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Sacco S, Foschi M, Ornello R, De Santis F, Pofi R, Romoli M. Prevention and treatment of ischaemic and haemorrhagic stroke in people with diabetes mellitus: a focus on glucose control and comorbidities. Diabetologia 2024; 67:1192-1205. [PMID: 38625582 PMCID: PMC11153285 DOI: 10.1007/s00125-024-06146-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
Diabetes mellitus is a significant risk factor for both ischaemic and haemorrhagic stroke, affecting up to a third of individuals with cerebrovascular diseases. Beyond being a risk factor for stroke, diabetes and hyperglycaemia have a negative impact on outcomes after ischaemic and haemorrhagic stroke. Hyperglycaemia during the acute ischaemic stroke phase is associated with a higher risk of haemorrhagic transformation and poor functional outcome, with evidence in favour of early intervention to limit and manage severe hyperglycaemia. Similarly, intensive glucose control nested in a broader bundle of care, including blood pressure, coagulation and temperature control, can provide substantial benefit for clinical outcomes after haemorrhagic stroke. As micro- and macrovascular complications are frequent in people with diabetes, cardiovascular prevention strategies also need to consider tailored treatment. In this regard, the broader availability of sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists can allow tailored treatments, particularly for those with heart failure and chronic kidney disease as comorbidities. Here, we review the main concepts of hyperacute stroke management and CVD prevention among people with diabetes, capitalising on results from large studies and RCTs to inform clinicians on preferred treatments.
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Affiliation(s)
- Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Matteo Foschi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico De Santis
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Riccardo Pofi
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, Churchill Hospital, University of Oxford, Oxford, UK
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
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Schweitzer N, Son SJ, Aizenstein H, Yang S, Iordanova B, Hong CH, Rho HW, Cho YH, Park B, Kim NR, Choi JW, Cheong JY, Seo SW, An YS, Moon SY, Han SJ, Wu M. Higher HbA1c Is Associated With Greater 2-Year Progression of White Matter Hyperintensities. Diabetes 2024; 73:604-610. [PMID: 38211578 PMCID: PMC10958578 DOI: 10.2337/db23-0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
White matter hyperintensity (WMH) lesions on brain MRI images are surrogate markers of cerebral small vessel disease. Longitudinal studies examining the association between diabetes and WMH progression have yielded mixed results. Thus, in this study, we investigated the association between HbA1c, a biomarker for the presence and severity of hyperglycemia, and longitudinal WMH change after adjusting for known risk factors for WMH progression. We recruited 64 participants from South Korean memory clinics to undergo brain MRI at the baseline and a 2-year follow-up. We found the following. First, higher HbA1c was associated with greater global WMH volume (WMHV) changes after adjusting for known risk factors (β = 7.7 × 10-4; P = 0.025). Second, the association between baseline WMHV and WMHV progression was only significant at diabetic levels of HbA1c (P < 0.05, when HbA1c >6.51%), and non-apolipoprotein E (APOE) ε4 carriers had a stronger association between HbA1c and WMHV progression (β = -2.59 × 10-3; P = 0.004). Third, associations of WMHV progression with HbA1c were particularly apparent for deep WMHV change (β = 7.17 × 10-4; P < 0.01) compared with periventricular WMHV change and, for frontal (β = 5.00 × 10-4; P < 0.001) and parietal (β = 1.53 × 10-4; P < 0.05) lobes, WMHV change compared with occipital and temporal WMHV change. In conclusion, higher HbA1c levels were associated with greater 2-year WMHV progression, especially in non-APOE ε4 participants or those with diabetic levels of HbA1c. These findings demonstrate that diabetes may potentially exacerbate cerebrovascular and white matter disease. ARTICLE HIGHLIGHTS
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Affiliation(s)
- Noah Schweitzer
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Sang Joon Son
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Howard Aizenstein
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Shaolin Yang
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Bistra Iordanova
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Chang Hyung Hong
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyun Woong Rho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Yong Hyuk Cho
- Department of Psychiatry, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Bumhee Park
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
- Office of Biostatistics, Medical Research Collaborating Centre, Ajou Research Institute for Innovative Medicine, Ajou University Medical Centre, Suwon, Republic of Korea
| | - Na-Rae Kim
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jae Youn Cheong
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Republic of Korea
- Human Genome Research and Bio-Resource Centre, Ajou University Medical Centre, Suwon, Republic of Korea
| | - Sang Woon Seo
- Department of Neurology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young-Sil An
- Department of Nuclear Medicine and Molecular Imaging, Ajou University School of Medicine, Suwon, Republic of Korea
| | - So Young Moon
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seung Jin Han
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Minjie Wu
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
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3
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Feng L, Gao L. The role of neurovascular coupling dysfunction in cognitive decline of diabetes patients. Front Neurosci 2024; 18:1375908. [PMID: 38576869 PMCID: PMC10991808 DOI: 10.3389/fnins.2024.1375908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Neurovascular coupling (NVC) is an important mechanism to ensure adequate blood supply to active neurons in the brain. NVC damage can lead to chronic impairment of neuronal function. Diabetes is characterized by high blood sugar and is considered an important risk factor for cognitive impairment. In this review, we provide fMRI evidence of NVC damage in diabetic patients with cognitive decline. Combined with the exploration of the major mechanisms and signaling pathways of NVC, we discuss the effects of chronic hyperglycemia on the cellular structure of NVC signaling, including key receptors, ion channels, and intercellular connections. Studying these diabetes-related changes in cell structure will help us understand the underlying causes behind diabetes-induced NVC damage and early cognitive decline, ultimately helping to identify the most effective drug targets for treatment.
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Affiliation(s)
| | - Ling Gao
- Department of Endocrinology, Renmin Hospital of Wuhan University, Wuhan, China
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Kasai S, Watanabe K, Ide S, Ishimoto Y, Sasaki M, Umemura Y, Tatsuo S, Kakeda S, Mikami T, Tamada Y, Miki Y, Wakabayashi K, Tomiyama M, Kakeda S. FLAIR Hyperintensities in the Anterior Part of the Callosal Splenium in the Elderly Population: A Large Cohort Study. Acad Radiol 2024:S1076-6332(24)00072-2. [PMID: 38413313 DOI: 10.1016/j.acra.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/24/2024] [Accepted: 02/01/2024] [Indexed: 02/29/2024]
Abstract
RATIONALE AND OBJECTIVES Although hyperintensity in the anterior portion of the callosal splenium on FLAIR (aCS-hyperintensity) is a common finding in elderly adults, no previous studies have examined the clinical significance. In this large elderly population study, we aimed to investigate the associations of aCS-hyperintensity with vascular risk factors, cognitive decline, and other MRI measurements. MATERIALS AND METHODS This cross-sectional study included 2110 participants (median age, 69 years; 61.1% females) who underwent 3 T MRI. The participants were grouped as 215 with mild cognitive impairment (MCI) and 1895 cognitively normal older adults (NOAs). Two neuroradiologists evaluated aCS-hyperintensity by using a four-point scale (none, mild, moderate, and severe). Periventricular hyperintensities (PVHs) were also rated on a four-point scale according to the Fazekas scale. The total intracranial volume (ICV), total brain volume, choroid plexus volume (CPV), and lateral ventricle volume (LVV) were calculated. RESULTS Logistic regression analysis showed diabetes was the main predictor of aCS-hyperintensity after adjusting for potential confounders (age, sex, hypertension, and hyperlipidemia) (p < 0.01), whereas PVH was associated with hypertension (p < 0.01). aCS-hyperintensity rated as "severe" was associated with a presence of MCI (p < 0.01). For the imaging factors, LVV was an independent predictor of aCS-hyperintensity when brain volume and PVH grade were added to the analysis (p < 0.01). CONCLUSION Cerebral small vessel disease due to diabetes is a major contributor to the development of aCS-hyperintensity. Cerebrospinal fluid clearance failure may also relate to aCS-hyperintensity, which may offer new insights into the pathologic processes underlying MCI.
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Affiliation(s)
- Sera Kasai
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Keita Watanabe
- Department of radiology, Kyoto Prefectural University of Medicine, 465 Kajiimachi, Jokyo-ku, Kyoto-shi, Kyoto, Japan.
| | - Satoru Ide
- Department of Radiology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Yuka Ishimoto
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Miho Sasaki
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshihito Umemura
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Soichiro Tatsuo
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sachi Kakeda
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tatsuya Mikami
- Innovation Center for Health Promotion, Hirosaki University, Hirosaki, Japan
| | - Yoshinori Tamada
- Innovation Center for Health Promotion, Hirosaki University, Hirosaki, Japan
| | - Yasuo Miki
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Koichi Wakabayashi
- Department of Neuropathology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Masahiko Tomiyama
- Department of Neurology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Kakeda
- Department of Radiology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Liu Y, Jiang Y, Du W, Gao B, Gao J, Hu S, Song Q, Wang W, Miao Y. White matter microstructure alterations in type 2 diabetes mellitus and its correlation with cerebral small vessel disease and cognitive performance. Sci Rep 2024; 14:270. [PMID: 38167604 PMCID: PMC10762026 DOI: 10.1038/s41598-023-50768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 12/25/2023] [Indexed: 01/05/2024] Open
Abstract
Microstructural abnormalities of white matter fiber tracts are considered as one of the etiology of diabetes-induced neurological disorders. We explored the cerebral white matter microstructure alteration accurately, and to analyze its correlation between cerebral small vessel disease (CSVD) burden and cognitive performance in type 2 diabetes mellitus (T2DM). The clinical-laboratory data, cognitive scores [including mini-mental state examination (MMSE), Montreal cognitive assessment (MoCA), California verbal learning test (CVLT), and symbol digit modalities test (SDMT)], CSVD burden scores of the T2DM group (n = 34) and healthy control (HC) group (n = 21) were collected prospectively. Automatic fiber quantification (AFQ) was applied to generate bundle profiles along primary white matter fiber tracts. Diffusion tensor images (DTI) metrics and 100 nodes of white matter fiber tracts between groups were compared. Multiple regression analysis was used to analyze the relationship between DTI metrics and cognitive scores and CSVD burden scores. For fiber-wise and node-wise, DTI metrics in some commissural and association fibers were increased in T2DM. Some white matter fiber tracts DTI metrics were independent predictors of cognitive scores and CSVD burden scores. White matter fiber tracts damage in patients with T2DM may be characterized in specific location, especially commissural and association fibers. Aberrational specific white matter fiber tracts are associated with visuospatial function and CSVD burden.
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Affiliation(s)
- Yangyingqiu Liu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
- Department of Radiology, Zibo Central Hospital, 54 Gongqingtuan Road, Zhangdian, Zibo, China
| | - Yuhan Jiang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Wei Du
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Bingbing Gao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Jie Gao
- Department of Neurology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Shuai Hu
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Qingwei Song
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China
| | - Weiwei Wang
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China.
| | - Yanwei Miao
- Department of Radiology, First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Xigang, Dalian, China.
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Gao R, Zhan M, Ke S, Wu K, He G, Qi L, Liu X, Liu X, Wang L, Liu L. Potential risk factors for mild cognitive impairment among patients with type 2 diabetes experiencing hypoglycemia. Diabetes Res Clin Pract 2024; 207:111036. [PMID: 38049036 DOI: 10.1016/j.diabres.2023.111036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/25/2023] [Accepted: 12/01/2023] [Indexed: 12/06/2023]
Abstract
AIMS This study examined the association between hypoglycemia and mild cognitive impairment (MCI) among patients with type 2 diabetes mellitus (T2DM) and identified risk factors for MCI in patients with hypoglycemia. METHODS In this retrospective study, 328 patients with T2DM were screened in 2019 and followed up in 2022. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA). The diagnosis of MCI was based on established criteria. Risk ratio (RR) with 95 % confidence intervals (CI) was calculated to estimate the risk of MCI. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for MCI in those with hypoglycemia. RESULTS Patients with hypoglycemia had lower cognitive performance 3 years later. The RR of MCI was 2.221 (95 % CI 1.269-3.885). Multivariate logistic analysis showed that low grip strength, existing diabetic retinopathy (DR), and multiple hypoglycemia episodes were associated with higher odds of MCI in patients with hypoglycemia (adjusted odds ratio [OR] 0.909 [95 % CI 0.859-0.963]), 3.078 [95 % CI 1.158-12.358], and 4.642 [95 % CI 1.284-16.776], respectively, all P < 0.05). CONCLUSIONS Hypoglycemia increased MCI risk among patients with T2DM. Low grip strength, DR, and multiple hypoglycemia episodes may be potential risk factors for hypoglycemia-associated MCI.
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Affiliation(s)
- Ruonan Gao
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Menglan Zhan
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Sujie Ke
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Kejun Wu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Guanlian He
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Liqin Qi
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaoying Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaohong Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Lijing Wang
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Libin Liu
- Department of Endocrinology, Fujian Medical University Union Hospital, Fuzhou, China.
