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Sumbul‐Sekerci B, Velioglu HA, Sekerci A. Diabetes-related clinical and microstructural white matter changes in patients with Alzheimer's disease. Brain Behav 2024; 14:e3533. [PMID: 38715429 PMCID: PMC11077244 DOI: 10.1002/brb3.3533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
AIM Although there exists substantial epidemiological evidence indicating an elevated risk of dementia in individuals with diabetes, our understanding of the neuropathological underpinnings of the association between Type-2 diabetes mellitus (T2DM) and Alzheimer's disease (AD) remains unclear. This study aims to unveil the microstructural brain changes associated with T2DM in AD and identify the clinical variables contributing to these changes. METHODS In this retrospective study involving 64 patients with AD, 31 individuals had concurrent T2DM. The study involved a comparative analysis of diffusion tensor imaging (DTI) images and clinical features between patients with and without T2DM. The FSL FMRIB software library was used for comprehensive preprocessing and tractography analysis of DTI data. After eddy current correction, the "bedpost" model was utilized to model diffusion parameters. Linear regression analysis with a stepwise method was used to predict the clinical variables that could lead to microstructural white matter changes. RESULTS We observed a significant impairment in the left superior longitudinal fasciculus (SLF) among patients with AD who also had T2DM. This impairment in patients with AD and T2DM was associated with an elevation in creatine levels. CONCLUSION The white matter microstructure in the left SLF appears to be sensitive to the impairment of kidney function associated with T2DM in patients with AD. The emergence of AD in association with T2DM may be driven by mechanisms distinct from the typical AD pathology. Compromised renal function in AD could potentially contribute to impaired white matter integrity.
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Affiliation(s)
- Betul Sumbul‐Sekerci
- Department of Clinical Pharmacy, Faculty of PharmacyBezmialem Vakıf UniversityIstanbulTurkey
| | - Halil Aziz Velioglu
- Center for Psychiatric NeuroscienceFeinstein Institutes for Medical ResearchManhassetNew YorkUSA
- Department of Neuroscience, Faculty of MedicineIstanbul Medipol UniversityIstanbulTurkey
| | - Abdusselam Sekerci
- Department of Internal Medicine, Faculty of MedicineBezmialem Vakif UniversityIstanbulTurkey
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2
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Zhao Q, Du X, Liu F, Zhang Y, Qin W, Zhang Q. ECHDC3 Variant Regulates the Right Hippocampal Microstructural Integrity and Verbal Memory in Type 2 Diabetes Mellitus. Neuroscience 2024; 538:30-39. [PMID: 38070593 DOI: 10.1016/j.neuroscience.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 11/29/2023] [Accepted: 12/02/2023] [Indexed: 12/25/2023]
Abstract
ECHDC3 is a risk gene for white matter (WM) hyperintensity and is associated with insulin resistance. This study aimed to investigate whether ECHDC3 variants selectively regulate brain WM microstructures and episodic memory in patients with type 2 diabetes mellitus (T2DM). We enrolled 106 patients with T2DM and 111 healthy controls. A voxel-wise general linear model was employed to explore the interaction effect between ECHDC3 rs11257311 polymorphism and T2DM diagnosis on fractional anisotropy (FA). A linear modulated mediation analysis was conducted to examine the potential of FA value to mediate the influence of T2DM on episodic memory in an ECHDC3-dependent manner. We observed a noteworthy interaction between genotype and diagnosis on FA in the right inferior temporal WM, right anterior limb of the internal capsule, right frontal WM, and the right hippocampus. Modulated mediation analysis revealed a significant ECHDC3 modulation on the T2DM → right hippocampal FA → short-term memory pathway, with only rs11257311 G risk homozygote demonstrating significant mediation effect. Together, our findings provide evidence of ECHDC3 modulating the effect of T2DM on right hippocampal microstructural impairment and short-term memory decline, which might be a neuro-mechanism for T2DM related episodic memory impairment.
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Affiliation(s)
- Qiyu Zhao
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xin Du
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Feng Liu
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yang Zhang
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Wen Qin
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Quan Zhang
- Department of Medical Imaging and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China.
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3
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Huang L, Zhang Q, Tang T, Yang M, Chen C, Tao J, Liang S. Abnormalities of Brain White Matter in Type 2 Diabetes Mellitus: A Meta-Analysis of Diffusion Tensor Imaging. Front Aging Neurosci 2021; 13:693890. [PMID: 34421572 PMCID: PMC8378805 DOI: 10.3389/fnagi.2021.693890] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/05/2021] [Indexed: 11/13/2022] Open
Abstract
Aims: The study aimed to conduct a meta-analysis to determine the abnormalities of white matter in patients with type 2 diabetes mellitus (T2DM) by identifying the consistency of diffusion tensor imaging (DTI). Method: The literature for DTI comparing patients with T2DM with controls published before October 30, 2020, were reviewed in PubMed, Web of Science, Embase, CNKI, and Wan Fang databases. The meta-analysis was performed using the activation likelihood estimation (ALE) method, including 12 reports and 381 patients with T2DM. Results: The meta-analysis identified 10 white matter regions that showed a consistent reduction of fractional anisotropy (FA) in patients with T2DM, including genu of the corpus callosum, the body of corpus callosum, bilateral anterior corona radiata, bilateral superior corona radiata, bilateral cingulum, and bilateral superior fronto-occipital fasciculus. Conclusion: This study revealed the abnormal characteristics of white matter in T2DM, which would be helpful to understand the underlying neuropathological and physiological mechanisms of T2DM and provide evidence for clinical diagnosis and treatment.
