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Malucelli A, Skoch A, Ostry S, Tomek A, Urbanova B, Martinkovic L, Buksakowska I, Mohapl M, Netuka D, Hort J, Sroubek J, Vrana J, Moravec T, Bartos R, Sames M, Hajek M, Horinek D. Magnetic resonance markers of bilateral neuronal metabolic dysfunction in patients with unilateral internal carotid artery occlusion. MAGMA (NEW YORK, N.Y.) 2021; 34:141-151. [PMID: 32594274 DOI: 10.1007/s10334-020-00864-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To evaluate cerebral hemodynamic, metabolic and anatomic changes occurring in patients with unilateral occlusion of the internal carotid artery (ICA). MATERIALS AND METHODS Twenty-two patients with unilateral occlusion of ICA and twenty age and sex matched healthy subjects were included in the study. Single voxel proton magnetic resonance spectroscopy (1H-MRS) of the centrum semiovale, semi-automated hippocampal volumetry in T1-weighted scans and transcranial Doppler examination (TCD) with calculation of Breath Holding Index (BHI) were performed in both groups. Metabolic, anatomic, and hemodynamic features were compared between the two groups. RESULTS The N-acetylaspartate (NAA)/choline (Cho) ratio was significantly lower in both hemispheres of enrolled patients compared to controls (p = 0.005 for the side with occlusion, p = 0.04 for the side without occlusion). The hippocampus volume was significantly reduced bilaterally in patients compared to healthy subjects (p = 0.049). A statistically significant difference in BHI values was observed between the side with occlusion and without occlusion (p = 0.037) of the patients, as well as between BHI values of the side with occlusion and healthy volunteers (p = 0.014). DISCUSSION Patients with unilateral ICA occlusion have reduced NAA/Cho ratio in the white matter of both hemispheres and have bilateral atrophy of hippocampus. The alteration of hemodynamics alone cannot explain these changes.
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Affiliation(s)
- Alberto Malucelli
- Department of Neurosurgery, Masaryk Hospital, J.E. Purkyne University, Usti nad Labem, Czech Republic.
| | - Antonin Skoch
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Svapotluk Ostry
- Department of Neurology, Ceske Budejovice Hospital, Ceske Budejovice, Czech Republic
| | - Ales Tomek
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Barbora Urbanova
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Lukas Martinkovic
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Irena Buksakowska
- Department of Radiology, University Hospital Motol, Prague, Czech Republic
| | - Milan Mohapl
- Department of Neurosurgery, Central Military Hospital, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery, Central Military Hospital, Prague, Czech Republic
| | - Jakub Hort
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Jan Sroubek
- Department of Neurosurgery, Hospital Na Homolce, Prague, Czech Republic
| | - Jiri Vrana
- Department of Radiology, Central Military Hospital, Prague, Czech Republic
| | - Tomas Moravec
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Robert Bartos
- Department of Neurosurgery, Masaryk Hospital, J.E. Purkyne University, Usti nad Labem, Czech Republic
| | - Martin Sames
- Department of Neurosurgery, Masaryk Hospital, J.E. Purkyne University, Usti nad Labem, Czech Republic
| | - Milan Hajek
- MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Horinek
- Department of Neurology, 2nd Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
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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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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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Lee CS, Chen CY. Reduction ofN-acetyl Aspartate in Bilateral Cerebral Tissue in Relation to Compromised Cerebrovascular Reserve Capacity as Investigated by Proton MR Spectroscopy and Acetazolamide Test. J CHIN CHEM SOC-TAIP 2013. [DOI: 10.1002/jccs.201000117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Zahr NM, Mayer D, Rohlfing T, Chanraud S, Gu M, Sullivan EV, Pfefferbaum A. In vivo glutamate measured with magnetic resonance spectroscopy: behavioral correlates in aging. Neurobiol Aging 2013; 34:1265-76. [PMID: 23116877 PMCID: PMC3545108 DOI: 10.1016/j.neurobiolaging.2012.09.014] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Revised: 09/11/2012] [Accepted: 09/12/2012] [Indexed: 02/07/2023]
Abstract
Altered availability of the brain biochemical glutamate might contribute to the neural mechanisms underlying age-related changes in cognitive and motor functions. To investigate the contribution of regional glutamate levels to behavior in the aging brain, we used an in vivo magnetic resonance spectroscopy protocol optimized for glutamate detection in 3 brain regions targeted by cortical glutamatergic efferents-striatum, cerebellum, and pons. Data from 61 healthy men and women ranging in age from 20 to 86 years were used. Older age was associated with lower glutamate levels in the striatum, but not cerebellum or pons. Older age was also predictive of poorer performance on tests of visuomotor skills and balance. Low striatal glutamate levels were associated with high systolic blood pressure and worse performance on a complex visuomotor task, the Grooved Pegboard. These findings suggest that low brain glutamate levels are related to high blood pressure and that changes in brain glutamate levels might mediate the behavioral changes noted in normal aging.