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7
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Mauricio D, Gratacòs M, Franch-Nadal J. Diabetic microvascular disease in non-classical beds: the hidden impact beyond the retina, the kidney, and the peripheral nerves. Cardiovasc Diabetol 2023; 22:314. [PMID: 37968679 PMCID: PMC10652502 DOI: 10.1186/s12933-023-02056-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023] Open
Abstract
Diabetes microangiopathy, a hallmark complication of diabetes, is characterised by structural and functional abnormalities within the intricate network of microvessels beyond well-known and documented target organs, i.e., the retina, kidney, and peripheral nerves. Indeed, an intact microvascular bed is crucial for preserving each organ's specific functions and achieving physiological balance to meet their respective metabolic demands. Therefore, diabetes-related microvascular dysfunction leads to widespread multiorgan consequences in still-overlooked non-traditional target organs such as the brain, the lung, the bone tissue, the skin, the arterial wall, the heart, or the musculoskeletal system. All these organs are vulnerable to the physiopathological mechanisms that cause microvascular damage in diabetes (i.e., hyperglycaemia-induced oxidative stress, inflammation, and endothelial dysfunction) and collectively contribute to abnormalities in the microvessels' structure and function, compromising blood flow and tissue perfusion. However, the microcirculatory networks differ between organs due to variations in haemodynamic, vascular architecture, and affected cells, resulting in a spectrum of clinical presentations. The aim of this review is to focus on the multifaceted nature of microvascular impairment in diabetes through available evidence of specific consequences in often overlooked organs. A better understanding of diabetes microangiopathy in non-target organs provides a broader perspective on the systemic nature of the disease, underscoring the importance of recognising the comprehensive range of complications beyond the classic target sites.
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Affiliation(s)
- Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain.
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, IR Sant Pau, Barcelona, Spain.
- Department of Medicine, University of Vic - Central University of Catalonia, Vic, Spain.
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Josep Franch-Nadal
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain
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8
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Li MZ, Zhang L, Shi ZY, Jiang DC, Yang XY. Magnetic resonance imaging detects cerebral gray and white matter injury correlated with cognitive impairments in diabetic db/db mice. Behav Brain Res 2023; 451:114510. [PMID: 37244436 DOI: 10.1016/j.bbr.2023.114510] [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: 03/15/2023] [Revised: 05/08/2023] [Accepted: 05/25/2023] [Indexed: 05/29/2023]
Abstract
Type-2 diabetes not only causes gray matter injury but also induces widespread white matter damages, which may contribute the cognitive impairments. This study aimed to assess the structural alterations of the gray and white matter in 20-week-old diabetic db/db mice using magnetic resonance imaging including T2-weighted imaging (T2WI) and diffusion tensor imaging (DTI), and to correlate them with the cognitive performance detected by Morris water maze (MWM). The results revealed impaired spatial learning and memory in db/db mice. T2WI detected severe brain atrophy involving the hippocampus and cortex after diabetes. DTI showed reduced fractional anisotropy (FA) in the cortex, hippocampus, corpus callosum/external capsule, and increased radial diffusivity in the corpus callosum/external capsule of the db/db mice. The immunostaining confirmed the MRI findings showing decreased cell density in the cortex, hippocampus, and reduced integrated optical density of Luxol fast blue staining in the corpus callosum/external capsule. The correlational analysis revealed that the T2WI-derived tissue atrophy and DTI-derived FA in the relevant gray matter and white matter significantly correlated with the behavior performance in the MWM test. Collectively, the present in vivo MRI detected varying degrees of structural abnormalities in the gray and white matter of db/db mice, which might be favorable predictors of diabetic cognitive dysfunction. Our findings might provide new clues for identifying gray and white matter damages associated with cognitive decline, which is imperative for the evaluation of potential pharmacological therapies in preclinical phase.
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Affiliation(s)
- Man-Zhong Li
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China
| | - Lei Zhang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China
| | - Zheng-Yuan Shi
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China
| | - De-Chun Jiang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China.
| | - Xin-Yu Yang
- Department of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China; Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China.
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9
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Inoue Y, Shue F, Bu G, Kanekiyo T. Pathophysiology and probable etiology of cerebral small vessel disease in vascular dementia and Alzheimer's disease. Mol Neurodegener 2023; 18:46. [PMID: 37434208 PMCID: PMC10334598 DOI: 10.1186/s13024-023-00640-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Vascular cognitive impairment and dementia (VCID) is commonly caused by vascular injuries in cerebral large and small vessels and is a key driver of age-related cognitive decline. Severe VCID includes post-stroke dementia, subcortical ischemic vascular dementia, multi-infarct dementia, and mixed dementia. While VCID is acknowledged as the second most common form of dementia after Alzheimer's disease (AD) accounting for 20% of dementia cases, VCID and AD frequently coexist. In VCID, cerebral small vessel disease (cSVD) often affects arterioles, capillaries, and venules, where arteriolosclerosis and cerebral amyloid angiopathy (CAA) are major pathologies. White matter hyperintensities, recent small subcortical infarcts, lacunes of presumed vascular origin, enlarged perivascular space, microbleeds, and brain atrophy are neuroimaging hallmarks of cSVD. The current primary approach to cSVD treatment is to control vascular risk factors such as hypertension, dyslipidemia, diabetes, and smoking. However, causal therapeutic strategies have not been established partly due to the heterogeneous pathogenesis of cSVD. In this review, we summarize the pathophysiology of cSVD and discuss the probable etiological pathways by focusing on hypoperfusion/hypoxia, blood-brain barriers (BBB) dysregulation, brain fluid drainage disturbances, and vascular inflammation to define potential diagnostic and therapeutic targets for cSVD.
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Affiliation(s)
- Yasuteru Inoue
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Francis Shue
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
| | - Guojun Bu
- SciNeuro Pharmaceuticals, Rockville, MD 20850 USA
| | - Takahisa Kanekiyo
- Department of Neuroscience, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224 USA
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10
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Rakotomanana JL, Randrianantoandro NR, Rasaholiarison NF, Faoulat AY, Rafanomezantsoa R, Raobela L, Tehindrazanarivelo AD. Correlation between silent lacunar strokes and retinopathies seen on fundus among patients hospitalized for lacunar strokes: An observational study at the neurology department of Befelatanana University Hospital. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:250-255. [PMID: 36464420 DOI: 10.1016/j.jdmv.2022.10.011] [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: 08/08/2022] [Accepted: 10/20/2022] [Indexed: 06/17/2023]
Abstract
Retinal and cerebral arterioles have similar characteristics. Silent infarcts are associated with a risk of incident lacunar stroke and dementia. The objective of our study was to determine the correlation between silent lacunar strokes and retinopathy in patients hospitalized in our department for lacunar strokes. This is an observational, retrospective study, from July 2018 to December 2019, of patients diagnosed with lacunar stroke at the neurology department of Befelatanana Hospital, Antananarivo. Stroke was diagnosed with brain CT scan and retinopathy was classified according to fundus examination. The correlation between the presence of silent lacunar stroke and different types and stages of retinopathy was studied. Silent lacunar lesions were discovered on imaging in 70.59% of patients with lacunar strokes. All patients with symptomatic lacunar stroke, with or without associated silent lacunar lesions, were hypertensives. No statistical difference was found between patients with or without associated silent lacunar lesions according to age and gender. Among patients with silent lacunar lesions, dysexecutive syndrome was more prevalent as compared to patients without silent lesions (52.63% vs. 47.36%, P=0.03). Arteriolopathy was more prevalent in patients with silent lacunar lesions (85.71% vs. 14.28%, P=0.047). Silent lacunar lesions were unique in 72% of cases (P=0.022). The presence of stage II hypertensive retinopathy was significantly correlated with the presence of silent lacunar lesions (OR 5.20 [1.02-267] [1.02-26.47], P=0.018). Upon discovery of stage II hypertensive retinopathy on fundus examination, brain imaging should be performed for silent lacunar stroke screening to optimize hypertension management. This management is expected to prevent the incidence of lacunar stroke and vascular dementia.
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Affiliation(s)
- J L Rakotomanana
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar.
| | - N R Randrianantoandro
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - N F Rasaholiarison
- Neurology Department, University Teaching Hospital Tambohobe, Fianarantsoa, Madagascar
| | - A Y Faoulat
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
| | - R Rafanomezantsoa
- Ophtalmology Department, University Teaching Hospital Joseph Ravoahangy Ampefiloha, Antananarivo, Madagascar
| | - L Raobela
- Ophtalmology Department, University Teaching Hospital Joseph Ravoahangy Ampefiloha, Antananarivo, Madagascar
| | - A D Tehindrazanarivelo
- Neurology Department, University Teaching Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar
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11
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Reduced white matter microstructural integrity in prediabetes and diabetes: A population-based study. EBioMedicine 2022; 82:104144. [PMID: 35810560 PMCID: PMC9278067 DOI: 10.1016/j.ebiom.2022.104144] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background White matter (WM) microstructural abnormalities have been observed in diabetes. However, evidence of prediabetes is currently lacking. This study aims to investigate the WM integrity in prediabetes and diabetes. We also assess the association of WM abnormalities with glucose metabolism status and continuous glucose measures. Methods The WM integrity was analyzed using cross-sectional baseline data from a population-based PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events (PRECISE) study. The cohort, including a total of 2218 cases with the mean age of 61.3 ± 6.6 years and 54.1% female, consisted of 1205 prediabetes which are categorized into two subgroups (a group of 254 prediabetes with combined impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and the other group of 951 prediabetes without combined IFG/IGT), 504 diabetes, and 509 normal control subjects. Alterations of WM integrity were determined by diffusion tensor imaging along with tract-based spatial statistics analysis to compare diffusion metrics on WM skeletons between groups. The mixed-effects multivariate linear regression models were used to assess the association between WM microstructural alterations and glucose status. Findings Microstructural abnormalities distributed in local WM tracts in prediabetes with combined IFG/IGT and spread widely in diabetes. These WM abnormalities are associated with higher glucose measures. Interpretation Our findings suggest that WM microstructural abnormalities are already present at the prediabetes with combined IFG/IGT stage. Preventative strategies should begin early to maintain normal glucose metabolism and avert further destruction of WM integrity. Funding Partially supported by National Key R&D Program of China (2016YFC0901002).
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12
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Chai YH, Zhang YP, Qiao YS, Gong HJ, Xu H, She HC, Patel I, Liu W, Stehouwer CDA, Zhou JB, Simó R. Association Between Diabetic Retinopathy, Brain Structural Abnormalities, and Cognitive Impairment for Accumulated Evidence in Observational Studies. Am J Ophthalmol 2022; 239:37-53. [PMID: 35063409 DOI: 10.1016/j.ajo.2022.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the association between diabetic retinopathy (DR) and cerebral disease or cognitive impairment. DESIGN Systematic review and meta-analysis. METHOD The hypothesis was formulated prior to data collection. Cross-sectional studies and cohort studies that assessed the association between any measure of DR and cerebral small vessel disease or any type of cognitive impairment in diabetic participants were included. The data were independently extracted by two investigators. This systematic review and meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses and Meta-analysis of Observational Studies in Epidemiology guidelines RESULTS: A total of 27 studies were included. The combined odds ratio of 5 cross-sectional/cohort studies that reported that the associations between DR and cerebral structural changes was 1.75 (95% confidence interval [CI]: 1.36-2.25). The combined hazard ratio of 4 cohort studies that examined the association between DR and cognitive impairment events was 1.47 (95% CI: 1.22-1.78). The combined odds ratio of 14 cross-sectional/cohort studies that examined the association between DR and different cognitive impairment events was 1.43 (95% CI: 1.06-1.93). The overall coefficient (β) of 4 studies that examined the relationship between DR and specific cognitive performance was 0.09 (95% CI: 0.00-0.18). Considering the quality of the data, we have performed subgroup analysis in studies scored >7 and studies scored ≤7, respectively, according to the Newcastle-Ottawa scale. CONCLUSION The present meta-analysis suggests that DR is associated with an increased risk of structural abnormalities in the brain and cognitive impairment. This association remained significant after adjusting for blood glucose, and the presence of hypertension, indicating that DR is an important danger signal for cerebral abnormalities.