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Affiliation(s)
- Li Huang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Qingqing Zhang
- College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Tong Tang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,College of Rehabilitation Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Minguang Yang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Cong Chen
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Jing Tao
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Shengxiang Liang
- National-Local Joint Engineering Research Center of Rehabilitation Medicine Technology, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Rehabilitation Industry Institute, Fujian University of Traditional Chinese Medicine, Fuzhou, China.,Traditional Chinese Medicine Rehabilitation Research Center of State Administration of Traditional Chinese Medicine, Fujian University of Traditional Chinese Medicine, Fuzhou, China
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4
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Alotaibi A, Tench C, Stevenson R, Felmban G, Altokhis A, Aldhebaib A, Dineen RA, Constantinescu CS. Investigating Brain Microstructural Alterations in Type 1 and Type 2 Diabetes Using Diffusion Tensor Imaging: A Systematic Review. Brain Sci 2021; 11:brainsci11020140. [PMID: 33499073 PMCID: PMC7911883 DOI: 10.3390/brainsci11020140] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/15/2021] [Accepted: 01/17/2021] [Indexed: 12/13/2022] Open
Abstract
Type 1 and type 2 diabetes mellitus have an impact on the microstructural environment and cognitive functions of the brain due to its microvascular/macrovascular complications. Conventional Magnetic Resonance Imaging (MRI) techniques can allow detection of brain volume reduction in people with diabetes. However, conventional MRI is insufficiently sensitive to quantify microstructural changes. Diffusion Tensor Imaging (DTI) has been used as a sensitive MRI-based technique for quantifying and assessing brain microstructural abnormalities in patients with diabetes. This systematic review aims to summarise the original research literature using DTI to quantify microstructural alterations in diabetes and the relation of such changes to cognitive status and metabolic profile. A total of thirty-eight published studies that demonstrate the impact of diabetes mellitus on brain microstructure using DTI are included, and these demonstrate that both type 1 diabetes mellitus and type 2 diabetes mellitus may affect cognitive abilities due to the alterations in brain microstructures.
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Affiliation(s)
- Abdulmajeed Alotaibi
- Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (C.T.); (R.S.); (G.F.); (A.A.); (R.A.D.); (C.S.C.)
- School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia;
- Correspondence: ; Tel.: +44-115-823-1443; Fax: +44-115-9709738
| | - Christopher Tench
- Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (C.T.); (R.S.); (G.F.); (A.A.); (R.A.D.); (C.S.C.)
| | - Rebecca Stevenson
- Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (C.T.); (R.S.); (G.F.); (A.A.); (R.A.D.); (C.S.C.)
| | - Ghadah Felmban
- Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (C.T.); (R.S.); (G.F.); (A.A.); (R.A.D.); (C.S.C.)
- School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia;
| | - Amjad Altokhis
- Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (C.T.); (R.S.); (G.F.); (A.A.); (R.A.D.); (C.S.C.)
- School of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, Riyadh 11564, Saudi Arabia
| | - Ali Aldhebaib
- School of Applied Medical Sciences, King Saud bin Abdul-Aziz University for Health Sciences, Riyadh 14611, Saudi Arabia;
| | - Rob A. Dineen
- Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (C.T.); (R.S.); (G.F.); (A.A.); (R.A.D.); (C.S.C.)
- NIHR Nottingham Biomedical Research Centre, Nottingham NG1 5DU, UK
| | - Cris S. Constantinescu
- Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK; (C.T.); (R.S.); (G.F.); (A.A.); (R.A.D.); (C.S.C.)
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Cardiometabolic determinants of early and advanced brain alterations: Insights from conventional and novel MRI techniques. Neurosci Biobehav Rev 2020; 115:308-320. [DOI: 10.1016/j.neubiorev.2020.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/21/2020] [Accepted: 04/02/2020] [Indexed: 12/11/2022]
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6
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Sanjari Moghaddam H, Ghazi Sherbaf F, Aarabi MH. Brain microstructural abnormalities in type 2 diabetes mellitus: A systematic review of diffusion tensor imaging studies. Front Neuroendocrinol 2019; 55:100782. [PMID: 31401292 DOI: 10.1016/j.yfrne.2019.100782] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/27/2019] [Accepted: 08/07/2019] [Indexed: 12/13/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is associated with deficits in the structure and function of the brain. Diffusion tensor imaging (DTI) is a highly sensitive method for characterizing cerebral tissue microstructure. Using PRISMA guidelines, we identified 29 studies which have demonstrated widespread brain microstructural impairment and topological network disorganization in patients with T2DM. Most consistently reported structures with microstructural abnormalities were frontal, temporal, and parietal lobes in the lobar cluster; corpus callosum, cingulum, uncinate fasciculus, corona radiata, and internal and external capsules in the white matter cluster; thalamus in the subcortical cluster; and cerebellum. Microstructural abnormalities were correlated with pathological derangements in the endocrine profile as well as deficits in cognitive performance in the domains of memory, information-processing speed, executive function, and attention. Altogether, the findings suggest that the detrimental effects of T2DM on cognitive functions might be due to microstructural disruptions in the central neural structures.