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Affiliation(s)
- Natalie M. Zahr
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd. Stanford, CA, United States, Phone: 650-859-2880, Fax: 650-859-2743
- Neuroscience Program, SRI International, Menlo Park, CA 94025, United States
| | - Dirk Mayer
- Neuroscience Program, SRI International, Menlo Park, CA 94025, United States
- Radiology Department, Lucas MRS/I Center, Stanford University, 1201 Welch Road, P-273, Stanford, CA, 94305-5488, United States
| | - Torsten Rohlfing
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd. Stanford, CA, United States, Phone: 650-859-2880, Fax: 650-859-2743
| | - Sandra Chanraud
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd. Stanford, CA, United States, Phone: 650-859-2880, Fax: 650-859-2743
| | - Meng Gu
- Radiology Department, Lucas MRS/I Center, Stanford University, 1201 Welch Road, P-273, Stanford, CA, 94305-5488, United States
| | - Edith V. Sullivan
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd. Stanford, CA, United States, Phone: 650-859-2880, Fax: 650-859-2743
| | - Adolf Pfefferbaum
- Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd. Stanford, CA, United States, Phone: 650-859-2880, Fax: 650-859-2743
- Neuroscience Program, SRI International, Menlo Park, CA 94025, United States
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Craciunas SC, Brooks WM, Nudo RJ, Popescu EA, Choi IY, Lee P, Yeh HW, Savage CR, Cirstea CM. Motor and premotor cortices in subcortical stroke: proton magnetic resonance spectroscopy measures and arm motor impairment. Neurorehabil Neural Repair 2013; 27:411-20. [PMID: 23300210 DOI: 10.1177/1545968312469835] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although functional imaging and neurophysiological approaches reveal alterations in motor and premotor areas after stroke, insights into neurobiological events underlying these alterations are limited in human studies. OBJECTIVE We tested whether cerebral metabolites related to neuronal and glial compartments are altered in the hand representation in bilateral motor and premotor areas and correlated with distal and proximal arm motor impairment in hemiparetic persons. METHODS In 20 participants at >6 months postonset of a subcortical ischemic stroke and 16 age- and sex-matched healthy controls, the concentrations of N-acetylaspartate and myo-inositol were quantified by proton magnetic resonance spectroscopy. Regions of interest identified by functional magnetic resonance imaging included primary (M1), dorsal premotor (PMd), and supplementary (SMA) motor areas. Relationships between metabolite concentrations and distal (hand) and proximal (shoulder/elbow) motor impairment using Fugl-Meyer Upper Extremity (FMUE) subscores were explored. RESULTS N-Acetylaspartate was lower in M1 (P = .04) and SMA (P = .004) and myo-inositol was higher in M1 (P = .003) and PMd (P = .03) in the injured (ipsilesional) hemisphere after stroke compared with the left hemisphere in controls. N-Acetylaspartate in ipsilesional M1 was positively correlated with hand FMUE subscores (P = .04). Significant positive correlations were also found between N-acetylaspartate in ipsilesional M1, PMd, and SMA and in contralesional M1 and shoulder/elbow FMUE subscores (P = .02, .01, .02, and .02, respectively). CONCLUSIONS Our preliminary results demonstrated that proton magnetic resonance spectroscopy is a sensitive method to quantify relevant neuronal changes in spared motor cortex after stroke and consequently increase our knowledge of the factors leading from these changes to arm motor impairment.
