13177] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/17/2016] [Accepted: 08/30/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Evidence indicates that thyroid hormones have effects on the inhibitory GABAergic system. The aim of this study was to investigate whether brain GABA levels are altered in patients with hypothyroidism compared with healthy controls. DESIGN/METHODS Fifteen patients with primary hypothyroidism and 15 matched healthy controls underwent single-voxel MEGA-PRESS magnetic resonance spectroscopy at 3T, to quantify GABA levels in the median prefrontal cortex (mPFC) and posterior cingulate cortex (PCC). All participants underwent thyroid function test. Neuropsychological performances were evaluated by administration of the Montreal Cognitive Assessment (MoCA) and the 21-item Beck Depression Inventory-II (BDI-II). RESULTS The patients with hypothyroidism had significantly lower GABA+ levels in the mPFC compared with healthy controls (P = 0·016), whereas no significant difference (P = 0·214) was observed in the PCC. Exploratory analyses revealed that mPFC GABA+ levels were negatively correlated with the BDI-II scores in patient group (r = -0·60, P = 0·018). No correlations were found between GABA+ levels and TSH or fT3 or fT4 levels in either region (all P > 0·05). CONCLUSION This study suggests that alteration of GABAergic neurotransmission may play an important role in the pathophysiology of primary hypothyroidism, providing intriguing neurochemical clues to understand thyroid-brain interactions.
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Affiliation(s)
- Bo Liu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Huan Yang
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Fei Gao
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Bin Zhao
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Tao Gong
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Zhensong Wang
- Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | | | - Guangbin Wang
- Shandong Medical Imaging Research Institute affiliated to Shandong University, Jinan, China
| | - Richard A.E. Edden
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Singh S, Rana P, Kumar P, Shankar LR, Khushu S. Hippocampal Neurometabolite Changes in Hypothyroidism: An In Vivo (1) H Magnetic Resonance Spectroscopy Study Before and After Thyroxine Treatment. J Neuroendocrinol 2016; 28. [PMID: 27203419 DOI: 10.1111/jne.12399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 05/17/2016] [Accepted: 05/17/2016] [Indexed: 11/28/2022]
Abstract
The hippocampus is a thyroid hormone receptor-rich region of the brain. A change in thyroid hormone levels may be responsible for an alteration in hippocampal-associated function, such as learning, memory and attention. Neuroimaging studies have shown functional and structural changes in the hippocampus as a result of hypothyroidism. However, the underlying process responsible for this dysfunction remains unclear. Therefore, the present study aimed to investigate the metabolic changes in the brain of adult hypothyroid patients during pre- and post-thyroxine treatment using in vivo proton magnetic resonance spectroscopy ((1) H MRS). (1) H MRS was performed in both healthy control subjects (n = 15) and hypothyroid patients (n = 15) (before and after thyroxine treatment). The relative ratios of the neurometabolites were calculated using the linear combination model (LCModel). Our results revealed a significant decrease of glutamate (Glu) (P = 0.045) and myo-inositol (mI) (P = 0.002) levels in the hippocampus of hypothyroid patients compared to controls. No significant changes in metabolite ratios were observed in the hypothyroid patients after thyroxine treatment. The findings of the present study reveal decreased Glu/tCr and mI/tCr ratios in the hippocampus of hypothyroid patients and these metabolite alterations persisted even after the patients became clinically euthyroid subsequent to thyroxine treatment.
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Affiliation(s)
- S Singh
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), Delhi, India
| | - P Rana
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), Delhi, India
| | - P Kumar
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), Delhi, India
| | - L R Shankar
- Thyroid Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), Delhi, India
| | - S Khushu
- NMR Research Centre, Institute of Nuclear Medicine and Allied Sciences (INMAS), Delhi, India.
