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(Stroke. 2008;39:1600.)
© 2008 American Heart Association, Inc.

Research Letters

Diabetes Increases Atrophy and Vascular Lesions on Brain MRI in Patients With Symptomatic Arterial Disease

Audrey M. Tiehuis, MD; Yolanda van der Graaf, MD, PhD; Frank L. Visseren, MD, PhD; Koen L. Vincken, PhD; Geert Jan Biessels, MD, PhD; Auke P.A. Appelman, MD; L. Jaap Kappelle, MD, PhD; Willem P.T.M. Mali, MD, PhD for the SMART Study Group

From the Department of Radiology and Image Sciences Institute (A.M.T., K.L.V., A.P.A.A., W.P.T.M.M.); Julius Center for Health Sciences and Primary Care (Y.v.d.G., A.P.A.A.); the Department of Internal Medicine (F.L.V.); and Rudolf Magnus Institute of Neuroscience, Department of Neurology, University Medical Center Utrecht, the Netherlands (G.J.B., L.J.K.).

Correspondence to Audrey Tiehuis, MD, University Medical Center Utrecht, Department of Radiology (Hp E01.332), PO Box 85500, 3508 GA Utrecht, The Netherlands. E-mail a.m.tiehuis{at}umcutrecht.nl

Background and Purpose— Diabetes type 2 (DM2) is associated with accelerated cognitive decline and structural brain abnormalities. Macrovascular disease has been described as a determinant for brain MRI changes in DM2, but little is known about the involvement of other DM2-related factors.

Methods— Brain MRI was performed in 1043 participants (151 DM2) with symptomatic arterial disease. Brain volumes were obtained through automated segmentation.

Results— Patients with arterial disease and DM2 had more global and subcortical brain atrophy (–1.20% brain/intracranial volume [95%CI –1.58 to –0.82], P<0.0005 and 0.20% ventricular/intracranial volume [0.05 to 0.34], P<0.01), larger WMH volumes (0.22 logtransformed volume [0.07 to 0.38], P<0.005), and more lacunar infarcts (OR 1.75 [1.13 to 2.69], P<0.01) than identical patients without DM2. In patients with DM2, high glucose levels (B–0.12% per mmol/L [–0.23 to –0.01], P<0.05) and diabetes duration (B–0.05% per year [–0.10 to –0.001], P<0.05) were associated with global brain atrophy.

Conclusion— In patients with symptomatic arterial disease, DM2 has an added detrimental effect on the brain. In patients with DM2, hyperglycemia and diabetes duration contribute to brain atrophy.

Key Words: brain imaging • diabetes mellitus type 2 • cardiovascular disease • cognition

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