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Neuronal-glial alterations in non-primary motor areas in chronic subcortical stroke. Brain Res 2012; 1463:75-84. [PMID: 22575560 DOI: 10.1016/j.brainres.2012.04.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 04/18/2012] [Accepted: 04/28/2012] [Indexed: 11/22/2022]
Abstract
Whether functional changes of the non-primary motor areas, e.g., dorsal premotor (PMd) and supplementary motor (SMA) areas, after stroke, reflect reorganization phenomena or recruitment of a pre-existing motor network remains to be clarified. We hypothesized that cellular changes in these areas would be consistent with their involvement in post-stroke reorganization. Specifically, we expected that neuronal and glial compartments would be altered in radiologically normal-appearing, i.e., spared, PMd and SMA in patients with arm paresis. Twenty survivors of a single ischemic subcortical stroke and 16 age-matched healthy controls were included. At more than six months after stroke, metabolites related to neuronal and glial compartments: N-acetylaspartate, myo-inositol, and glutamate/glutamine, were quantified by proton magnetic resonance spectroscopy in PMd and SMA in both injured (ipsilesional) and un-injured (contralesional) hemispheres. Correlations between metabolites were also calculated. Finally, relationships between metabolite concentrations and arm motor impairment (total and proximal Fugl-Meyer Upper Extremity, FMUE, scores) were analyzed. Compared to controls, stroke survivors showed significantly higher ipsilesional PMd myo-inositol and lower SMA N-acetylaspartate. Significantly lower metabolite correlations were found between ipsilesional and contralesional SMA. Ipsilesional N-acetylaspartate was significantly related to proximal FMUE scores. This study provides evidence of abnormalities in metabolites, specific to neuronal and glial compartments, across spared non-primary motor areas. Ipsilesional alterations were related to proximal arm motor impairment. Our results suggest the involvement of these areas in post-stroke reorganization.
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Ben Salem D, Walker PM, Aho S, Tavernier B, Giroud M, Tzourio C, Ricolfi F, Brunotte F. Brain flexibility and balance and gait performances mark morphological and metabolic abnormalities in the elderly. J Clin Neurosci 2008; 15:1360-5. [PMID: 18954988 DOI: 10.1016/j.jocn.2008.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 12/11/2007] [Accepted: 01/03/2008] [Indexed: 12/21/2022]
Abstract
Although previous studies have found that cerebral white matter hyperintensities are associated with balance-gait disorders, no proton magnetic resonance spectroscopy data at the plane of the basal ganglia have been published. We investigated a possible relationship between balance performance and brain metabolite ratios or structural MRI measurements. We also included neuropsychological tests to determine whether such tests are related to structural or metabolic findings. All 80 participants were taken from the cohort of the Three-City study (Dijon-Bordeaux-Montpellier, France). The ratios of N-acetyl-aspartate to creatine (NAA/Cr) and choline to creatine (Cho/Cr) were calculated in the basal ganglia, thalami and insular cortex. We used univariate regression to identify which variables predicted changes in NAA/Cr and Cho/Cr, and completed the analysis with a multiple linear or logistic regression. After the multivariate analysis including hypertension, age, balance-gait, sex, white matter lesions, brain atrophy and body mass index, only balance-gait performance remained statistically significant for NAA/Cr (p=0.01) and for deep white-matter lesions (p=0.02). The Trail-Making Test is independently associated with brain atrophy and periventricular white-matter hyperintensities. Neuronal and axonal integrity at the plane of the basal ganglia is associated with balance and gait in the elderly, whereas brain flexibility is associated with structural MRI brain abnormalities.