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Affiliation(s)
- Yin-He Chai
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yong-Peng Zhang
- Beijing Tongren Eye Center (Y.P.Z., H.C.S.), Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yu-Shun Qiao
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hong-Jian Gong
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hui Xu
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Hai-Cheng She
- Beijing Tongren Eye Center (Y.P.Z., H.C.S.), Beijing Key Laboratory of Ophthalmology and Visual Science, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ikramulhaq Patel
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Wei Liu
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Coen D A Stehouwer
- Department of Internal Medicine and CARIM School for Cardiovascular Diseases (C.D.A.S.), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jian-Bo Zhou
- From the Department of Endocrinology (Y.-H.C., Y.-S.Q, H.-J.G, H.X., I.P., W.L. J.B.Z.), Beijing Tongren Hospital, Capital Medical University, Beijing, China.
| | - Rafael Simó
- Department of Endocrinology and Nutrition (R.S.), Vall d'Hebron University Hospital, Autonomous University, Barcelona, Spain; Diabetes and Metabolism Research Unit (R.S.), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM) (R.S.), Instituto de Salud Carlos III (ICSIII), Madrid, Spain
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13
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Morton JS, Patton B, Morse CJ, El Karsh Z, Rodrigues LA, Mousseau DD, Ferguson DP, Columbus DA, Weber LP, Olver TD. Altered cerebrovascular regulation in low birthweight swine. Comp Biochem Physiol A Mol Integr Physiol 2022; 267:111163. [PMID: 35151870 DOI: 10.1016/j.cbpa.2022.111163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/04/2022] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
Full-term low birthweight (LBW) offspring exhibit peripheral vascular dysfunction in the postnatal period; however, whether such impairments extend to the cerebrovasculature remains to be elucidated. We used a swine model to test the hypothesis that LBW offspring would exhibit cerebrovascular dysfunction at later stages of life. Offspring from 14 sows were identified as normal birthweight (NBW) or LBW and were assessed at 28 (similar to end of infancy) and 56 (similar to childhood) days of age. LBW swine had lower absolute brain mass, but demonstrated evidence of brain sparing (increased brain mass scaled to body mass) at 56 days of age. The cerebral pulsatility index, based on transcranial Doppler, was increased in LBW swine. Moreover, arterial myography of isolated cerebral arteries revealed impaired vasoreactivity to bradykinin and reduced contribution of nitric oxide (NO) to vasorelaxation in the LBW swine. Immunoblotting demonstrated a lower ratio of phosphorylated-to-total endothelial NO synthase in LBW offspring. This impairment in NO signaling was greater at 28 vs. 56 days of age. Vasomotor responses to sodium nitroprusside (NO-donor) were unaltered, while Leu31, Pro34 neuropeptide Y-induced vasoconstriction was enhanced in LBW swine. Increases in total Y1 receptor protein content in the LBW group were not significant. In summary, LBW offspring displayed signs of cerebrovascular dysfunction at 28 and 56 days of age, evidenced by altered cerebral hemodynamics (reflective of increased impedance) coupled with endothelial dysfunction and altered vasomotor control. Overall, the data reveal that normal variance in birthweight of full-term offspring can influence cerebrovascular function later in life.
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Affiliation(s)
- Jude S Morton
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Breanna Patton
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cameron J Morse
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Zeyad El Karsh
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lucas A Rodrigues
- Department of Animal and Poultry Science, College of Agriculture and Bioresources, University of Saskatchewan, Saskatoon, SK, Canada; Prairie Swine Center, Inc., Saskatoon, SK, Canada
| | - Darrell D Mousseau
- Cell Signalling Laboratory, Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - David P Ferguson
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA
| | - Daniel A Columbus
- Department of Animal and Poultry Science, College of Agriculture and Bioresources, University of Saskatchewan, Saskatoon, SK, Canada; Prairie Swine Center, Inc., Saskatoon, SK, Canada
| | - Lynn P Weber
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - T Dylan Olver
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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14
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Inkeri J, Adeshara K, Harjutsalo V, Forsblom C, Liebkind R, Tatlisumak T, Thorn LM, Groop PH, Shams S, Martola J, Putaala J, Gordin D. Glycemic control is not related to cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. Acta Diabetol 2022; 59:481-490. [PMID: 34778921 PMCID: PMC8917104 DOI: 10.1007/s00592-021-01821-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
AIMS To determine if medium- and long-term blood glucose control as well as glycemic variability, which are known to be strong predictors of vascular complications, are associated with underlying cerebral small vessel disease (cSVD) in neurologically asymptomatic individuals with type 1 diabetes. METHODS A total of 189 individuals (47.1% men; median age 40.0, IQR 33.0-45.2 years) with type 1 diabetes (median diabetes duration of 21.7, IQR 18.3-30.7 years) were enrolled in a cross-sectional retrospective study, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. Glycated hemoglobin (HbA1c) values were collected over the course of ten years before the visit including a clinical examination, biochemical sampling, and brain magnetic resonance imaging. Markers of glycemic control, measured during the visit, included HbA1c, fructosamine, and glycated albumin. RESULTS Signs of cSVD were present in 66 (34.9%) individuals. Medium- and long-term glucose control and glycemic variability did not differ in individuals with signs of cSVD compared to those without. Further, no difference in any of the blood glucose variables and cSVD stratified for cerebral microbleeds (CMBs) or white matter hyperintensities were detected. Neither were numbers of CMBs associated with the studied glucose variables. Additionally, after dividing the studied variables into quartiles, no association with cSVD was observed. CONCLUSIONS We observed no association between glycemic control and cSVD in neurologically asymptomatic individuals with type 1 diabetes. This finding was unexpected considering the large number of signs of cerebrovascular pathology in these people after two decades of chronic hyperglycemia and warrants further studies searching for underlying factors of cSVD.
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Affiliation(s)
- Jussi Inkeri
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Krishna Adeshara
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Ron Liebkind
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience/Neurology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Australia.
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Juha Martola
- HUS Medical Imaging Center, Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Jukka Putaala
- Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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15
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Vidyashree M, Deepeshwar S, Nagarathna R, Manjunath NK, Kaligal C, Kanthi A, Nagendra HR, Bathala L, Sharma VK. Transcranial Doppler studies in Type 2 diabetes mellitus: A systematic review. Diabetes Res Clin Pract 2022; 186:109808. [PMID: 35247526 DOI: 10.1016/j.diabres.2022.109808] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 02/15/2022] [Accepted: 02/28/2022] [Indexed: 12/20/2022]
Abstract
BACKGROUND Type II Diabetes mellitus (T2DM) patients are at the risk of developing cerebrovascular diseases, often contributed by altered cerebral haemodynamics. We present a systematic review of studies on cerebral haemodynamics assessment using transcranial Doppler (TCD) in T2DM. REVIEW METHOD A systematic review of the published articles in the English language between 1991 to 2021. DATA SOURCES Articles were retrieved via Pubmed and Cochrane library. We included Cross-sectional, prospective, retrospective, randomized controlled, and cross-over studies for this review. RESULTS A total of 25 articles met the inclusion criteria, which provided data for 3212 patients. CONCLUSION Cerebral autoregulation is often impaired among patients with T2DM. The risk increased with the duration of T2DM, related complications and presence of comorbidities.
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Affiliation(s)
- Mahadevappa Vidyashree
- Yoga and Life Sciences, Swami Vivekananda Yoga Anusandana Samsthana(S-VYASA), Bangalore, India.
| | - Singh Deepeshwar
- Yoga and Life Sciences, Swami Vivekananda Yoga Anusandana Samsthana(S-VYASA), Bangalore, India.
| | - Raghuram Nagarathna
- Yoga and Life Sciences, Swami Vivekananda Yoga Anusandana Samsthana(S-VYASA), Bangalore, India
| | | | - Chidananda Kaligal
- Yoga and Life Sciences, Swami Vivekananda Yoga Anusandana Samsthana(S-VYASA), Bangalore, India
| | - Amit Kanthi
- Yoga and Life Sciences, Swami Vivekananda Yoga Anusandana Samsthana(S-VYASA), Bangalore, India
| | | | | | - Vijay K Sharma
- Yong Loo Lin School of Medicine, National University of Singapore and Division of Neurology, National University Hospital, Singapore
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16
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Karjee H, Ghosh S, Dhibar T. Association of mid-life cerebral small vessel disease with diabetic retinopathy in type 2 diabetes in an Indian population. J Diabetes Complications 2022; 36:108149. [PMID: 35172935 DOI: 10.1016/j.jdiacomp.2022.108149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/18/2022] [Accepted: 02/06/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Prevalence of cerebral small vessel disease (SVD) in elderly patients with diabetic retinopathy (DR) is higher than in those without DR. We determined the prevalence and severity of SVD in middle-aged patients with DR and compared it with those without DR (NODR) in a subset of the Indian population. We feel this information is critical with evolving trends of an increasing incidence of stroke at younger ages. METHOD Institution-based analytical cross-sectional study with 88 middle-aged type 2 diabetes patients; 44 in each group with <10 years diabetes duration, <8% HbA1C value, and with no history of cardiovascular disease. The presence and severity of SVD were determined by magnetic resonance imaging (MRI). RESULT Prevalence of SVD was 59.1% among study participants; 70.5% in DR and 47.7% in NODR (p = .03). Significantly increased SVD score (p = .008), high SVD score (p = .030), and white matter hyperintensity (WMH) load (p = .017) were observed in DR compared to NODR. There was no difference in the load of lacune and microbleed. SVD score did not differ according to the severity of DR (p = .395). The location-wise study of MRI revealed a significantly higher SVD load at the centrum semiovale in DR than in NODR (p = .014). We observed a 2.6 times greater chance of SVD (Odds ratio: 2.6, 95% CI 1.1-6.3) and a 9.6 times greater chance of high SVD score (Odds ratio: 9.6, 95% CI 1.1-80.0) in DR compared to NODR. CONCLUSION Significantly higher burden of SVD in DR was observed, particularly affecting the centrum semiovale suggesting an association of mid-life SVD with DR in this population.
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Affiliation(s)
- Himadri Karjee
- Department of Ophthalmology, Calcutta National Medical College, 32 Gorachand Road, Kolkata 700014, India
| | - Sambuddha Ghosh
- Department of Ophthalmology, Calcutta National Medical College, 32 Gorachand Road, Kolkata 700014, India.
| | - Tapan Dhibar
- Department of Radiology, Bangur Institue of Neurosciences, 52/1a, Sambhunath Pandit St, Gokhel Road, Bhowanipore, Kolkata 700020, India
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17
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Zhang Y, Zhang Z, Zhang M, Cao Y, Yun W. Correlation Between Retinal Microvascular Abnormalities and Total Magnetic Resonance Imaging Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes. Front Neurosci 2022; 15:727998. [PMID: 34970109 PMCID: PMC8712683 DOI: 10.3389/fnins.2021.727998] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Purpose: Diabetic retinopathy (DR) is one of the common microvascular complications in diabetes. The total magnetic resonance imaging (MRI) burden of cerebral small vessel disease (CSVD) tends to be increased in diabetic patients and is a marker of microvascular disease; however, the relationship between DR and CSVD is unclear. This study aimed to explore the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD in patients with type 2 diabetes. Methods: Data were collected from patients with type 2 diabetes who were hospitalized between December 2019 and November 2020 in Changzhou Second People’s Hospital affiliated to Nanjing Medical University. All patients underwent retinal photography and cerebral MRI. The central retinal artery equivalent (CRAE), the central retinal venous equivalent (CRVE), and arteriole-to-venule ratio (AVR) were calculated using Image J software to determine the retinal vascular calibers for each patient. The total MRI burden score for CSVD was determined, and the relationship between retinal microvascular abnormalities and the total MRI burden of CSVD was analyzed. Results: Of the 151 diabetic patients included in the study, 84 (55.6%) had no diabetic retinopathy (NDR), 27 (17.9%) had mild DR, and 40 (26.5%) had moderate, or severe non-proliferative DR (grouped together for this study as “more than mild DR”). In patients with more than mild DR, the proportion of moderate to severe burden of CSVD was 75%, which was higher than in patients with mild DR (48.1%) or NDR (26.2%). Patients with moderate to severe burden of CSVD were more likely than those with mild burden of CSVD to have narrowed retinal arterioles (105.24 ± 8.42 μm vs. 109.45 ± 7.93 μm), widened retinal venules (201.67 ± 16.25 μm vs. 193.95 ± 13.54 μm), and lower arteriole-to-venule ratio (0.52 ± 0.05 vs. 0.57 ± 0.04) (P < 0.05 for all). The degree of DR (r = 0.465, P < 0.001) and CRVE (r = 0.366, P < 0.001) were positively correlated with the total MRI burden of CSVD. Multivariate logistic regression analysis indicated that, after adjustments were made for age, smoking, alcohol consumption, hypertension, and other factors, more than mild DR (OR, 4.383; P = 0.028), CRAE (OR, 0.490; P = 0.031), and CRVE (OR, 1.475; P = 0.041) were independently associated with moderate to severe burden of CSVD. Conclusion: Retinal microvascular abnormalities in patients with type 2 diabetes are associated with the presence of cerebral small vessel lesions. The degree of DR and retinal vessel changes can be used as predictors of intracranial microcirculation lesions.