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Correlation Between the Reduction in Lenticulostriate Arteries Caused by Hypertension and Changes in Brain Metabolism Detected With MRI. AJR Am J Roentgenol 2016; 206:395-400. [PMID: 26797370 DOI: 10.2214/ajr.15.14514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Hypertension can alter the vascular structure, mechanics, and function of small arteries and arterioles. It remains unknown whether microvascular changes are associated with brain metabolism. The purpose of this study was to analyze the correlation between the reduction in small arteries and changes in brain metabolism in patients with hypertension. SUBJECTS AND METHODS The study population comprised 50 patients with hypertension and 50 volunteers without hypertension. The two groups underwent 3-T 3D time-of-flight MR angiography, and the numbers of lenticulostriate arteries (LSAs) were determined for both groups. Single-voxel proton MR spectroscopic data on the basal ganglia regions were also acquired. The ratios of N-acetylaspartate to creatine (NAA/Cr), myo-inositol to creatine (Mi/Cr), and choline to creatine (Cho/Cr) were measured. Statistical analysis was performed to evaluate the differences between the two groups with respect to metabolite ratios. RESULTS The average total number of LSA stems on both sides in patients with hypertension was 5.12 ± 0.98 compared with 6.10 ± 0.95 in volunteers without hypertension (p < 0.0001). The NAA/Cr ratio decreased according to a reduction in the number of LSAs in the hypertension group, which was significantly reduced when the number of LSAs was 3 or fewer. CONCLUSION Hypertension can lead to a statistically significant reduction in NAA/Cr ratio in the basal ganglia regions when the number of LSAs decreases to a certain extent. Reduced numbers of LSAs correlated with brain metabolism changes caused by hypertension, which can provide important insights for understanding the pathophysiologic mechanism of hypertension and may be valuable in evaluating this disease.
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Region-specific cerebral metabolic alterations in streptozotocin-induced type 1 diabetic rats: an in vivo proton magnetic resonance spectroscopy study. J Cereb Blood Flow Metab 2015; 35:1738-45. [PMID: 26036938 PMCID: PMC4635228 DOI: 10.1038/jcbfm.2015.111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 04/01/2015] [Accepted: 05/06/2015] [Indexed: 12/26/2022]
Abstract
Clinical and experimental in vivo (1)H-magnetic resonance spectroscopy ((1)H-MRS) studies have demonstrated that type 1 diabetes mellitus (T1DM) is associated with cerebral metabolic abnormalities. However, less is known whether T1DM induces different metabolic disturbances in different brain regions. In this study, in vivo (1)H-MRS was used to measure metabolic alterations in the visual cortex, striatum, and hippocampus of streptozotocin (STZ)-induced uncontrolled T1DM rats at 4 days and 4 weeks after induction. It was observed that altered neuronal metabolism occurred in STZ-treated rats as early as 4 days after induction. At 4 weeks, T1DM-related metabolic disturbances were clearly region specific. The diabetic visual cortex had more or less normal-appearing metabolic profile; while the striatum and hippocampus showed similar abnormalities in neuronal metabolism involving N-acetyl aspartate and glutamate; but only the hippocampus exhibited significant changes in glial markers such as taurine and myo-inositol. It is concluded that cerebral metabolic perturbations in STZ-induced T1DM rats are region specific at 4 weeks after induction, perhaps as a manifestation of varied vulnerability among the brain regions to sustained hyperglycemia.
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Wang Y, Xu XY, Feng CH, Li YL, Ge X, Zong GL, Wang YB, Feng B, Zhang P. Patients with type 2 diabetes exhibit cognitive impairment with changes of metabolite concentration in the left hippocampus. Metab Brain Dis 2015; 30:1027-34. [PMID: 25875132 PMCID: PMC4491369 DOI: 10.1007/s11011-015-9670-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 04/07/2015] [Indexed: 11/26/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is associated with cognitive dysfunction. Previous studies have reported the relationship between cerebral metabolite changes and glucose levels. However, the specific aspects of cognition that are affected by metabolic changes in T2DM- related cognitive impairment remain undetermined. In this study, 188 T2DM patients and 266 controls were recruited. Proton magnetic resonance spectra with a single voxel stimulated echo acquisition mode (STEAM) were acquired from the left hippocampus and the frontal lobe. Presence of T2DM negatively affected the scores of Mini-Mental State Examination (MMSE), sub-tests (i.e., attention and language) of MMSE, Montreal Cognitive Assessment (MoCA) according to the Beijing version, and sub-tests (i.e., visuospatial/executive reasoning, attention, and language) of MoCA, rather than the Wechsler Memory Scale - Revised in China (WMS-RC), and all memory sub-tests contained with the MMSE and MoCA frameworks. T2DM positively affected creatine and myoinositol peak areas from the left hippocampus, rather than metabolites in the left frontal lobe. Negative correlations were shown between the left hippocampal myoinositol levels and language scores, and between the left hippocampal creatine levels and visuospatial/executive scores in T2DM. These findings suggest that T2DM may be an independent risk factor for cognitive impairment. Further, the cognitive domains of visuospatial /executive reasoning, attention and language may be predominantly impaired in the early phases of T2DM-related cognitive impairment. In addition, left hippocampal myoinositol and creatine concentrations were associated with cognitive impairment in patients with T2DM.