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Affiliation(s)
| | - Farzaneh Ghazi Sherbaf
- Neuroradiology Division, Tehran University of Medical Sciences, School of Medicine, Tehran, Iran
| | - Mohammad Hadi Aarabi
- Neuroradiology Division, Tehran University of Medical Sciences, School of Medicine, Tehran, Iran.
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7
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Zhao Y, Ke Z, He W, Cai Z. Volume of white matter hyperintensities increases with blood pressure in patients with hypertension. J Int Med Res 2019; 47:3681-3689. [PMID: 31242795 PMCID: PMC6726811 DOI: 10.1177/0300060519858023] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Hypertension is a risk factor for development of white matter hyperintensities (WMHs). However, the relationship between hypertension and WMHs remains obscure. We sought to clarify this relationship using clinical data from different regions of China. Methods We analyzed the data of 333 patients with WMHs in this study. All included patients underwent conventional magnetic resonance imaging (MRI) examination. A primary diagnosis of WMHs was made according to MRI findings. The volume burden of WMHs was investigated using the Fazekas scale, which is widely used to rate the degree of WMHs. We conducted retrospective clinical analysis of the data in this study. Results Our findings showed that WMHs in patients with hypertension were associated with diabetes, cardiovascular diseases, history of cerebral infarct, and plasma glucose and triglyceride levels. Fazekas scale scores for WMHs increased with increased blood pressure values in patients with hypertension. Conclusion This analysis indicates that hypertension is an independent contributor to the prevalence and severity of WMHs.
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Affiliation(s)
- Yu Zhao
- 1 Department of Neurology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zunyu Ke
- 2 Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, China
| | - Wenbo He
- 2 Department of Neurology, Renmin Hospital, Hubei University of Medicine, Shiyan Renmin Hospital, Shiyan, Hubei Province, China
| | - Zhiyou Cai
- 3 Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, Chongqing, China.,4 Chongqing Key Laboratory of Neurodegenerative Diseases, Chongqing, Chongqing, China
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8
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Zhang X, Huang-Fu Z, Lang XY, Chun P, Chi YY, Yuan XY, Wang XG. Pathological and cognitive changes in patients with type 2 diabetes mellitus and comorbid MCI and protective hypoglycemic therapies: a narrative review. Rev Neurosci 2019; 30:757-770. [PMID: 31199776 DOI: 10.1515/revneuro-2018-0083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 01/30/2019] [Indexed: 01/04/2023]
Abstract
Type 2 diabetes mellitus (T2DM) is becoming a significant health issue worldwide. Many studies support the hypothesis that patients with T2DM have a higher-than-expected incidence of mild cognitive impairment (MCI) than individuals without diabetes. Based on the results from recent studies, MCI might be associated with the effects of T2DM on glucose metabolism and brain atrophy. As a narrative review, we will illuminate pathological and cognitive changes in patients with T2DM and comorbid MCI and protective hypoglycemic therapies. The early abnormal signs of cognition must be elucidated, and extensive investigations are needed to develop improved therapies for use in the clinic.