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Affiliation(s)
- Ying Zhang
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Zhixiang Zhang
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Min Zhang
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Yin Cao
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
| | - Wenwei Yun
- Department of Neurology, Changzhou Second People's Hospital Affiliated to Nanjing Medical University, Changzhou, China
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18
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Purroy F, Sánchez E, Lecube A, Arqué G, Vicente-Pascual M, Mauri-Capdevila G, Torreguitart N, Hernández M, Barbé F, Fernández E, Pamplona R, Farràs C, Mauricio D, Bermúdez-López M. Prevalence and Predictors of Cerebral Microangiopathy Determined by Pulsatility Index in an Asymptomatic Population From the ILERVAS Project. Front Neurol 2022; 12:785640. [PMID: 34970215 PMCID: PMC8712482 DOI: 10.3389/fneur.2021.785640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Little is known about the prevalence of cerebral microangiopathy (CM), which is related to cognitive impairment, in an asymptomatic population. Pulsatility index (PI) is an easily measurable parameter of cerebral vascular resistance in transcranial duplex of the middle cerebral artery (MCA) study. We aimed to determine the prevalence of CM measured by PI of MCA in low to moderate vascular risk subjects. Methods: We included 3,721 subjects between 45 and 70 years without previous history of vascular disease or diabetes mellitus and with at least one other vascular risk factor from the cross-sectional study ILERVAS (Lleida, Spain). Patients underwent transcranial duplex to determine MCA-PI. Possible CM was defined by MCA-PI >1.1. Carotid and femoral arteries ultrasound registration was done to determine the presence, the number, and the area of atheromatous plaques. Body mass index (BMI), pulse pressure (PP) and laboratory data were also recorded. Results: 439 (11.8%) subjects were excluded due to the low quality of transcranial duplex images. Median age was 57 [IQR 52, 62] years. Possible CM was found in 424 (12.9%) subjects. CM patients had higher prevalence of plaques than non-CM (77.4 vs. 66.4%, p < 0.001). PI showed a positive linear correlation with the number of territories with plaques (r = 0.130, p < 0.001), and the total plaque area (r = 0.082, p < 0.001). The predictors of possible CM were the age, male gender, and PP. Conclusions: In low-to-moderate vascular risk asymptomatic population, the proportion of abnormal brain microvascular bed determined by MCA-PI is not negligible. The planned 10-year follow-up will describe the clinical relevance of these findings.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, University Hospital Arnau de Vilanova, Lleida, Spain.,Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Enric Sánchez
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain
| | - Albert Lecube
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain.,CIBER de Diabetes y Enfermedades Metabólicas Asociadas, CIBERDEM, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Gloria Arqué
- Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | | | - Gerard Mauri-Capdevila
- Stroke Unit, University Hospital Arnau de Vilanova, Lleida, Spain.,Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Núria Torreguitart
- Clinical Neurosciences Group, IRBLleida, University of Lleida, Lleida, Spain.,Vascular Surgery Service, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Marta Hernández
- Endocrinology and Nutrition Department, University Hospital Arnau de Vilanova, Lleida, Spain.,Obesity, Diabetes and Metabolism (ODIM) Research Group, IRBLleida, Lleida, Spain.,University of Lleida, Lleida, Spain
| | - Ferrán Barbé
- Pneumology Service, Translational Research in Respiratory Medicine Research Group, IRBLleida, University Hospital Arnau de Vilanova, University of Lleida, Lleida, Spain.,CIBER de Enfermedades Respiratorias, CIBERES, Instituto de Salud Carlos III (ISCIII), Lleida, Spain
| | - Elvira Fernández
- Vascular and Renal Translational Research Group, IRBLleida, ReinRen-ISCIII, University of Lleida, Lleida, Spain
| | - Reinald Pamplona
- Department of Experimental Medicine, Metabolic Pathophysiology Research Group, IRBLleida, University of Lleida, Lleida, Spain
| | - Cristina Farràs
- DAP Lleida, Unitat de Suport a la Recerca - IDIAP Jordi Gol, Lleida, Spain
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, CIBER of Diabetes and Associated Metabolic Diseases, Hospital de la Sant Creu i Sant Pau, Barcelona, Spain
| | - Marcelino Bermúdez-López
- Vascular and Renal Translational Research Group, IRBLleida, ReinRen-ISCIII, University of Lleida, Lleida, Spain
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19
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Choi EY, Park YW, Lee M, Kim M, Lee CS, Ahn SS, Kim J, Lee SK. Magnetic Resonance Imaging-Visible Perivascular Spaces in the Basal Ganglia Are Associated With the Diabetic Retinopathy Stage and Cognitive Decline in Patients With Type 2 Diabetes. Front Aging Neurosci 2021; 13:666495. [PMID: 34867262 PMCID: PMC8633948 DOI: 10.3389/fnagi.2021.666495] [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: 02/10/2021] [Accepted: 10/13/2021] [Indexed: 01/14/2023] Open
Abstract
Purpose: The aim of this study was to evaluate whether perivascular space (PVS) severity and retinal ganglion cell layer (GCL) thickness differed based on the stage of diabetic retinopathy (DR) and the cognitive status in patients with DR. Methods: A total of 81 patients with DR (51 in the non-proliferative group and 30 in the proliferative group) were included in this retrospective, cross-sectional study. PVS severity was assessed in the basal ganglia (BG) and centrum semiovale using MRI. The total cerebral small vessel disease (SVD) score was determined based on the numbers of lacunes and microbleeds and the severity of white matter hyperintensity. Optical coherence tomography was used to measure foveal and perifoveal GCL thicknesses. Cerebral SVD markers and cognitive function were compared between the groups, and correlations between the BG-PVS severity and the Mini-Mental Status Examination (MMSE) scores and GCL parameters were evaluated. Results: Patients with proliferative DR had higher BG-PVS severity (P = 0.012), higher total cerebral SVD scores (P = 0.035), reduced GCL thicknesses in the inferior (P = 0.027), superior (P = 0.046), and temporal (P = 0.038) subfields compared to patients with non-proliferative DR. In addition, the BG-PVS severity was negatively correlated with the MMSE score (P = 0.007), and the GCL thickness was negatively correlated with the BG-PVS severity (P-values < 0.05 for inferior, superior, and temporal subfields). Conclusion: BG-PVS severity and retinal GCL thickness may represent novel imaging biomarkers reflecting the stage of DR and cognitive decline in diabetic patients. Furthermore, these results suggest a possible link between cerebral and retinal neurodegeneration at the clinical level.
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Affiliation(s)
- Eun Young Choi
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | - Yae Won Park
- Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Minyoung Lee
- Department of Endocrinology, Yonsei University College of Medicine, Seoul, South Korea
| | - Min Kim
- Department of Ophthalmology, Yonsei University College of Medicine, Seoul, South Korea
| | | | - Sung Soo Ahn
- Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinna Kim
- Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung-Koo Lee
- Department of Radiology, Center for Clinical Imaging Data Science, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, South Korea
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20
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Carotid revascularization and cognitive impairment: the neglected role of cerebral small vessel disease. Neurol Sci 2021; 43:139-152. [PMID: 34596778 DOI: 10.1007/s10072-021-05629-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
Carotid atherosclerosis is a pathological process that leads to narrowing of the vessel lumen and a consequent risk of stroke. Revascularization procedures such as carotid endarterectomy (CEA) and carotid stenting aim to reduce occurrence of stroke in selected patients. Due to the proven benefit and low intraoperative risk, CEA is currently the preferred choice in candidates for carotid revascularization. However, the risk of cognitive impairment subsequent to CEA has not been fully elucidated and is unclear whether certain conditions, such as frailty, may increase this risk. There is consistent evidence that shows that frail patients have higher risk of cognitive impairment after surgical procedure. Moreover, brain pre-existing conditions may play a role in cognitive impairment after CEA. Cerebral small vessel disease (SVD) is a pathology that involves microcirculation and is detectable with computed tomography or magnetic resonance. SVD shares common vascular risk factors with carotid atherosclerosis, is a major contributor to vascular cognitive impairment and vascular dementia, and has been proposed as a marker of brain frailty. In this review, we discuss the current evidence about the link between carotid revascularization and cognitive impairment and advance the hypothesis that SVD may play a relevant role in development of cognitive impairment after carotid revascularization.
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21
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Fang F, Cao R, Luo Q, Ge R, Lai M, Yang J, Ma M, Kang M, Zhang L, Wang Y, Peng Y. The silent occurrence of cerebral small vessel disease in nonelderly patients with type 2 diabetes mellitus. J Diabetes 2021; 13:735-743. [PMID: 33559402 DOI: 10.1111/1753-0407.13164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/22/2021] [Accepted: 02/03/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The prevalence of cerebral small vessel disease (SVD) increases in elderly patients with type 2 diabetes (T2DM), exacerbating cognitive decline. However, the prevalence and the severity of SVD in dementia-free nonelderly T2DM patients were largely unknown. Our primary aim is to investigate SVD in such patients, with a specific focus on the correlation between SVD and diabetic peripheral sensorimotor polyneuropathy (DSP). METHODS We recruited 180 young and middle-aged subjects without cognitive impairment (106 with T2DM, 74 controls). Signs of cerebral SVD on magnetic resonance image were investigated, and the overall SVD burden was evaluated by a combined score. Patients with T2DM underwent further detailed DSP assessment. Regression models were used to investigate the association of SVD with the presence of T2DM, and the associations of the prevalence and severity of SVD and DSP were also explored in patients with T2DM. RESULTS The prevalence of microbleeds and overall burden of SVD were significantly higher in T2DM patients than in the controls. Further, the presence of DSP related to an increased risk of SVD after adjustment in diabetic group. Moreover, Toronto Clinical Scoring System values were positively associated with the increased SVD scores, and bilateral sural sensory nerve conduction velocities were negatively associated with increasingly severity of SVD scores. CONCLUSION The current findings extended the increasing prevalence of SVD to dementia-free nonelderly patients with T2DM, suggesting that the time for cognitive screening and prevention might be moved forward in T2DM patients, especially for those with DSP.
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Affiliation(s)
- Fang Fang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Rong Cao
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Qian Luo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Renbin Ge
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mengyu Lai
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jiaying Yang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mingming Ma
- Department of Ophthalmology, National Clinical Research Center for Eye Disease, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Mei Kang
- Clinical Research Center, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Zhang
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yufan Wang
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yongde Peng
- Department of Endocrinology and Metabolism, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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22
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Eriksson MI, Summanen P, Gordin D, Forsblom C, Shams S, Liebkind R, Tatlisumak T, Putaala J, Groop PH, Martola J, Thorn LM. Cerebral small-vessel disease is associated with the severity of diabetic retinopathy in type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002274. [PMID: 34429281 PMCID: PMC8386215 DOI: 10.1136/bmjdrc-2021-002274] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/19/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Cerebral small-vessel disease is common in neurologically asymptomatic individuals with type 1 diabetes. The retinal vasculature is thought to mirror the brain's vasculature, but data on this association are limited in type 1 diabetes. Our aim was to study associations between diabetic retinopathy severity and cerebral small-vessel disease in type 1 diabetes. RESEARCH DESIGN AND METHODS For this cross-sectional study, we enrolled 189 participants with type 1 diabetes (median age 40 (33-45) years; 53% female; diabetes duration 21.6 (18.2-30.7) years) and 29 healthy age-matched and sex-matched controls as part of the Finnish Diabetic Nephropathy Study. Participants underwent a clinical investigation, brain MRI, and fundus imaging. Signs of cerebral small-vessel disease in brain MRIs were analyzed in relation to diabetic retinopathy severity (Early Treatment Diabetic Retinopathy Study (ETDRS) score). RESULTS In type 1 diabetes, participants with cerebral small-vessel disease had higher ETDRS scores (35 (20-61) vs 20 (20-35), p=0.022) and a higher prevalence of proliferative diabetic retinopathy than those without cerebral small-vessel disease (25% vs 9%, p=0.002). In adjusted analysis, proliferative diabetic retinopathy was associated with cerebral small-vessel disease (OR 2.57 (95% CI 1.04 to 6.35)). Median ETDRS score (35 (20-65) vs 20 (20-35), p=0.024) and proliferative diabetic retinopathy prevalence were higher (29% vs 13%, p=0.002) in participants with versus without cerebral microbleeds. ETDRS scores increased by number of cerebral microbleeds (p=0.001), both ETDRS score (OR 1.05 (95% CI 1.02 to 1.09)) and proliferative diabetic retinopathy (8.52 (95% CI 1.91 to 37.94)) were associated with >2 cerebral microbleeds in separate multivariable analysis. We observed no association with white matter hyperintensities or lacunar infarcts. CONCLUSIONS Presence of cerebral small-vessel disease on brain MRI, particularly cerebral microbleeds, is associated with the severity of diabetic retinopathy.