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Affiliation(s)
- Yue Wang
- />Department of Neurology, East Hospital, Tongji University, Shanghai, China
| | - Xiao-yun Xu
- />Department of Neurology, Pudong New Area Zhoupu Hospital, Shanghai, China
| | - Chun-hua Feng
- />Department of Neurology, East Hospital, Tongji University, Shanghai, China
| | - Yuan-ling Li
- />Department of Neurology, East Hospital, Tongji University, Shanghai, China
| | - Xia Ge
- />Department of Neurology, East Hospital, Tongji University, Shanghai, China
| | - Gen-lin Zong
- />Department of Radiology, East Hospital, Tongji University, Shanghai, China
| | - Yi-bin Wang
- />Department of Radiology, East Hospital, Tongji University, Shanghai, China
| | - Bo Feng
- />Department of Endocrinology, East Hospital, Tongji University, Shanghai, China
| | - Peng Zhang
- />Shanghai Pudong New Area Center for Disease Control & Prevention, Shanghai, China
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Brundel M, Kappelle LJ, Biessels GJ. Brain imaging in type 2 diabetes. Eur Neuropsychopharmacol 2014; 24:1967-81. [PMID: 24726582 DOI: 10.1016/j.euroneuro.2014.01.023] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 01/23/2014] [Indexed: 02/08/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is associated with cognitive dysfunction and dementia. Brain imaging may provide important clues about underlying processes. This review focuses on the relationship between T2DM and brain abnormalities assessed with different imaging techniques: both structural and functional magnetic resonance imaging (MRI), including diffusion tensor imaging and magnetic resonance spectroscopy, as well as positron emission tomography and single-photon emission computed tomography. Compared to people without diabetes, people with T2DM show slightly more global brain atrophy, which increases gradually over time compared with normal aging. Moreover, vascular lesions are seen more often, particularly lacunar infarcts. The association between T2DM and white matter hyperintensities and microbleeds is less clear. T2DM has been related to diminished cerebral blood flow and cerebrovascular reactivity, particularly in more advanced disease. Diffusion tensor imaging is a promising technique with respect to subtle white matter involvement. Thus, brain imaging studies show that T2DM is associated with both degenerative and vascular brain damage, which develops slowly over the course of many years. The challenge for future studies will be to further unravel the etiology of brain damage in T2DM, and to identify subgroups of patients that will develop distinct progressive brain damage and cognitive decline.
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Affiliation(s)
- Manon Brundel
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands.
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands
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Lee JH, Choi Y, Jun C, Hong YS, Cho HB, Kim JE, Lyoo IK. Neurocognitive changes and their neural correlates in patients with type 2 diabetes mellitus. Endocrinol Metab (Seoul) 2014; 29:112-21. [PMID: 25031883 PMCID: PMC4091490 DOI: 10.3803/enm.2014.29.2.112] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
As the prevalence and life expectancy of type 2 diabetes mellitus (T2DM) continue to increase, the importance of effective detection and intervention for the complications of T2DM, especially neurocognitive complications including cognitive dysfunction and dementia, is receiving greater attention. T2DM is thought to influence cognitive function through an as yet unclear mechanism that involves multiple factors such as hyperglycemia, hypoglycemia, and vascular disease. Recent developments in neuroimaging methods have led to the identification of potential neural correlates of T2DM-related neurocognitive changes, which extend from structural to functional and metabolite alterations in the brain. The evidence indicates various changes in the T2DM brain, including global and regional atrophy, white matter hyperintensity, altered functional connectivity, and changes in neurometabolite levels. Continued neuroimaging research is expected to further elucidate the underpinnings of cognitive decline in T2DM and allow better diagnosis and treatment of the condition.
