CHICAGO—Patients with type 1 diabetes and microangiopathy had a greater loss of executive function and brain volume during the course of four years, compared with healthy controls, a small study has shown.
Also, poorer glycemic control and higher systolic blood pressure at the beginning of the study were predictors of alterations in cognition and the brain over time, said Eelco van Duinkerken, PhD, a postdoctoral researcher at the VU University Medical Center in Amsterdam, who presented his findings at the 2013 Annual Meeting of the American Diabetes Association (ADA). He added that the decline was not comparable with mild cognitive impairment.
Dr. van Duinkerken and his colleagues studied 25 patients with type 1 diabetes who had microangiopathy. They had an average age of 46 at baseline; 40% were male, with an average IQ of 112 and a hemoglobin A1c level of 7.9. Subjects had had diabetes for at least 10 years, and they had no disease affecting their brain, no psychiatric comorbidity, and no MRI contraindications. The patients were compared with 25 closely matched controls (baseline age, 44; males, 52%; average IQ, 109; HbA1c, 5.4).
The researchers analyzed the patients’ general cognitive ability, memory, information-processing speed, executive function, attention, and motor and psychomotor speed at baseline and at follow-up, which was four years later. They used a 3D-T1 structural MRI scan at baseline and follow-up to determine whole-brain volume loss.
After four years, the study group had a significantly greater decline in executive function, compared with the control group. Also, the study group showed a larger percentage of whole-brain volume loss (–1.34% vs –0.68% in controls), markedly in the right frontal and central areas.
A larger loss of frontal and central brain volume was related to an accelerated decline in executive function in both groups. In addition, a higher baseline HbA1c level was associated with a larger decline in executive performance, and a higher baseline systolic blood pressure was correlated with frontal brain volume loss at follow-up.
—Naseem S. Miller
IMNG Medical News