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Affiliation(s)
- Marika I Eriksson
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Paula Summanen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of Ophthalmology, Helsinki University Central Hospital, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
| | - Sara Shams
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Radiology, Stanford Medicine, Stanford, California, USA
| | - Ron Liebkind
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
- Department of Neurology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Juha Martola
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Radiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
- Department of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- Research Program in Clinical and Molecular Metabolism, University of Helsinki, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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23
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Zhang YH, Guo W, Zeng T, Zhang S, Chen L, Gamarra M, Mansour RF, Escorcia-Gutierrez J, Huang T, Cai YD. Identification of Microbiota Biomarkers With Orthologous Gene Annotation for Type 2 Diabetes. Front Microbiol 2021; 12:711244. [PMID: 34305880 PMCID: PMC8299781 DOI: 10.3389/fmicb.2021.711244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 01/03/2023] Open
Abstract
Type 2 diabetes (T2D) is a systematic chronic metabolic condition with abnormal sugar metabolism dysfunction, and its complications are the most harmful to human beings and may be life-threatening after long-term durations. Considering the high incidence and severity at late stage, researchers have been focusing on the identification of specific biomarkers and potential drug targets for T2D at the genomic, epigenomic, and transcriptomic levels. Microbes participate in the pathogenesis of multiple metabolic diseases including diabetes. However, the related studies are still non-systematic and lack the functional exploration on identified microbes. To fill this gap between gut microbiome and diabetes study, we first introduced eggNOG database and KEGG ORTHOLOGY (KO) database for orthologous (protein/gene) annotation of microbiota. Two datasets with these annotations were employed, which were analyzed by multiple machine-learning models for identifying significant microbiota biomarkers of T2D. The powerful feature selection method, Max-Relevance and Min-Redundancy (mRMR), was first applied to the datasets, resulting in a feature list for each dataset. Then, the list was fed into the incremental feature selection (IFS), incorporating support vector machine (SVM) as the classification algorithm, to extract essential annotations and build efficient classifiers. This study not only revealed potential pathological factors for diabetes at the microbiome level but also provided us new candidates for drug development against diabetes.
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Affiliation(s)
- Yu-Hang Zhang
- School of Life Sciences, Shanghai University, Shanghai, China.,Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Wei Guo
- Key Laboratory of Stem Cell Biology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences (CAS) and Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Zeng
- Bio-Med Big Data Center, CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - ShiQi Zhang
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Lei Chen
- College of Information Engineering, Shanghai Maritime University, Shanghai, China
| | - Margarita Gamarra
- Department of Computational Science and Electronic, Universidad de la Costa, CUC, Barranquilla, Colombia
| | - Romany F Mansour
- Department of Mathematics, Faculty of Science, New Valley University, El-Kharga, Egypt
| | - José Escorcia-Gutierrez
- Electronic and Telecommunications Engineering Program, Universidad Autónoma del Caribe, Barranquilla, Colombia
| | - Tao Huang
- Bio-Med Big Data Center, CAS Key Laboratory of Computational Biology, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China.,CAS Key Laboratory of Tissue Microenvironment and Tumor, Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yu-Dong Cai
- School of Life Sciences, Shanghai University, Shanghai, China
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24
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Cheng D, Zhao X, Yang S, Wang G, Ning G. Association Between Diabetic Retinopathy and Cognitive Impairment: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:692911. [PMID: 34276346 PMCID: PMC8278198 DOI: 10.3389/fnagi.2021.692911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/07/2021] [Indexed: 01/11/2023] Open
Abstract
Diabetic retinopathy (DR) is one of the most common microvascular complications associated with diabetes mellitus. However, its correlation with another diabetes-related disorder, cognitive impairment, has not been well studied. This systematic review and meta-analysis aimed to explore the association between DR and cognitive impairment. MEDLINE (PubMed), the Cochrane Library, and EMBASE databases were searched for observational studies that reported an association between DR and cognitive impairment. Data from selected studies were extracted, and a meta-analysis was conducted using fixed-effects modeling. Fifteen observational studies were included in the systematic review, and 10 studies were included in the meta-analysis. The odds ratio of the association between DR and cognitive impairment was 2.24 (95% confidence interval [CI], 1.89-2.66; I 2 = 0.8%). The hazard ratio of the association between DR and cognitive impairment was significant in four studies, ranging from 1.09-1.32. Minimal or mild DR was not significantly associated with cognitive impairment (odds ratio [OR], 2.04; 95% CI, 0.87-4.77). However, the association between proliferative DR and cognitive impairment (OR, 3.57; 95% CI, 1.79-7.12; I 2 = 16.6%) was not stronger than the association between moderate or worse DR and cognitive impairment (OR, 4.26; 95% CI, 2.01-9.07; I 2 = 0.0%). DR is associated with cognitive impairment, and screening for DR will be helpful for the early identification of individuals with cognitive impairment. Further studies are needed to confirm the association between proliferative DR and cognitive impairment.
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Affiliation(s)
- Dihe Cheng
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Xue Zhao
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Shuo Yang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guixia Wang
- Department of Endocrinology and Metabolism, The First Hospital of Jilin University, Changchun, China
| | - Guang Ning
- Key Laboratory for Endocrine and Metabolic Diseases of Ministry of Health of China, Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Shanghai Institute for Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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25
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Chen YC, Lu BZ, Shu YC, Sun YT. Spatiotemporal Dynamics of Cerebral Vascular Permeability in Type 2 Diabetes-Related Cerebral Microangiopathy. Front Endocrinol (Lausanne) 2021; 12:805637. [PMID: 35087478 PMCID: PMC8786705 DOI: 10.3389/fendo.2021.805637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/13/2021] [Indexed: 12/22/2022] Open
Abstract
AIMS Diabetes-related cerebral microangiopathy can manifest as cerebral small vessel disease (CSVD) and exhibit cognitive decline. To find the early change of function in advance, this study examined the spatiotemporal dynamics of cerebral vascular permeability (Ktrans) in the progression of type 2 diabetes mellitus (T2DM). METHODS Ktrans was cross-sectionally measured in T2DM and non-diabetes groups with or without CSVD using dynamic contrast-enhanced MRI (DCE-MRI). RESULTS In all patients with T2DM, the Ktrans of white matter (WM) was increased, whereas the Ktrans of gray matter (GM) was increased only in T2DM with CSVD. The involvement of WM was earlier than GM and was before the CSVD features could be visualized on MRI. Among the commonly available four CSVD items of MRI, microbleeds were the most sensitive, indicating the increased permeability in all patients. Increased Ktrans in T2DM was more associated with moderate WM hyperintensity but less with the presence of lacunae or multiple perivascular spaces, in contrast to patients without diabetes. The differential correlation suggested distinct mechanisms underlying diabetes-related CSVD and other CSVDs. CONCLUSIONS This study highlights the early development of cerebral microangiopathy with increased BBB leakage in T2DM, before the CSVD features can be visualized on MRI. The results may increase the proactivity of clinicians in recognizing the subsequent neurological comorbidities.
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Affiliation(s)
- Ying-Chen Chen
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Radiology, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
| | - Bing-Ze Lu
- Department of Mathematics, College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Chen Shu
- Department of Mathematics, College of Science, National Cheng Kung University, Tainan, Taiwan
| | - Yuan-Ting Sun
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Medical Genomics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- *Correspondence: Yuan-Ting Sun,
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26
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Mauricio D, Alonso N, Gratacòs M. Chronic Diabetes Complications: The Need to Move beyond Classical Concepts. Trends Endocrinol Metab 2020; 31:287-295. [PMID: 32033865 DOI: 10.1016/j.tem.2020.01.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/22/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022]
Abstract
Chronic-diabetes-related complications simultaneously compromise both the micro- and macrovascular trees, with target organs considered as the paradigm of large vessel injury also entailing microangiopathic changes. However, complications independent or partially independent from vascular damage are often overlooked. This includes neuronal dysfunction (e.g., retinal neurodegeneration), interstitial injury (e.g., tubulointerstitial disease), metabolic damage (e.g., in the heart and liver), and nonclassical conditions such as cognitive decline, impaired pulmonary function, or increased risk of cancer. In this scenario, researchers, endocrinologists and primary care physicians should have a holistic view of the disease and pay further attention to all organs and all potential clinical repercussions, which would certainly contribute to a more rational and integrated patient health care.
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Affiliation(s)
- Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
| | - Núria Alonso
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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Porta M, Striglia E. Intravitreal anti-VEGF agents and cardiovascular risk. Intern Emerg Med 2020; 15:199-210. [PMID: 31848994 DOI: 10.1007/s11739-019-02253-7] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/03/2019] [Indexed: 12/20/2022]
Abstract
Antagonists of Vascular Endothelial Growth Factor (Anti-VEGF) are widely administered by intravitreal injection for the treatment of ocular pathologies such as Age-related Macular Degeneration, Diabetic Macular Edema, Proliferative Diabetic Retinopathy and occlusion of retinal vessels. Anti-VEGF agents, in particular bevacizumab, were introduced in oncology to inhibit tumor-induced angiogenesis feeding neoplastic tissues. Subsequently, other specific agents were developed for intraocular administration. Whereas systemic administration of anti-VEGF agents in oncology is burdened by increased risk of arterial hypertension and embolism, agents administered for ophthalmic indications are delivered locally into the eye globe in much smaller quantities. Nevertheless, clinical observations have raised the possibility that, even in these conditions, anti-VEGF agents may increase cardiovascular risk in patients who, being elderly and/or diabetic, are intrinsically prone to such events. This paper aims at reviewing the current knowledge on VEGF and its pharmacologic antagonists from mechanistic and side effect points of view, with specific reference to patients with sight-threatening conditions. Internists should be aware of the need to collaborate with ophthalmologists and pharmacovigilance operators to define as best as possible the risk/benefit balance of intravitreal agents in patients who might lose their sight if left untreated, or increase their risk of suffering a cardiovascular event if treated.
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Affiliation(s)
- Massimo Porta
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy.
| | - Elio Striglia
- Department of Medical Sciences, University of Turin, Corso AM Dogliotti 14, 10126, Turin, Italy
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Yang H, Hong W, Chen L, Tao Y, Peng Z, Zhou H. Analysis of risk factors for depression in Alzheimer's disease patients. Int J Neurosci 2020; 130:1136-1141. [PMID: 32053409 DOI: 10.1080/00207454.2020.1730369] [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] [Indexed: 12/11/2022]
Abstract
Purpose: Depression, which affects about 52% of Alzheimer's disease (AD) patients, can worsen cognitive impairment and increase mortality and suicide rates. We hope to provide clinical evidence for the prevention and treatment of depression in AD patients by investigating related risk factors of depression in AD patients.Methods: 158 AD inpatients of the Department of Neurology, Daping Hospital from September 2017 to March 2019 were enrolled. General information, laboratory tests, cognitive and emotional function assessments of the inpatients were collected. Logistic regression was used to analyze the risk factors of depression in AD patients, and the relationship between 17 Hamilton depression scale scores and HbA1c levels in AD patients was further analyzed.Results: The prevalence of age, gender, hypertension, hyperlipidemia, Type 2 diabetes mellitus (T2DM), and white matter lesions (WML) in the AD with depression group was significantly different from without depression group. Hypertension, T2DM, and WML are independent risk factors for depression in AD patients. The depression scores of AD patients with HbA1c>6.5% were significantly higher than AD patients with HbA1c ≤ 6.5%, and there were significant difference in depression scale scores between using anti-diabetes drugs group and not using anti-diabetes drugs group whose HbA1c level is >6.5%, while no difference in depression scores between using anti-diabetes drugs group and not using anti-diabetes drugs group whose HbA1c level is ≤6.5%.Conclusion: T2DM is an independent risk factor for AD patients with depression. Increased HbA1c levels aggravate depression in AD patients, and controlling HbA1c levels and anti-diabetes drugs can reduce the severity of depression in AD patients.
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Affiliation(s)
- Hai Yang
- Department of Neurology, Daping Hospital, Army Military Medical University, Chongqing, China
| | - Wenjuan Hong
- Graduate School of Bengbu Medical College, Bengbu City, China
| | - Le Chen
- Graduate School of Bengbu Medical College, Bengbu City, China
| | - Yong Tao
- Department of Neurology, Daping Hospital, Army Military Medical University, Chongqing, China
| | - Zeyan Peng
- Department of Neurology, Daping Hospital, Army Military Medical University, Chongqing, China
| | - Huadong Zhou
- Department of Neurology, Daping Hospital, Army Military Medical University, Chongqing, China
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Wang DQ, Wang L, Wei MM, Xia XS, Tian XL, Cui XH, Li X. Relationship Between Type 2 Diabetes and White Matter Hyperintensity: A Systematic Review. Front Endocrinol (Lausanne) 2020; 11:595962. [PMID: 33408693 PMCID: PMC7780232 DOI: 10.3389/fendo.2020.595962] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/18/2020] [Indexed: 01/14/2023] Open
Abstract
White matter (WM) disease is recognized as an important cause of cognitive decline and dementia. White matter lesions (WMLs) appear as white matter hyperintensities (WMH) on T2-weighted magnetic resonance imaging (MRI) scans of the brain. Previous studies have shown that type 2 diabetes (T2DM) is associated with WMH. In this review, we reviewed the literature on the relationship between T2DM and WMH in PubMed and Cochrane over the past five years and explored the possible links among the presence of T2DM, the course or complications of diabetes, and WMH. We found that: (1) Both from a macro- and micro-scopic point of view, most studies support the relationship of a larger WMH and a decrease in the integrity of WMH in T2DM; (2) From the relationship between brain structural changes and cognition in T2DM, the poor performance in memory, attention, and executive function tests associated with abnormal brain structure is consistent; (3) Diabetic microangiopathy or peripheral neuropathy may be associated with WMH, suggesting that the brain may be a target organ for T2DM microangiopathy; (4) Laboratory markers such as insulin resistance and fasting insulin levels were significantly associated with WMH. High HbA1c and high glucose variability were associated with WMH but not glycemic control.