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Affiliation(s)
- Xiao Zhang
- The First Affiliated Hospital of Dalian Medical University, Dalian 116000, P.R. China
| | - Zhao Huang-Fu
- The Second Affiliated Hospital of Dalian Medical University, Dalian 116027, P.R. China
| | - Xing-Ying Lang
- Dalian Center for Disease Control and Prevention, Dalian 116021, P.R. China
| | - Pu Chun
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian 16044, P.R. China
| | - Yan-Yan Chi
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian 16044, P.R. China
| | - Xiao-Ying Yuan
- Department of Anatomy, College of Basic Medicine, Dalian Medical University, Dalian 16044, P.R. China
| | - Xu-Gang Wang
- Department of Neurology, The Second Affiliated Hospital of Dalian Medical University, Dalian 116027, P.R. China
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Hannawi Y, Yanek L, Kral B, Vaidya D, Becker L, Becker D, Nyquist P. Hypertension Is Associated with White Matter Disruption in Apparently Healthy Middle-Aged Individuals. AJNR Am J Neuroradiol 2018; 39:2243-2248. [PMID: 30442693 PMCID: PMC6368444 DOI: 10.3174/ajnr.a5871] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 09/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND PURPOSE Traditional cardiovascular risk factors have been associated with white matter disease. Because hypertension results in vascular stiffness and impaired cerebral perfusion, we hypothesized that it would be the most relevant risk factor for microstructural white matter disruption in apparently healthy middle-aged individuals with a family history of early-onset coronary artery disease. MATERIALS AND METHODS This was a cross-sectional analysis of participants in the Genetic Study of Atherosclerosis Risk with DTI. Regional fractional anisotropy of 181 segmented brain regions was measured using Eve WM Atlas. Risk factors were examined using univariate analysis for 48 regions representing deep WM structures. Minimal multivariable linear regression models adjusting for age, sex, and race and maximal linear regression models adjusting for cardiovascular risk factors were performed for regions meeting the Bonferroni threshold in the initial analysis. RESULTS Included were 116 subjects (mean age, 49 ± 11 years; 57% men) with a moderate load of cardiovascular risk factors. Subjects with hypertension had significantly lower regional fractional anisotropy in the right cingulum and left stria terminalis in the minimal and maximal regression models. Additionally, there was lower regional fractional anisotropy in the left fornix in the maximal model and right sagittal stratum in the minimal model. Systolic blood pressure values were significantly associated with regional fractional anisotropy in the left superior longitudinal fasciculus in the maximal model. There were no significant differences among regional fractional anisotropy values for other cardiovascular risk factors. CONCLUSIONS In middle-aged apparently healthy individuals with susceptibility to vascular disease, among all known cardiovascular risk factors, hypertension was associated with microstructural WM disruption.
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Affiliation(s)
- Y. Hannawi
- From the Department of Neurology (Y.H.), Division of Cerebrovascular Diseases and Neurocritical Care, Ohio State University, Columbus, Ohio
| | - L.R. Yanek
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - B.G. Kral
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D. Vaidya
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - L.C. Becker
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - D.M. Becker
- GeneSTAR Research Program (L.R.Y., B.G.K., D.V., L.C.B., D.M.B.), Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - P.A. Nyquist
- Department of Anesthesiology and Critical Care Medicine (P.A.N.), Neurosciences Critical Care,Department of Neurology (P.A.N.), Johns Hopkins University, Baltimore, Maryland
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Alfaro FJ, Gavrieli A, Saade-Lemus P, Lioutas VA, Upadhyay J, Novak V. White matter microstructure and cognitive decline in metabolic syndrome: a review of diffusion tensor imaging. Metabolism 2018; 78:52-68. [PMID: 28920863 PMCID: PMC5732847 DOI: 10.1016/j.metabol.2017.08.009] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 08/18/2017] [Accepted: 08/22/2017] [Indexed: 12/13/2022]
Abstract
Metabolic syndrome is a cluster of cardiovascular risk factors defined by the presence of abdominal obesity, glucose intolerance, hypertension and/or dyslipidemia. It is a major public health epidemic worldwide, and a known risk factor for the development of cognitive dysfunction and dementia. Several studies have demonstrated a positive association between the presence of metabolic syndrome and worse cognitive outcomes, however, evidence of brain structure pathology is limited. Diffusion tensor imaging has offered new opportunities to detect microstructural white matter changes in metabolic syndrome, and a possibility to detect associations between functional and structural abnormalities. This review analyzes the impact of metabolic syndrome on white matter microstructural integrity, brain structure abnormalities and their relationship to cognitive function. Each of the metabolic syndrome components exerts a specific signature of white matter microstructural abnormalities. Metabolic syndrome and its components exert both additive/synergistic, as well as, independent effects on brain microstructure thus accelerating brain aging and cognitive decline.
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Affiliation(s)
- Freddy J Alfaro
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA 02215, USA.
| | - Anna Gavrieli
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA 02215, USA.
| | - Patricia Saade-Lemus
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA 02215, USA.
| | - Vasileios-Arsenios Lioutas
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA 02215, USA.
| | - Jagriti Upadhyay
- Department of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215,USA.
| | - Vera Novak
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Palmer 127, Boston, MA 02215, USA.