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Affiliation(s)
- Junghyun H Lee
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
- Ewha Brain Institute, Ewha Womans University, Seoul, Korea
| | - Yera Choi
- Ewha Brain Institute, Ewha Womans University, Seoul, Korea
- Interdisciplinary Program in Neuroscience, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Chansoo Jun
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
- Ewha Brain Institute, Ewha Womans University, Seoul, Korea
| | - Young Sun Hong
- Ewha Brain Institute, Ewha Womans University, Seoul, Korea
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Han Byul Cho
- Ewha Brain Institute, Ewha Womans University, Seoul, Korea
- Interdisciplinary Program in Neuroscience, Seoul National University College of Natural Sciences, Seoul, Korea
| | - Jieun E Kim
- Ewha Brain Institute, Ewha Womans University, Seoul, Korea
- Department of Brain and Cognitive Sciences, Ewha Womans University Graduate School, Seoul, Korea
| | - In Kyoon Lyoo
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Korea
- Ewha Brain Institute, Ewha Womans University, Seoul, Korea
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Tong J, Geng H, Zhang Z, Zhu X, Meng Q, Sun X, Zhang M, Qian R, Sun L, Liang Q. Brain metabolite alterations demonstrated by proton magnetic resonance spectroscopy in diabetic patients with retinopathy. Magn Reson Imaging 2014; 32:1037-42. [PMID: 24985566 DOI: 10.1016/j.mri.2014.04.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 04/25/2014] [Accepted: 04/27/2014] [Indexed: 01/06/2023]
Abstract
Due to the homology between retinal and cerebral microvasculatures, retinopathy is a putative indicator of cerebrovascular dysfunction. This study aimed to detect metabolite changes of brain tissue in type 2 diabetes mellitus (T2DM) patients with diabetic retinopathy (DR) using proton magnetic resonance spectroscopy ((1)H-MRS). Twenty-nine T2DM patients with DR (DR group), thirty T2DM patients without DR (DM group) and thirty normal controls (NC group) were involved in this study. Single-voxel (1)H-MRS (TR: 2000ms, TE: 30ms) was performed at 3.0T MRI/MRS imager in cerebral left frontal white matter, left lenticular nucleus, and left optic radiation. Our data showed that NAA/Cr ratios of the DR group were significantly lower than those of the DM group in the frontal white matter and optic radiation. In the lenticular nucleus, MI/Cr ratios were significantly higher in the DM group than those in the NC group, while MI/Cr ratios were significantly lower in the DR group than those in the DM group. In the frontal white matter, NAA/Cho ratios were found to be decreased in the DR group as compared to the NC group. Additionally, our finding indicated that NAA/Cr ratios were negatively associated with DR severity in both the frontal white matter and optic radiation. A decrease in NAA indicated neuronal loss and the likely explanation for a decrease in MI was glial loss. In conclusion, we inferred that cerebral neurons and glia cells were damaged in patients with DR. Our data support that DR is associated with brain tissue damage.
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Affiliation(s)
- Jia Tong
- Shandong University, Shandong, 250100, China
| | - Houfa Geng
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Shandong, 272029, China
| | - Zhengjun Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Shandong, 272029, China
| | - Xuelei Zhu
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Shandong, 272029, China
| | - Qiang Meng
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Shandong, 272029, China
| | - Xinhai Sun
- Department of Magnetic Resonance Imaging, Affiliated Hospital of Jining Medical University, Shandong, 272029, China
| | - Min Zhang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Shandong, 272029, China
| | - Ruikun Qian
- Shandong Academy of Medical Sciences, Shandong, 250001, China
| | - Lin Sun
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Shandong, 272029, China.
| | - Qiuhua Liang
- Department of Endocrinology, Affiliated Hospital of Jining Medical University, Shandong, 272029, China.
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15
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Kratochvílová S, Skoch A, Dezortová M, Svehlíková E, Hill M, Brunová J, Hájek M, Pelikánová T. Effect of acute hyperinsulinemia on brain metabolism evaluated by 1H MR spectroscopy--a pilot study. Physiol Res 2014; 63:513-9. [PMID: 24702495 DOI: 10.33549/physiolres.932505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To determine whether acutely-induced supraphysiological hyperinsulinemia influences brain metabolism in patients with type 1 diabetes (D) and healthy controls (C) as detected by MR Spectroscopy. Group D consisted of 4 patients with the average duration of diabetes for 7 years. They were matched according to age, sex and BMI to 4 healthy controls. 1H MR Spectroscopy was performed with a 1.5 Tesla. Spectra were obtained from parietooccipital white matter repeatedly during a 3-h hyperinsulinemic euglycemic clamp with 2 mU.kg(-1).min(-1). In group D, significantly lower basal concentrations of N-acetylaspartate (p=0.02), choline (p=0.03), creatine (p=0.002) and inositol (p=0.007) were detected compared to C. After the induction of hyperinsulinemia, concentrations of choline, creatine, GABA, inositol, lactate, NAA and composite signal glutamate + glutamine (Glx) stayed stable. The detection of glucose signal is less realiable at 1.5 Tesla but we registered the alteration in glucose concentration (p=0.003) in the whole group. Originally sightly elevated glucose concentration in D decreased on the contrary to the increase of originally lower glucose level in C. In conclusions, brain metabolism was altered in D. Short term supraphysiological euglycemic hyperinsulinemia induced changes in the concentration of brain glucose in both C and D.