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Affiliation(s)
- Dan-Qiong Wang
- Department of General Medical, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lei Wang
- Department of General Medical, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Miao-Miao Wei
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiao-Shuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiao-Lin Tian
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiao-Hong Cui
- Department of Psychiatry, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
- *Correspondence: Xin Li,
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Minami T, Ito Y, Yamada M, Furuta R, Minagawa F, Kamata K, Kameda A, Terauchi Y. The effect of long-term past glycemic control on executive function among patients with type 2 diabetes mellitus. Diabetol Int 2019; 11:114-120. [PMID: 32206481 DOI: 10.1007/s13340-019-00411-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/23/2019] [Indexed: 01/21/2023]
Abstract
Objective Patients with type 2 diabetes mellitus (T2DM) show more executive dysfunction than nondiabetics. However, how long poor glycemic control affects executive function remains unclear. Thus, we aimed to investigate the relationships in a cross-sectional study. Methods We studied 118 T2DM outpatients (age, ≥ 60 years; excluding history of stroke, dementia and severe hypoglycemia). HbA1c values were recorded every ≤ 12 weeks for ≥ 5 years. All patients underwent verbal-fluency tests (reflecting executive function) and Mini-Mental State Examination (MMSE). The correlation between past glycemic control values and both cognitive tests scores was investigated. As markers of past glycemic control, we used average hemoglobin A1c (HbA1c) values and glycemic control variability [coefficient of variation (CV) of HbA1c values (HbA1c-CV)]. Results Verbal-fluency tests scores correlated with HbA1c-CV, but not with average HbA1c values, after adjusting for age, years of education and sex. Verbal-fluency tests scores correlated with HbA1c-CV for the past 5 years, best compared with HbA1c-CV for past < 5 years. MMSE scores were also related to only HbA1c-CV for the past 3 years in an adjustment model. Conclusions Five-year HbA1c variability affected executive function in T2DM patients, but not average HbA1c values. Long-term longitudinal studies may be required.
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Affiliation(s)
- Taichi Minami
- 1Division of Metabolism and Endocrinology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, 132 Katsura-cho, Sakae-ku, Yokohama, Japan.,Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Nanbu Hospital, 3-2-9 Konandai, Konan-ku, Yokohama, Japan.,5Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yuzuru Ito
- 5Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Masayo Yamada
- 1Division of Metabolism and Endocrinology, Department of Internal Medicine, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, 132 Katsura-cho, Sakae-ku, Yokohama, Japan
| | - Ryutaro Furuta
- 2Department of Psychology, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, 132 Katsura-cho, Sakae-ku, Yokohama, Japan
| | - Fuyuki Minagawa
- Minagawa-naika Clinic, 2-14-1 Kasama, Sakae-ku, Yokohama, Japan
| | - Kentaro Kamata
- 2Department of Psychology, Yokohama Sakae Kyosai Hospital, Federation of National Public Service Personnel Mutual Associations, 132 Katsura-cho, Sakae-ku, Yokohama, Japan
| | - Akiko Kameda
- Department of Diabetes and Endocrinology, Saiseikai Yokohamashi Nanbu Hospital, 3-2-9 Konandai, Konan-ku, Yokohama, Japan
| | - Yasuo Terauchi
- 5Department of Endocrinology and Metabolism, Graduate School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan
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Abstract
Small vessel disease (SVD) refers to conditions where damage to arterioles and capillaries is predominant, leading to reduced, or interrupted perfusion of the affected organ. Data suggest that when this condition is evident in any organ, it is already systemic in its occurrence and consequences. SVD affects primarily organs that receive significant portions of cardiac output such as the brain, the kidney, and the retina. Thus, SVD is a major etiologic cause in debilitating conditions such as renal failure, blindness, lacunar infarcts, and dementia. The factors that lead to this devastating condition include all the known vascular risk factors when they are not strictly controlled, but lifestyles that include sedentary existence, obesity, and poor sleep patterns are also recognized drivers of SVD. In addition, depression is now recognized as a vascular risk factor. Inflammation is a mediator of SVD, but it is not known which factor(s) predominate in its etiology. This article emphasizes the need for more investigations to define this link further and suggests clinical and societal responses that might reduce the major impacts of this condition on populations.
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Affiliation(s)
- Antoine M Hakim
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Faculty of Medicine, Brain and Mind Research Institute, University of Ottawa, Ottawa, ON, Canada.,Division of Neurology, University of Ottawa, Ottawa, ON, Canada
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Hegde V, Vijayan M, Kumar S, Akheruzzaman M, Sawant N, Dhurandhar NV, Reddy PH. Adenovirus 36 improves glycemic control and markers of Alzheimer's disease pathogenesis. Biochim Biophys Acta Mol Basis Dis 2019; 1865:165531. [PMID: 31398466 DOI: 10.1016/j.bbadis.2019.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022]
Abstract
Alzheimer's disease (AD) is the most prevalent neurodegenerative disorder worldwide. While the causes of AD are unclear, several risk factors have been identified, including impaired glycemic control, which significantly increases the risk of cognitive decline and AD. In vitro and in vivo studies show that human adenovirus 36 (Ad36) improves glycemic control by increasing cellular glucose uptake in cells, experimental animal models and in humans who are naturally exposed to the virus. This study, tested improvement in glycemic control by Ad36 and delay in onset of cognitive decline in APPswe transgenic mice (Tg2576 line), a model of genetic predisposition to impaired glycemic control and AD. Three-month old APPswe mice were divided into Ad36 infected (Ad36) or mock infected (control) groups and baseline glycemic control measured by glucose tolerance test (GTT) prior to infection. Changes in glycemic control were determined 10- and 24-week post infection. Serum insulin was also measured during GTT. Cognition was determined by Y-maze test, while motor coordination and skill acquisition by rotarod test. Glycemic control as determined by GTT showed less deterioration in Ad36 infected mice over time, accompanied by a significant attenuation of cognitive decline. Analysis of brain tissue lysate showed significantly reduced levels of amyloid beta 42 in Ad36 mice relative to control mice. Golgi-Cox staining analysis also revealed reduced dendritic spines and synaptic gene expression in control mice compared to Ad36 infected mice. This proof of concept study shows that in a mouse model of AD, Ad36 improves glycemic control and ameliorates cognitive decline.
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Affiliation(s)
- V Hegde
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA.
| | - M Vijayan
- Internal Medicine, Cell Biology and Biochemistry, Neuroscience/Pharmacology and Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - S Kumar
- Internal Medicine, Cell Biology and Biochemistry, Neuroscience/Pharmacology and Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Md Akheruzzaman
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - N Sawant
- Internal Medicine, Cell Biology and Biochemistry, Neuroscience/Pharmacology and Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - N V Dhurandhar
- Obesity and Metabolic Health Laboratory, Department of Nutritional Sciences, Texas Tech University, Lubbock, TX 79409, USA
| | - P H Reddy
- Internal Medicine, Cell Biology and Biochemistry, Neuroscience/Pharmacology and Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
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Dong S, Dongwei L, Zhang J, Liang J, Sun Z, Fang J. Individuals in the prediabetes stage exhibit reduced hippocampal tail volume and executive dysfunction. Brain Behav 2019; 9:e01351. [PMID: 31240857 PMCID: PMC6710206 DOI: 10.1002/brb3.1351] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/05/2019] [Accepted: 05/28/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION High glucose levels are associated with cognitive impairment and total hippocampal volume reductions. However, the effects of the blood glucose level on hippocampal subfield volumes remain unclear, especially in the prediabetes stage. METHODS Sixty participants were enrolled in this cross-sectional study and were divided into the nondiabetes, prediabetes, and diabetes groups according to their medical history and A1c level. A full battery of neuropsychological tests was used to assess the global cognition, executive function, attention, verbal fluency, working memory, immediate memory, and delayed memory. FreeSurfer 6.0 was used for the hippocampus parcellation. Hippocampal subfield volumes were adjusted by intracranial volume. Analyses of covariance, multiple linear regression, and partial correlation analysis were used to explore the relationship between A1c level, cognitive function, and hippocampal subfields volume, in which age, sex, education years, body mass index, history of hypertension, level of cholesterol, and the presence of ApoE4-positive status were adjusted. RESULTS Significant differences in the total left hippocampal volume (p = 0.046) and left hippocampal tail volume (p = 0.014) were noted among three groups. Significant correlation was identified between the A1c level and the volume of left hippocampal tail (r = -0.334, p = 0.009) after adjusting all the covariants. Increased A1c level was significantly associated with executive dysfunction, as assessed by trail making test B (R = 0.503, p = 0.0016) and Stroop test C (R = 0.506, p = 0.001). CONCLUSIONS Our results support that the left hippocampal tail volume may be served as an early marker of diabetes-related brain damage, associated with executive dysfunction. Clinicians should pay closer attention to adults in the prediabetes stage to prevent later cognitive impairment.
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Affiliation(s)
- Sun Dong
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Lu Dongwei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jinyu Liang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhenmeng Sun
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Jian Fang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
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Tuttolomondo A, Di Raimondo D, Casuccio A, Guercio G, Del Cuore A, Puleo MG, Della Corte V, Bellia C, Caronia A, Maida C, Pecoraro R, Simonetta I, Gulotta G, Ciaccio M, Pinto A. Endothelial function, adipokine serum levels and white matter hyperintesities in subjects with diabetic foot syndrome. J Clin Endocrinol Metab 2019; 104:3920-3930. [PMID: 30977833 DOI: 10.1210/jc.2018-02507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/08/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT No study analysed the prevalence of white matter hyperintesities (WMHs) in subjects with diabetic foot syndrome (DFS) and their relationship with adipokine serum levels and indexes of endothelial and cognitive performance. OBJECTIVE To evaluate omentin and vaspin serum levels and WMHs prevalence in subjects with DFS and to analyse their relationship with other endothelial, arterial stiffness and cognitive function. RESEARCH DESIGN AND METHODS Case-control study enrolling 40 subjects with DFS, 40 diabetic subjects without foot complications, 40 controls with foot lesions without diabetes and 40 patients without diabetes mellitus. MAIN OUTCOME MEASURE Pulse wave velocity (PWV), augmentation index (Aix), Reactive hyperemia index (RHI), serum vaspin and omentin levels, Fazekas Score, MMSE. RESULTS Subjects with DFS showed higher mean PWV values if compared with diabetic controls, lower RHI values if compared with controls. They also showed a lower mean MMSE score, significantly lower omentin serum levels, a higher prevalence of grade 2 severity of periventricular hyperintensities (PVH). We observed a significant positive correlation between PWV and PVH, between Fazekas Score and PWV among diabetic subjects, whereas among subjects with diabetic foot we observed a significant negative correlation between PVH and RHI. CONCLUSIONS Diabetes seems to be more associated with endothelial function disturbance in comparison with patients with diabetic foot that exhibit a more strict association with microvascular brain damage as indicated by our significant finding of an association with periventricular hyperintensities.
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Affiliation(s)
| | | | - Alessandra Casuccio
- Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Giovanni Guercio
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.)
| | | | - Maria Grazia Puleo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Vittoriano Della Corte
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Chiara Bellia
- Section of Clinical Biochemistry and Molecular Biology, Department of Biopathology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo
| | | | - Carlo Maida
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Rosaria Pecoraro
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Irene Simonetta
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Gaspare Gulotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.)
| | - Marcello Ciaccio
- Section of Clinical Biochemistry and Molecular Biology, Department of Biopathology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo
| | - Antonio Pinto
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
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Huang X, Tong Y, Qi CX, Xu YT, Dan HD, Shen Y. Disrupted topological organization of human brain connectome in diabetic retinopathy patients. Neuropsychiatr Dis Treat 2019; 15:2487-2502. [PMID: 31695385 PMCID: PMC6717727 DOI: 10.2147/ndt.s214325] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/03/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE There is increasing neuroimaging evidence that type 2 diabetes patients with retinal microvascular complications show abnormal brain functional and structural architecture and are at an increased risk of cognitive decline and dementia. However, changes in the topological properties of the functional brain connectome in diabetic retinopathy (DR) patients remain unknown. The aim of this study was to explore the topological organization of the brain connectome in DR patients using graph theory approaches. METHODS Thirty-five DR patients (18 males and 17 females) and 38 healthy controls (HCs) (18 males and 20 females), matched for age, sex, and education, underwent resting-state magnetic resonance imaging scans. Graph theory analysis was performed to investigate the topological properties of brain functional connectome at both global and nodal levels. RESULTS Both DR and HC groups showed high-efficiency small-world network in their brain functional networks. Notably, the DR group showed reduction in the clustering coefficient (P=0.0572) and local efficiency (P=0.0151). Furthermore, the DR group showed reduced nodal centralities in the default-mode network (DMN) and increased nodal centralities in the visual network (VN) (P<0.01, Bonferroni-corrected). The DR group also showed abnormal functional connections among the VN, DMN, salience network (SN), and sensorimotor network (SMN). Altered network metrics and nodal centralities were significantly correlated with visual acuity and fasting blood glucose level in DR patients. CONCLUSION DR patients showed abnormal topological organization of the human brain connectome. Specifically, the DR group showed reduction in the clustering coefficient and local efficiency, relative to HC group. Abnormal nodal centralities and functional disconnections were mainly located in the DMN, VN, SN, and SMN in DR patients. Furthermore, the disrupted topological attributes showed correlations with clinical variables. These findings offer important insight into the neural mechanism of visual loss and cognitive deficits in DR patients.