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11
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Understanding a role for hypoxia in lesion formation and location in the deep and periventricular white matter in small vessel disease and multiple sclerosis. Clin Sci (Lond) 2017; 131:2503-2524. [PMID: 29026001 DOI: 10.1042/cs20170981] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 08/01/2017] [Accepted: 08/15/2017] [Indexed: 12/28/2022]
Abstract
The deep and periventricular white matter is preferentially affected in several neurological disorders, including cerebral small vessel disease (SVD) and multiple sclerosis (MS), suggesting that common pathogenic mechanisms may be involved in this injury. Here we consider the potential pathogenic role of tissue hypoxia in lesion development, arising partly from the vascular anatomy of the affected white matter. Specifically, these regions are supplied by a sparse vasculature fed by long, narrow end arteries/arterioles that are vulnerable to oxygen desaturation if perfusion is reduced (as in SVD, MS and diabetes) or if the surrounding tissue is hypoxic (as in MS, at least). The oxygen crisis is exacerbated by a local preponderance of veins, as these can become highly desaturated 'sinks' for oxygen that deplete it from surrounding tissues. Additional haemodynamic deficiencies, including sluggish flow and impaired vasomotor reactivity and vessel compliance, further exacerbate oxygen insufficiency. The cells most vulnerable to hypoxic damage, including oligodendrocytes, die first, resulting in demyelination. Indeed, in preclinical models, demyelination is prevented if adequate oxygenation is maintained by raising inspired oxygen concentrations. In agreement with this interpretation, there is a predilection of lesions for the anterior and occipital horns of the lateral ventricles, namely regions located at arterial watersheds, or border zones, known to be especially susceptible to hypoperfusion and hypoxia. Finally, mitochondrial dysfunction due to genetic causes, as occurs in leucodystrophies or due to free radical damage, as occurs in MS, will compound any energy insufficiency resulting from hypoxia. Viewing lesion formation from the standpoint of tissue oxygenation not only reveals that lesion distribution is partly predictable, but may also inform new therapeutic strategies.
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Currie G, Delles C. Use of Biomarkers in the Evaluation and Treatment of Hypertensive Patients. Curr Hypertens Rep 2017; 18:54. [PMID: 27221728 DOI: 10.1007/s11906-016-0661-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The current definition of hypertension is based on blood pressure values, and blood pressure also drives treatment decisions, is the most important treatment monitoring tool and helps estimating risk of hypertension-related organ damage. In an era of precision medicine, additional biomarkers are needed in the diagnosis and management of patients with hypertension. In this review, we outline the areas in which functional, imaging and circulating biomarkers could help in a more individualised definition of hypertension and associated risk. We will cover biomarkers for diagnosis; of pathophysiology and prediction of hypertension; response to treatment, organ damage; and to monitor treatment. A clear focus is on the vasculature, the heart and the kidneys, whereas we see a need to further develop biomarkers of cerebral function in order to diagnose cognition deficits and monitor changes in cognition in the future to support addressing the growing burden of hypertension-associated vascular dementia.
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Affiliation(s)
- Gemma Currie
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, UK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow, G12 8TA, Scotland, UK.
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13
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Nouwen A, Chambers A, Chechlacz M, Higgs S, Blissett J, Barrett TG, Allen HA. Microstructural abnormalities in white and gray matter in obese adolescents with and without type 2 diabetes. NEUROIMAGE-CLINICAL 2017; 16:43-51. [PMID: 28752059 PMCID: PMC5514690 DOI: 10.1016/j.nicl.2017.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 06/24/2017] [Accepted: 07/03/2017] [Indexed: 01/15/2023]
Abstract
Aims/hypotheses In adults, type 2 diabetes and obesity have been associated with structural brain changes, even in the absence of dementia. Some evidence suggested similar changes in adolescents with type 2 diabetes but comparisons with a non-obese control group have been lacking. The aim of the current study was to examine differences in microstructure of gray and white matter between adolescents with type 2 diabetes, obese adolescents and healthy weight adolescents. Methods Magnetic resonance imaging data were collected from 15 adolescents with type 2 diabetes, 21 obese adolescents and 22 healthy weight controls. Volumetric differences in the gray matter between the three groups were examined using voxel based morphology, while tract based spatial statistics was used to examine differences in the microstructure of the white matter. Results Adolescents with type 2 diabetes and obese adolescents had reduced gray matter volume in the right hippocampus, left putamen and caudate, bilateral amygdala and left thalamus compared to healthy weight controls. Type 2 diabetes was also associated with significant regional changes in fractional anisotropy within the corpus callosum, fornix, left inferior fronto-occipital fasciculus, left uncinate, left internal and external capsule. Fractional anisotropy reductions within these tracts were explained by increased radial diffusivity, which may suggest demyelination of white matter tracts. Mean diffusivity and axial diffusivity did not differ between the groups. Conclusion/interpretation Our data shows that adolescent obesity alone results in reduced gray matter volume and that adolescent type 2 diabetes is associated with both white and gray matter abnormalities. Type 2 diabetes and obesity in adolescents is associated with reduced gray matter volume. Type 2 diabetes was associated with significant regional changes in FA. FA reductions within these tracts were explained by increased RD. Mean diffusivity and axial diffusivity did not differ between the groups.