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Affiliation(s)
- S Kratochvílová
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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16
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Yau PL, Kluger A, Borod JC, Convit A. Neural substrates of verbal memory impairments in adults with type 2 diabetes mellitus. J Clin Exp Neuropsychol 2014; 36:74-87. [PMID: 24417611 DOI: 10.1080/13803395.2013.869310] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Verbal memory impairment is well documented in type 2 diabetes mellitus (T2DM) but, to date, the neural substrates remain unclear. The present study evaluated verbal memory and ascertained the degree of frontal and temporal lobe involvement in the anticipated verbal memory impairment among adults with T2DM. METHOD Forty-six late-middle-aged and elderly adults with T2DM and 50 age-, sex-, and education-matched adults without T2DM underwent medical evaluation, verbal memory assessment, and brain magnetic resonance imaging (MRI) evaluations. RESULTS As anticipated, participants with T2DM had clear verbal memory impairments. Consistent with prior reports, we found volume reductions restricted to the hippocampus. Our diffusion tensor imaging analysis revealed that participants with T2DM had extensive cerebral gray and white matter microstructural abnormalities predominantly in the left hemisphere, with a larger concentration present in the temporal lobe. In contrast, we uncovered mostly nonspecific microstructural abnormalities in the absence of tissue loss in the frontal lobe. Of great importance, we present the first evidence among participants with T2DM linking verbal memory impairment and compromised microstructural integrity of the left parahippocampal gyrus, a key memory-relevant structure. CONCLUSIONS Our results suggest that the hippocampus and parahippocampal gyrus may be particularly vulnerable to the deleterious effects of T2DM. The parahippocampal gyrus in particular may play a crucial role in the verbal memory impairments frequently reported in T2DM. Future studies should employ methods such as resting state functional magnetic resonance imaging and diffusion tensor imaging tractography to better characterize network connectivity, which may help further characterize the verbal memory impairment frequently reported in T2DM.
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Affiliation(s)
- Po Lai Yau
- a Department of Psychiatry , New York University School of Medicine , New York , NY , USA
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Lin Y, Zhou J, Sha L, Li Y, Qu X, Liu L, Chen H, An Z, Wang Y, Sun C. Metabolite differences in the lenticular nucleus in type 2 diabetes mellitus shown by proton MR spectroscopy. AJNR Am J Neuroradiol 2013; 34:1692-6. [PMID: 23598834 DOI: 10.3174/ajnr.a3492] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE Previous studies by using proton MR spectroscopy found metabolite abnormalities in the cerebral cortex and white matter of patients with type 2 diabetes mellitus. The present study was undertaken to detect metabolite differences in the lenticular nuclei and thalamus in patients with T2DM. MATERIALS AND METHODS Twenty subjects with T2DM and 22 age-matched control subjects underwent single-voxel MR spectroscopy in the left and right lenticular nuclei and left and right thalami. NAA/Cr and Cho/Cr ratios were calculated. Brain lactic acid, fasting blood glucose, and glycosylated hemoglobin levels were also monitored. RESULTS The NAA/Cr ratio was lower in the left lenticular nuclei of subjects with T2DM (P = .007), whereas the Cho/Cr ratio was increased in both the and right lenticular nuclei (P = .001). The NAA/Cr ratio was negatively correlated with FBG in the left (r = -0.573, P = .008) and right nuclei (r = -0.564, P = .010). It was also negatively correlated to HbA1c in the left (r = -0.560, P = .010) and right (r = -0.453, P = .045) nuclei. The Cho/Cr ratio was positively correlated with these variables (P < .05). No significant differences in NAA/Cr or Cho/Cr ratios were observed in the thalamus of patients with T2DM. Lactic acid was not detected in any of the patients in the study. CONCLUSIONS The different metabolic statuses of the lenticular nuclei and thalamus suggest different effects of T2DM in each of these brain nuclei, with the lenticular nuclei being more vulnerable than the thalamus. The abnormal metabolic status was observed before lesions had appeared in these brain areas.
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Tiehuis A, van der Meer F, Mali W, Pleizier M, Biessels GJ, Kappelle J, Luijten P. MR spectroscopy of cerebral white matter in type 2 diabetes; no association with clinical variables and cognitive performance. Neuroradiology 2009; 52:155-61. [DOI: 10.1007/s00234-009-0598-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 09/09/2009] [Indexed: 10/20/2022]
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