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Affiliation(s)
- Xin Huang
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People's Republic of China
| | - Yan Tong
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People's Republic of China
| | - Chen-Xing Qi
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People's Republic of China
| | - Yang-Tao Xu
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People's Republic of China
| | - Han-Dong Dan
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People's Republic of China
| | - Yin Shen
- Eye Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei, People's Republic of China
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Pongrac Barlovic D, Harjutsalo V, Gordin D, Kallio M, Forsblom C, King G, Groop PH. The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up. Diabetes Care 2018; 41:2487-2494. [PMID: 30257963 PMCID: PMC6973548 DOI: 10.2337/dc18-0476] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 08/22/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE It is well established that diabetic nephropathy increases the risk of cardiovascular disease (CVD), but how severe diabetic retinopathy (SDR) impacts this risk has yet to be determined. RESEARCH DESIGN AND METHODS The cumulative incidence of various CVD events, including coronary heart disease (CHD), peripheral artery disease (PAD), and stroke, retrieved from registries, was evaluated in 1,683 individuals with at least a 30-year duration of type 1 diabetes drawn from the Finnish Diabetic Nephropathy Study (FinnDiane). The individuals were divided into four groups according to the presence of diabetic kidney disease (DKD) and/or SDR (+DKD/+SDR, +DKD/-SDR, -DKD/+SDR, and -DKD/-SDR) at baseline visit. Furthermore, age-specific incidences were compared with 4,016 control subjects without diabetes. SDR was defined as laser photocoagulation and DKD as estimated glomerular filtration rate <60 mL/min/1.73 m2. RESULTS During 12,872 person-years of follow-up, 416 incident CVD events occurred. Even in the absence of DKD, SDR increased the risk of any CVD (hazard ratio 1.46 [95% CI 1.11-1.92]; P < 0.01), after adjustment for diabetes duration, age at diabetes onset, sex, smoking, blood pressure, waist-to-hip ratio, history of hypoglycemia, and serum lipids. In particular, SDR alone was associated with the risk of PAD (1.90 [1.13-3.17]; P < 0.05) and CHD (1.50 [1.09-2.07; P < 0.05) but not with any stroke. Moreover, DKD increased the CVD risk further (2.85 [2.13-3.81]; P < 0.001). However, the risk was above that of the control subjects without diabetes also in patients without microvascular complications, until the patients reached their seventies. CONCLUSIONS SDR alone, even without DKD, increases cardiovascular risk, particularly for PAD, independently of common cardiovascular risk factors in long-standing type 1 diabetes. More remains to be done to fully understand the link between SDR and CVD. This knowledge could help combat the enhanced cardiovascular risk beyond currently available regimens.
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Affiliation(s)
- Drazenka Pongrac Barlovic
- University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Diabetes and Obesity, Research Programs Unit, University of Helsinki, Helsinki, Finland.,The Chronic Disease Prevention Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Diabetes and Obesity, Research Programs Unit, University of Helsinki, Helsinki, Finland.,Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Milla Kallio
- Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland.,Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.,Diabetes and Obesity, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - George King
- Research Division, Joslin Diabetes Center, Harvard Medical School, Boston, MA
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Parahippocampal gyrus expression of endothelial and insulin receptor signaling pathway genes is modulated by Alzheimer's disease and normalized by treatment with anti-diabetic agents. PLoS One 2018; 13:e0206547. [PMID: 30383799 PMCID: PMC6211704 DOI: 10.1371/journal.pone.0206547] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/15/2018] [Indexed: 12/14/2022] Open
Abstract
A large body of literature links risk of cognitive decline, mild cognitive impairment (MCI) and dementia with Type 2 Diabetes (T2D) or pre-diabetes. Accumulating evidence implicates a close relationship between the brain insulin receptor signaling pathway (IRSP) and the accumulation of amyloid beta and hyperphosphorylated and conformationally abnormal tau. We showed previously that the neuropathological features of Alzheimer's disease (AD were reduced in patients with diabetes who were treated with insulin and oral antidiabetic medications. To understand better the neurobiological substrates of T2D and T2D medications in AD, we examined IRSP and endothelial cell markers in the parahippocampal gyrus of controls (N = 30), of persons with AD (N = 19), and of persons with AD and T2D, who, in turn, had been treated with anti-diabetic drugs (insulin and or oral agents; N = 34). We studied the gene expression of selected members of the IRSP and selective endothelial cell markers in bulk postmortem tissue from the parahippocampal gyrus and in endothelial cell enriched isolates from the same brain region. The results indicated that there are considerable abnormalities and reductions in gene expression (bulk tissue homogenates and endothelial cell isolates) in the parahippocampal gyri of persons with AD that map directly to genes associated with the microvasculature and the IRSP. Our results also showed that the numbers of abnormally expressed microvasculature and IRSP associated genes in diabetic AD donors who had been treated with anti-diabetic agents were reduced significantly. These findings suggest that anti-diabetic treatments may reduce or normalize compromised microvascular and IRSP functions in AD.
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de la Cruz-Cosme C, Dawid-Milner MS, Ojeda-Burgos G, Gallardo-Tur A, Segura T. Doppler Resistivity and Cerebral Small Vessel Disease: Hemodynamic Structural Correlation and Usefulness for the Etiological Classification of Acute Ischemic Stroke. J Stroke Cerebrovasc Dis 2018; 27:3425-3435. [PMID: 30185397 DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/15/2018] [Accepted: 08/01/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND GOAL Lacunar stroke is defined as an <1.5 cm diameter infarct located in the territory of a perforating artery, that is not accessible for direct study using conventional imaging techniques. Diagnosis requires exclusion of other causes. It usually occurs in the context of chronic cerebral small vessel disease, which can be suspected during the neurosonography study in the form of high pulsatility [PI] or resistance index [RI]. Clinical research was performed to confirm that PI and RI correlate with cerebral small vessel lesion burden and to determine whether these parameters are useful for supporting a lacunar origin (LO) in acute stroke. MATERIAL AND METHODS We prospectively recorded internal carotid artery resistivity and the Fazekas score for all patients with acute ischemic stroke who met inclusion but not exclusion criteria over a 6-month period. RESULTS The study population comprised 74 patients. A correlation was observed between the Fazekas score and resistivity. Both parameters predicted a LO, with an area under the curve of .78 and .696, respectively. The optimal cut-offs were PI = .96/RI = .58 for screening (sensitivity, 96%) and PI = 1.46/RI = .83 for confirmation (specificity, 89%). CONCLUSIONS Doppler ultrasound is a useful technique for determining the LO of acute stroke.
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Affiliation(s)
| | - Marc Stefan Dawid-Milner
- Neurophysiology of the Autonomic Nervous System Unit, CIMES, Universidad de Málaga, Málaga, Spain
| | - Guillermo Ojeda-Burgos
- Internal Medicine Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain
| | - Alejandro Gallardo-Tur
- Neurology Service, Hospital Universitario Virgen de la Victoria (Málaga), Málaga, Spain; FIMABIS (Fundación Pública Andaluza para la Investigación de Málaga en Biomedicina y Salud [Andalusian Public Research Foundation]), Málaga, Spain
| | - Tomás Segura
- Neurology Department, Hospital Universitario de Albacete (Albacete), Albacete, Spain
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Incidental findings on brain MRI in a cohort of diabetic patients. J Neuroradiol 2018; 47:343-348. [PMID: 30098369 DOI: 10.1016/j.neurad.2018.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 06/24/2018] [Accepted: 07/26/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To study the frequency and management of incidental findings in nonenhanced brain MRI of a middle-aged population of type 2 diabetic patients. METHODS We retrospectively analyzed the results of 289 brain MRI obtained from subjects between 40-75 years recruited from a previous study. Incidental findings were classified into three categories: (1) Vascular findings; (2) neoplastic findings; and (3) others. On the other side, we made a classification of referral findings. To compare our results, we reviewed the prevalence and evidence about management of both incidental and referral findings in other series. RESULTS We found an overall prevalence of incidental findings of 10.4% (30/289). Incidental findings raised according to age. The most common incidental findings were: 7 vascular (2.4%), 6 calcifications (2.1%), 6 cystic (2.1%) and 5 neoplastic (1.7%) lesions. A percentage of 1.7% (5/289) were referral findings which required further clinical work-up. CONCLUSION Incidental findings are relatively common in patients with type 2 diabetes. The most frequent are vascular findings, accordance with previous studies. Referral findings are uncommon. Clinical evidence about how to best manage the majority of incidental findings is lacking.
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Fang F, Zhan YF, Zhuo YY, Yin DZ, Li KA, Wang YF. Brain atrophy in middle-aged subjects with Type 2 diabetes mellitus, with and without microvascular complications. J Diabetes 2018; 10:625-632. [PMID: 29380932 DOI: 10.1111/1753-0407.12646] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 01/05/2018] [Accepted: 01/24/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The rapid rise in Type 2 diabetes mellitus (T2DM) among young adults makes it important to understand structural changes in the brain at a presenile stage. This study examined global and regional brain atrophy in middle-aged adults with T2DM, with a focus on those without clinical evidence of microvascular complications. METHODS The study recruited 66 dementia-free middle-aged subjects (40 with T2DM, 26 healthy volunteers [HVs]). Patients were grouped according to the presence (T2DM-C; n = 20) or absence (T2DM-NC; n = 20) of diabetic microvascular complications. Global brain volume (including gray matter [GM] and white matter) was calculated based on voxel-based morphometry analysis. Regional GM volumes were further extracted using the anatomical automatic labeling template. RESULTS There was a significant difference in global brain volume among groups (P = 0.003, anova). Global brain volume was lower in T2DM-C patients than in both T2DM-NC patients and HVs (mean [±SD] 0.720 ± 0.024 vs 0.736 ± 0.021 and 0.743 ± 0.019, respectively; P = 0.032 and P = 0.001, respectively). Regional analysis showed significant GM atrophy in the right Rolandic operculum (t = 3.42, P = 0.001) and right superior temporal gyrus (t = 2.803, P = 0.007) in T2DM-NC patients compared with age- and sex-matched HVs. CONCLUSIONS Brain atrophy is present in dementia-free middle-aged adults with T2DM. Regional brain atrophy appears to be developing even in those with no clinical evidence of microvascular disturbances. The brain seems to be particularly vulnerable to metabolic disorders prior to peripheral microvascular pathologies associated with other target organs.
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Affiliation(s)
- Fang Fang
- Department of Endocrinology and Metabolic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Ya-Feng Zhan
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Yao-Yao Zhuo
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Da-Zhi Yin
- Institute of Neuroscience, State Key Laboratory of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institute for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Kang-An Li
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yu-Fan Wang
- Department of Endocrinology and Metabolic Diseases, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
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Harris S, Kurniawan M, Rasyid A, Mesiano T, Hidayat R. Cerebral small vessel disease in Indonesia: Lacunar infarction study from Indonesian Stroke Registry 2012-2014. SAGE Open Med 2018; 6:2050312118784312. [PMID: 29977554 PMCID: PMC6024285 DOI: 10.1177/2050312118784312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 05/24/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND AND PURPOSE Stroke is the number one cause of morbidity and mortality in Indonesia. Lacunar infarction is one of cerebral small vessel disease spectrum. This study aimed to present stroke epidemiology in Indonesia and risk factors associated with cerebral small vessel disease. METHODS A multicenter prospective cross-sectional study of 18 hospitals in Indonesia was conducted using Stroke Case Report Form from 2012 to 2014. Stroke was diagnosed based on clinical findings confirmed with non-contrast computed tomography of the brain. Subjects were classified into two large groups: ischemic (lacunar and non-lacunar) and hemorrhagic (intracranial and subarachnoid hemorrhage). Other risk factors were assessed on admission. RESULTS We enrolled 5411 patients, of whom 3627 (67.03%) had ischemic stroke and 1784 (32.97%) had hemorrhagic stroke. Male patients were prevalent in both large groups, although found less in subarachnoid hemorrhage group. Among patients with hemorrhagic stroke, 1603 (89.54%) of them had intracerebral hemorrhage and 181 (10.46%) had subarachnoid hemorrhage. From 3627 ischemic stroke patients, 1635 (45.07%) of them had lacunar infarction. We found that age above 55 years old, male gender, hypertension, dyslipidemia, and diabetes were important risk factors associated with lacunar stroke (p < 0.05). CONCLUSION Ischemic stroke was the leading cause of stroke in Indonesia. In total, 45% of the total ischemic stroke patients had lacunar infarction. Important risk factors associated with lacunar infarction were hypertension, dyslipidemia, diabetes, age over 55, and male population.