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Affiliation(s)
- Arie Nouwen
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Alison Chambers
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | - Suzanne Higgs
- School of Psychology, University of Birmingham, Birmingham, UK
| | | | | | - Harriet A Allen
- School of Psychology, University of Birmingham, Birmingham, UK
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Fang P, An J, Tan X, Zeng LL, Shen H, Qiu S, Hu D. Changes in the cerebellar and cerebro-cerebellar circuit in type 2 diabetes. Brain Res Bull 2017; 130:95-100. [DOI: 10.1016/j.brainresbull.2017.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 12/21/2016] [Accepted: 01/09/2017] [Indexed: 02/07/2023]
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15
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Crystal HA, Holman S, Lui YW, Baird AE, Yu H, Klein R, Rojas-Soto DM, Gustafson DR, Stebbins GT. Association of the Fractal Dimension of Retinal Arteries and Veins with Quantitative Brain MRI Measures in HIV-Infected and Uninfected Women. PLoS One 2016; 11:e0154858. [PMID: 27158911 PMCID: PMC4861324 DOI: 10.1371/journal.pone.0154858] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 04/20/2016] [Indexed: 01/05/2023] Open
Abstract
Objective The fractal dimension of retinal arteries and veins is a measure of the complexity of the vascular tree. We hypothesized that retinal fractal dimension would be associated with brain volume and white matter integrity in HIV-infected women. Design Nested case-control within longitudinal cohort study. Methods Women were recruited from the Brooklyn site of the Women’s Interagency HIV study (WIHS); 34 HIV-infected and 21 HIV-uninfected women with analyzable MRIs and retinal photographs were included. Fractal dimension was determined using the SIVA software program on skeletonized retinal images. The relationship between predictors (retinal vascular measures) and outcomes (quantitative MRI measures) were analyzed with linear regression models. All models included age, intracranial volume, and both arterial and venous fractal dimension. Some models were adjusted for blood pressure, race/ethnicity, and HIV-infection. Results The women were 45.6 ± 7.3 years of age. Higher arterial dimension was associated with larger cortical volumes, but higher venous dimension was associated with smaller cortical volumes. In fully adjusted models, venous dimension was significantly associated with fractional anisotropy (standardized β = -0.41, p = 0.009) and total gray matter volume (β = -0.24, p = 0.03), and arterial dimension with mean diffusivity (β = -0.33,.p = 0.04) and fractional anisotropy (β = 0.34, p = 0.03). HIV-infection was not associated with any retinal or MRI measure. Conclusions Higher venous fractal dimension was associated with smaller cortical volumes and lower fractional anisotropy, whereas higher arterial fractal dimension was associated with the opposite patterns. Longitudinal studies are needed to validate this finding.
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Affiliation(s)
- Howard A. Crystal
- Departments of Neurology, SUNY Downstate Medical School, Brooklyn, NY, United States of America
- * E-mail:
| | - Susan Holman
- Departments of Medicine, SUNY Downstate Medical School, Brooklyn, NY, United States of America
| | - Yvonne W. Lui
- Department of Radiology, NYU Langone School of Medicine, New York, NY, United States of America
| | - Alison E. Baird
- Departments of Neurology, SUNY Downstate Medical School, Brooklyn, NY, United States of America
| | - Hua Yu
- Departments of Neurology, SUNY Downstate Medical School, Brooklyn, NY, United States of America
| | - Ronald Klein
- Department of Ophthalmology, University of Wisconsin School of Medicine, Madison, WI, United States of America
| | | | - Deborah R. Gustafson
- Departments of Neurology, SUNY Downstate Medical School, Brooklyn, NY, United States of America
| | - Glenn T. Stebbins
- Department of Neurological Sciences, Rush University School of Medicine, Chicago, IL, United States of America
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Rofey DL, Arslanian SA, El Nokali NE, Verstynen T, Watt JC, Black JJ, Sax R, Krall JS, Proulx C, Dillon M, Erickson KI. Brain volume and white matter in youth with type 2 diabetes compared to obese and normal weight, non-diabetic peers: A pilot study. Int J Dev Neurosci 2015; 46:88-91. [PMID: 26287285 DOI: 10.1016/j.ijdevneu.2015.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/14/2015] [Accepted: 07/20/2015] [Indexed: 01/21/2023] Open
Abstract
Type 2 Diabetes Mellitus (T2DM) and obesity are linked to specific patterns of subcortical brain atrophy and decreased microstructural integrity of white matter. Fifteen adolescents (12-21-years-old, 80% Caucasian, 15% African American, mean BMI=32)-five with T2DM confirmed by oral glucose tolerance test, five matched obese adolescent controls without diabetes (OBCN), and five matched (race, sex) normal-weight controls (NWCN)-underwent Magnetic Resonance Imaging (MRI) for the collection of gray matter volume and white matter integrity. Analyses of Variance (ANOVAs) of the neuroimaging data revealed significant differences in caudate nucleus volume [F(2,12)=7.79, p<0.05] such that the normal-weight group had significantly greater volume than the obese and T2DM groups (NWCN>OBCN, p=0.020; OBCN>T2DM, p=0.042; and NWCN>T2DM; p=0.003) after controlling for participant Body Mass Index (BMI). Similarly, there was a main effect for the volume of the thalamus [F(2,12)=4.39, p<0.05] with greater volume for both the NWC and the OBC groups in comparison to the T2DM group (NWC>T2DM, p=0.020; OBC>T2DM; p=0.040). Finally, an examination of white matter integrity among the three groups illustrated a pattern of white matter integrity reduction between normal-weight participants and both obese controls and T2DM participants, with T2DM demonstrating the greatest deficit in functional anisotropy (FA) volume, but these results were not significant after further controlling for BMI. Results from the current pilot study illuminate a host of brain morphology differences between youth with T2DM, obese youth, and normal-weight controls; future research with a larger sample size is critical.