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Salem DB, Walker PM, Bejot Y, Aho SL, Tavernier B, Rouaud O, Ricolfi F, Brunotte F. N-Acetylaspartate/Creatine and Choline/Creatine Ratios in the Thalami, Insular Cortex and White Matter as Markers of Hypertension and Cognitive Impairment in the Elderly. Hypertens Res 2008; 31:1851-7. [DOI: 10.1291/hypres.31.1851] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Les apports du registre dijonnais des accidents vasculaires cérébraux en 20 ans d’activité. Rev Neurol (Paris) 2008; 164:138-47. [DOI: 10.1016/j.neurol.2007.06.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 05/10/2007] [Accepted: 06/17/2007] [Indexed: 11/18/2022]
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Moffett JR, Ross B, Arun P, Madhavarao CN, Namboodiri AMA. N-Acetylaspartate in the CNS: from neurodiagnostics to neurobiology. Prog Neurobiol 2007; 81:89-131. [PMID: 17275978 PMCID: PMC1919520 DOI: 10.1016/j.pneurobio.2006.12.003] [Citation(s) in RCA: 1006] [Impact Index Per Article: 59.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2006] [Revised: 12/07/2006] [Accepted: 12/11/2006] [Indexed: 01/02/2023]
Abstract
The brain is unique among organs in many respects, including its mechanisms of lipid synthesis and energy production. The nervous system-specific metabolite N-acetylaspartate (NAA), which is synthesized from aspartate and acetyl-coenzyme A in neurons, appears to be a key link in these distinct biochemical features of CNS metabolism. During early postnatal central nervous system (CNS) development, the expression of lipogenic enzymes in oligodendrocytes, including the NAA-degrading enzyme aspartoacylase (ASPA), is increased along with increased NAA production in neurons. NAA is transported from neurons to the cytoplasm of oligodendrocytes, where ASPA cleaves the acetate moiety for use in fatty acid and steroid synthesis. The fatty acids and steroids produced then go on to be used as building blocks for myelin lipid synthesis. Mutations in the gene for ASPA result in the fatal leukodystrophy Canavan disease, for which there is currently no effective treatment. Once postnatal myelination is completed, NAA may continue to be involved in myelin lipid turnover in adults, but it also appears to adopt other roles, including a bioenergetic role in neuronal mitochondria. NAA and ATP metabolism appear to be linked indirectly, whereby acetylation of aspartate may facilitate its removal from neuronal mitochondria, thus favoring conversion of glutamate to alpha ketoglutarate which can enter the tricarboxylic acid cycle for energy production. In its role as a mechanism for enhancing mitochondrial energy production from glutamate, NAA is in a key position to act as a magnetic resonance spectroscopy marker for neuronal health, viability and number. Evidence suggests that NAA is a direct precursor for the enzymatic synthesis of the neuron specific dipeptide N-acetylaspartylglutamate, the most concentrated neuropeptide in the human brain. Other proposed roles for NAA include neuronal osmoregulation and axon-glial signaling. We propose that NAA may also be involved in brain nitrogen balance. Further research will be required to more fully understand the biochemical functions served by NAA in CNS development and activity, and additional functions are likely to be discovered.
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Affiliation(s)
- John R Moffett
- Department of Anatomy, Physiology and Genetics, Uniformed Services University of the Health Sciences, Building C, 4301 Jones Bridge Rd., Bethesda, MD 20814, USA.
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Abstract
Diabetic complications result in much morbidity and mortality and considerable consumption of scarce medical resources. Thus, elucidation of the risk factors and pathophysiologic mechanisms underlying diabetic complications is important. The effects of diabetes on the central nervous system (CNS) result in cognitive dysfunction and cerebrovascular disease. Treatment-related hypoglycemia also has CNS consequences. Advances in neuroimaging now provide greater insights into the structural and functional impact of diabetes on the CNS. Greater understanding of CNS involvement could lead to new strategies to prevent or reverse the damage caused by diabetes mellitus.
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