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Affiliation(s)
- Salim Harris
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Mohammad Kurniawan
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Al Rasyid
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Taufik Mesiano
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Rakhmad Hidayat
- Department of Neurology, Faculty of Medicine, Universitas Indonesia and Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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Rodill LG, Exalto LG, Gilsanz P, Biessels GJ, Quesenberry CP, Whitmer RA. Diabetic Retinopathy and Dementia in Type 1 Diabetes. Alzheimer Dis Assoc Disord 2018; 32:125-130. [PMID: 29261519 PMCID: PMC5963957 DOI: 10.1097/wad.0000000000000230] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Retinopathy impacts over one-third of those with diabetes mellitus and is associated with impaired cognitive performance and cerebrovascular lesions in middle-aged adults with type 1 diabetes. However, the association between diabetic retinopathy (DR) and risk of dementia in type 1 diabetes is unknown. We investigated the association between DR and incident dementia in a large, elderly population with type 1 diabetes. METHODS A cohort of 3742 patients with type 1 diabetes aged 50 years and above was followed from January 1, 1996 to September 30, 2015 for incident dementia. DR diagnoses were identified from electronic medical records. Age as timescale Cox proportional hazard models evaluated associations between time-updated DR and dementia risk. Models were adjusted for demographics, severe glycemic events, glycosylated hemoglobin, and vascular comorbidities. RESULTS Among 3742 patients with type 1 diabetes (47% female, 21% nonwhite), 182 (5%) were diagnosed with dementia during a mean follow-up of 6.2 years. No significant association was found between DR and incident dementia in the main analyses [adjusted Hazard Ratio=1.12; 95% confidence interval, 0.82-1.54), nor among subgroup restricted to those aged 60 years and above or 70 years and above. CONCLUSIONS DR was not associated with risk of dementia, suggesting that pathophysiological processes underlying dementia may be different in type 1 versus type 2 diabetes.
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Affiliation(s)
- Liora G Rodill
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lieza G Exalto
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of Research
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
| | - Geert Jan Biessels
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Rachel A Whitmer
- Kaiser Permanente Division of Research
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA
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Intracranial pulsatility in patients with cerebral small vessel disease: a systematic review. Clin Sci (Lond) 2018; 132:157-171. [DOI: 10.1042/cs20171280] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/20/2017] [Accepted: 12/07/2017] [Indexed: 01/30/2023]
Abstract
Growing evidence suggests that increased intracranial pulsatility is associated with cerebral small vessel disease (SVD). We systematically reviewed papers that assessed intracranial pulsatility in subjects with SVD. We included 27 cross-sectional studies (n=3356): 20 used Doppler ultrasound and 7 used phase-contrast MRI. Most studies measured pulsatility in the internal carotid or middle cerebral arteries (ICA, MCA), whereas few assessed veins or cerebrospinal fluid (CSF). Methods to reduce bias and risk factor adjustment were poorly reported. Substantial variation between studies in assessment of SVD and of pulsatility indices precluded a formal meta-analysis. Eight studies compared pulsatility by SVD severity (n=26–159, median = 74.5): arterial pulsatility index was generally higher in more severe SVD (e.g. MCA: standardized mean difference = 3.24, 95% confidence interval [2.40, 4.07]), although most did not match for age. Seventeen studies (n=9–700; median = 110) performed regression or correlation analysis, of which most showed that increased pulsatility was associated with SVD after adjustment for age. In conclusion, most studies support a cross-sectional association between higher pulsatility in large intracranial arteries and SVD. Future studies should minimize bias, adjust for potential confounders, include pulsatility in veins and CSF, and examine longitudinal relationship between pulsatility and SVD. Agreement on reliable measures of intracranial pulsatility would be helpful.
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Liang Y, Chen YK, Deng M, Mok VCT, Wang DF, Ungvari GS, Chu CWW, Kamiya A, Tang WK. Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke. Front Aging Neurosci 2017; 9:372. [PMID: 29180960 PMCID: PMC5693845 DOI: 10.3389/fnagi.2017.00372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/31/2017] [Indexed: 01/12/2023] Open
Abstract
Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke. Methods: Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by the presence of any of the SVD markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS) in the basal ganglia or their combinations on brain magnetic resonance imaging (MRI). The presence of each individual marker scored 1 point and was summed up to generate an ordinal "SVD score" (0-4) capturing total SVD burden. Linear regression was used to determine the associations between SVD burden and HRQoL. Results: Of the743 acute ischemic stroke patients that formed he study sample (mean age: 66.3 ± 10.6 years; 41.7% women), 49.3%, 22.5%, 16.0%, 9.2% and 3.1% had SVD scores of 0, 1, 2, 3 and 4, respectively. After adjusting for demographic, clinical and imaging variables, the SVD score was independently associated with lower overall score of SSQoL (B = -1.39, SE = 0.56, p = 0.01), and its domains of mobility (B = -0.41, SE = 0.10, p < 0.001) and vision (B = -0.12, SE = 0.06, p = 0.03). Acute infract volume (B = -1.44, SE = 0.54, p = 0.01), functional independence (B = 5.69, SE = 0.34, p < 0.001) and anxious (B = -1.13, SE = 0.23, p < 0.001) and depressive symptoms (B = -3.41, SE = 0.22, p < 0.001) were also the significant predictors of the overall score of SSQoL. Conclusion: The brain's SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies.
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Affiliation(s)
- Yan Liang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Min Deng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - De-Feng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabor S Ungvari
- Australia/Marian Centre, University of Notre Dame, Perth, WA, Australia
| | - Chiu-Wing W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Akane Kamiya
- Department of Rehabilitation, Sagamihara Minami Hospital, Sagamihara, Japan
| | - Wai-Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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Circulating autoantibodies against the NR2 peptide of the NMDA receptor are associated with subclinical brain damage in hypertensive patients with other pre-existing conditions for vascular risk. J Neurol Sci 2017; 375:324-330. [DOI: 10.1016/j.jns.2017.02.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/22/2017] [Accepted: 02/13/2017] [Indexed: 12/18/2022]
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Nguyen CTO, Hui F, Charng J, Velaedan S, van Koeverden AK, Lim JKH, He Z, Wong VHY, Vingrys AJ, Bui BV, Ivarsson M. Retinal biomarkers provide "insight" into cortical pharmacology and disease. Pharmacol Ther 2017; 175:151-177. [PMID: 28174096 DOI: 10.1016/j.pharmthera.2017.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The retina is an easily accessible out-pouching of the central nervous system (CNS) and thus lends itself to being a biomarker of the brain. More specifically, the presence of neuronal, vascular and blood-neural barrier parallels in the eye and brain coupled with fast and inexpensive methods to quantify retinal changes make ocular biomarkers an attractive option. This includes its utility as a biomarker for a number of cerebrovascular diseases as well as a drug pharmacology and safety biomarker for the CNS. It is a rapidly emerging field, with some areas well established, such as stroke risk and multiple sclerosis, whereas others are still in development (Alzheimer's, Parkinson's, psychological disease and cortical diabetic dysfunction). The current applications and future potential of retinal biomarkers, including potential ways to improve their sensitivity and specificity are discussed. This review summarises the existing literature and provides a perspective on the strength of current retinal biomarkers and their future potential.
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Affiliation(s)
- Christine T O Nguyen
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia.
| | - Flora Hui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jason Charng
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Shajan Velaedan
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Anna K van Koeverden
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Jeremiah K H Lim
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Zheng He
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Vickie H Y Wong
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Algis J Vingrys
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Bang V Bui
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
| | - Magnus Ivarsson
- Department of Optometry and Vision Sciences, University of Melbourne, Parkville, 3010, Victoria, Australia
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Umemura T, Kawamura T. Retinopathy: A sign of cerebral small vessel disease in diabetes? J Diabetes Investig 2017; 8:428-430. [PMID: 27889950 PMCID: PMC5497027 DOI: 10.1111/jdi.12602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/11/2016] [Accepted: 11/23/2016] [Indexed: 11/28/2022] Open
Abstract
Retinal microvascular abnormalities may be useful predictive imaging marker for cerebral small vessel disease. Learning from retinal signs may provide clues to understanding pathophysiology of lacunar stroke and subclinical cerebrovascular diseases in diabetic patients.![]()
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Affiliation(s)
| | - Takahiko Kawamura
- Department of Diabetes and Endocrine Internal Medicine, Chubu Rosai Hospital, Nagoya, Japan.,Center for Preventive Medicine, Chubu Rosai Hospital, Nagoya, Japan
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Ramírez-Morros A, Granado-Casas M, Alcubierre N, Martinez-Alonso M, Real J, Castelblanco E, Esquerda A, Cao G, Rubinat E, Hernández M, Alonso N, Fernández E, Mauricio D. Calcium Phosphate Product Is Associated with Subclinical Carotid Atherosclerosis in Type 2 Diabetes. J Diabetes Res 2017; 2017:3498368. [PMID: 28840128 PMCID: PMC5559910 DOI: 10.1155/2017/3498368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/17/2017] [Accepted: 07/11/2017] [Indexed: 12/18/2022] Open
Abstract
AIMS To assess whether circulating 25-hydroxyvitamin D3 (25OHD) and mineral metabolism-related factors (serum phosphate, calcium, and parathormone) are associated with subclinical carotid atherosclerosis (SCA), defined as the presence of carotid atherosclerotic plaques (main study outcome), in patients with type 2 diabetes mellitus (T2DM) without kidney disease or previous cardiovascular disease. METHODS We undertook a post hoc analysis of a cross-sectional study in adults with T2DM in whom we evaluated SCA. A total of 303 subjects with T2DM were included. Clinical variables and carotid ultrasound imaging were obtained. RESULTS We found no association of 25OHD with the presence of SCA. However, calcium phosphate (CaP; mg2/dL2) product was positively associated with the presence of carotid plaques (ORadj = 1.078; 95% CI: 1.017-1.142). An inverse association was observed between higher levels of 25OHD (≥30 ng/mL versus <20 ng/mL concentrations) and common carotid intima-media thickness (cIMT; mm) (βadj ± SE = -0.055 ± 0.024). We conclude that the CaP product is independently associated with the presence of established subclinical carotid atherosclerosis in patients with T2DM.
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Affiliation(s)
- Anna Ramírez-Morros
- Health Sciences Research Institute Germans Trias i Pujol, Camí de les Escoles S/N, 08916 Badalona, Spain
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916 Badalona, Spain
| | - Minerva Granado-Casas
- Health Sciences Research Institute Germans Trias i Pujol, Camí de les Escoles S/N, 08916 Badalona, Spain
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916 Badalona, Spain
- Biomedical Research Institute of Lleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain
| | - Nuria Alcubierre
- Biomedical Research Institute of Lleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain
| | - Montserrat Martinez-Alonso
- Biostatistics and Epidemiology Unit, Biomedical Research Institute of Lleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain
| | - Jordi Real
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology and Public Health, Universitat Internacional de Catalunya, Sant Cugat, Spain
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
| | - Esmeralda Castelblanco
- Health Sciences Research Institute Germans Trias i Pujol, Camí de les Escoles S/N, 08916 Badalona, Spain
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916 Badalona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Aureli Esquerda
- Department of Laboratory Medicine, University Hospital Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain
| | - Gonzalo Cao
- Department of Laboratory Medicine, University Hospital Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain
| | - Esther Rubinat
- Biomedical Research Institute of Lleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Rovira Roure 80, 25198 Lleida, Spain
| | - Núria Alonso
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916 Badalona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
| | - Elvira Fernández
- Biomedical Research Institute of Lleida, University of Lleida, Rovira Roure 80, 25198 Lleida, Spain
- Unitat de Deteccio i Tractament de Malalties Aterotrombotiques, University Hospital Arnau de Vilanova, Lleida, Spain
- Department of Nephrology, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Didac Mauricio
- Department of Endocrinology and Nutrition, Health Sciences Research Institute and University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916 Badalona, Spain
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Madrid, Spain
- Unitat de Suport a la Recerca Barcelona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- *Didac Mauricio:
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