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Affiliation(s)
- Dana L Rofey
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States.
| | - Silva A Arslanian
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, United States
| | - Nermeen E El Nokali
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, United States
| | - Timothy Verstynen
- Carnegie Mellon University, Department of Neuroscience, United States
| | - Jennifer C Watt
- University of Pittsburgh, Department of Psychology, United States
| | - Jessica J Black
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States
| | - Rebecca Sax
- University of Pittsburgh, Department of Psychology, United States
| | - Jodi S Krall
- Division of Weight Management and Wellness, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, United States
| | - Chelsea Proulx
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States
| | - Meredith Dillon
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, United States
| | - Kirk I Erickson
- University of Pittsburgh, Department of Psychology, United States
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Wang R, Fratiglioni L, Laukka EJ, Lövdén M, Kalpouzos G, Keller L, Graff C, Salami A, Bäckman L, Qiu C. Effects of vascular risk factors and APOE ε4 on white matter integrity and cognitive decline. Neurology 2015; 84:1128-35. [PMID: 25672924 DOI: 10.1212/wnl.0000000000001379] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To investigate the effects of vascular risk factors and APOE status on white matter microstructure, and subsequent cognitive decline among older people. METHODS This study included 241 participants (age 60 years and older) from the population-based Swedish National Study on Aging and Care in Kungsholmen in central Stockholm, Sweden, who were free of dementia and stroke at baseline (2001-2004). We collected data through interviews, clinical examinations, and laboratory tests. We measured fractional anisotropy (FA) and mean diffusivity (MD) on diffusion tensor imaging, and estimated volume of white matter hyperintensities using automatic segmentation. We assessed global cognitive function with the Mini-Mental State Examination at baseline and at 3- and/or 6-year follow-up. We analyzed the data using multivariate linear regression and linear mixed models. RESULTS Heavy alcohol consumption, hypertension, and diabetes were significantly associated with lower FA or higher MD (p < 0.05). When aggregating heavy alcohol consumption, hypertension, and diabetes together with current smoking, having an increasing number of these 4 factors concurrently was associated with decreasing FA and increasing MD (ptrend < 0.01), independent of white matter hyperintensities. Vascular risk factors and APOE ε4 allele interacted to negatively affect white matter microstructure; having multiple (≥2) vascular factors was particularly detrimental to white matter integrity among APOE ε4 carriers. Lower tertile of FA and upper tertile of MD were significantly associated with faster Mini-Mental State Examination decline. CONCLUSIONS Vascular risk factors are associated with reduced white matter integrity among older adults, which subsequently predicted faster cognitive decline. The detrimental effects of vascular risk factors on white matter microstructure were exacerbated among APOE ε4 carriers.
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Affiliation(s)
- Rui Wang
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden.
| | - Laura Fratiglioni
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Erika J Laukka
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Martin Lövdén
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Grégoria Kalpouzos
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Lina Keller
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Caroline Graff
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Alireza Salami
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Lars Bäckman
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden
| | - Chengxuan Qiu
- From the Aging Research Center (R.W., L.F., E.J.L., M.L., G.K., L.K., A.S., L.B., C.Q.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University; Stockholm Gerontology Research Center (L.F., L.B.); and Division of Neurogeriatrics (C.G.), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Center for Alzheimer Research at Karolinska Institutet, Sweden.
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Maillard P, Carmichael OT, Reed B, Mungas D, DeCarli C. Cooccurrence of vascular risk factors and late-life white-matter integrity changes. Neurobiol Aging 2015; 36:1670-1677. [PMID: 25666995 DOI: 10.1016/j.neurobiolaging.2015.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/23/2014] [Accepted: 01/11/2015] [Indexed: 11/18/2022]
Abstract
Hypertension, hyperlipidemia, and diabetes are increasingly prevalent with advancing age and have been shown to cause white-matter (WM) injury that may contribute to dementia risk. However, cumulative and over time effects of these medical illnesses have not been systematically examined. One hundred twenty-one cognitively normal old participants received comprehensive clinical evaluations and brain diffusion tensor imaging on 2 occasions. Clinical history and medical treatment of diabetes, hypertension, and hyperlipidemia were assessed at both evaluations. We examined whether exposure to a greater number of vascular risk factors (VRFs) was associated with greater rate of WM integrity change using longitudinal differences in fractional anisotropy (FA). Compared with individuals with no VRF, individuals with 1 VRF did not exhibit significantly different change in FA. However, those with ≥ 2 VRFs had greater decrease in FA within multiple WM regions including the splenium of the corpus callosum. The accumulation of VRF increasingly affected WM integrity, particularly in areas known to be injured in patients with mild cognitive impairment and dementia.
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Affiliation(s)
- Pauline Maillard
- Imaging of Dementia and Aging (IDeA) Laboratory, University of California-Davis, Davis, CA, USA; Department of Neurology and Center for Neuroscience, University of California-Davis, Davis, CA, USA.
| | - Owen T Carmichael
- Imaging of Dementia and Aging (IDeA) Laboratory, University of California-Davis, Davis, CA, USA; Department of Neurology and Center for Neuroscience, University of California-Davis, Davis, CA, USA
| | - Bruce Reed
- Imaging of Dementia and Aging (IDeA) Laboratory, University of California-Davis, Davis, CA, USA; Department of Neurology and Center for Neuroscience, University of California-Davis, Davis, CA, USA
| | - Dan Mungas
- Imaging of Dementia and Aging (IDeA) Laboratory, University of California-Davis, Davis, CA, USA; Department of Neurology and Center for Neuroscience, University of California-Davis, Davis, CA, USA
| | - Charles DeCarli
- Imaging of Dementia and Aging (IDeA) Laboratory, University of California-Davis, Davis, CA, USA; Department of Neurology and Center for Neuroscience, University of California-Davis, Davis, CA, USA
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Yau PL, Kim M, Tirsi A, Convit A. Retinal vessel alterations and cerebral white matter microstructural damage in obese adolescents with metabolic syndrome. JAMA Pediatr 2014; 168:e142815. [PMID: 25436854 PMCID: PMC4420159 DOI: 10.1001/jamapediatrics.2014.2815] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
IMPORTANCE Cerebral white matter (WM) damage has been reported in childhood obesity and in metabolic syndrome (MetS) but mechanisms remain unclear. OBJECTIVES To ascertain whether adolescents with MetS have retinal vessel alterations and if the anticipated reductions in retinal arteriolar diameter are associated with diminished cerebral WM microstructural integrity and to test a model for vascular etiology of the WM abnormalities. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the brain correlates of obesity and related metabolic disease in youths. This study was conducted at the Brain, Obesity, and Diabetes Laboratory, New York University School of Medicine, New York. Thirty-nine obese adolescents with MetS and 51 matched adolescents without MetS received comprehensive endocrine, neuropsychological, retinal vessel, and diffusion tensor imaging-based cerebral WM evaluations. MAIN OUTCOMES AND MEASURES Retinal arteriolar diameter, cerebral WM microstructural integrity, waist circumference, and insulin resistance. RESULTS Obese adolescents with MetS had significant reductions in retinal arteriolar diameter relative to adolescents without MetS (mean [SD] central retinal arteriolar equivalent, 182.35 [16.10] vs. 198.62 [19.03] μm, respectively; P < .001). The greater the number of MetS criteria present, the greater the reduction was in retinal arteriolar diameter (β = -8.61; ∆r2 = 0.335; ∆F1,83 = 70.79; P < .001). We found that abdominal obesity (waist circumference) was the strongest MetS component related to reductions in retinal arteriolar diameter (rp[85] = -0.661; P < .001), and importantly, for the first time to our knowledge, we demonstrated that its effect was partially mediated by comorbid insulin resistance (indirect effect = -0.1355 [95% CI, -0.2471 to -0.0593]; Z = -2.56; P = .01). Consistent with our prior report of nondiabetic adolescents with MetS, we also uncovered cerebral WM microstructural damage. These subtle WM changes were associated with reductions in retinal arteriolar diameter, a proxy for cerebral microvascular health (3150 voxels or 3.15 cm3; P < .001). Importantly, some of the WM regions showing lower microstructural integrity also demonstrated associations with retinal arteriolar diameter, suggesting that the observed WM pathology is likely vascular in nature. CONCLUSIONS AND RELEVANCE We document, for the first time to our knowledge, the associations between retinal vessel alterations and subclinical WM pathology among obese adolescents with MetS. This suggests that the subtle WM pathology in adolescents with MetS may have a vascular origin. Future work should include direct assessments of cerebral microvascular health.
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Affiliation(s)
- Po Lai Yau
- Department of Psychiatry, New York University School of Medicine, New York, New York,Corresponding Author: Antonio Convit, M.D., Brain, Obesity, and Diabetes Laboratory (BODyLab), New York University School of Medicine, 145 East 32 Street, 8 Floor, New York, NY 10016, 212 263-7565 (phone), 212 263-4886 (fax),
| | - Minsung Kim
- Department of Psychiatry, New York University School of Medicine, New York, New York,Corresponding Author: Antonio Convit, M.D., Brain, Obesity, and Diabetes Laboratory (BODyLab), New York University School of Medicine, 145 East 32 Street, 8 Floor, New York, NY 10016, 212 263-7565 (phone), 212 263-4886 (fax),
| | - Aziz Tirsi
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Antonio Convit
- Department of Psychiatry, New York University School of Medicine, New York, New York,Department of Medicine, New York University School of Medicine, New York, New York,Department of Radiology, New York University School of Medicine, New York, New York,Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
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