Blood Pressure is Associated With Cerebral Blood Flow Alterations in Patients With T2DM as Revealed by Perfusion Functional MRI

Abstract

Type 2 diabetes mellitus (T2DM) and hypertension are both associated with cognitive impairment and brain function abnormalities. We investigated whether abnormal cerebral blood flow (CBF) patterns exists in T2DM patients and possible relationships between aberrant CBF and cognitive performance. Furthermore, we examined the influence of hypertension on CBF alterations in T2DM patients.T2DM patients (n = 38) and non-T2DM subjects (n = 40) were recruited from clinics, hospitals, and normal community health screenings. Cerebral blood flow images were collected and analyzed using arterial spin labeling perfusion functional magnetic resonance imaging (fMRI). Regions with major CBF differences between T2DM patients and non-T2DM controls were detected via 1-way ANOVA. The interaction effects between hypertension and T2DM for CBF alterations were also examined. Correlation analyses illustrated the association between CBF values and cognitive performance and between CBF and blood pressure.Compared with non-T2DM controls, T2DM patients exhibited decreased CBF, primarily in the visual area and the default mode network (DMN); decreased CBF in these regions was correlated with cognitive performance. There was a significant interaction effect between hypertension and diabetes for CBF in the precuneus and the middle occipital gyrus. Additionally, blood pressure correlated negatively with CBF in T2DM patients.T2DM patients exhibited reduced CBF in the visual area and DMN. Hypertension may facilitate a CBF decrease in the setting of diabetes. T2DM patients may benefit from blood pressure control to maintain their brain perfusion through CBF preservation.

The resting perfusion pattern associates with functional decline in type 2 diabetes

“…This is consistent with our previous findings that T2DM reduces CBF velocity and regional cerebral vasoreactivity of CO 2 challenges in the parietal and occipital regions (Novak et al 2006). Our findings are consistent with a recent T2DM ASL-CBF study (Xia et al 2015). They reported that the main effects of T2DM were primarily in visual and DMN regions.…”

“…The results did not reach an agreement yet. Some studies have reported decreased CBF in T2DM (Xia et al 2015; Novak et al 2006; Last et al 2007; Nagamachi et al 1994), while others did not observe CBF alteration in T2DM (Tiehuis et al 2008; Rusinek et al 2015; Novak et al 2011). Most of the studies reporting no CBF alteration in T2DM typically used large regions of interest (ROI) and/or did not adequately account for the potential risk factors.…”

“…ASL has been recently used to evaluate CBF in T2DM patients, however the reports are contradictory. Some studies found that resting CBF is similar between T2DM patients and controls (Tiehuis et al 2008; Rusinek et al 2015; Novak et al 2011), while others reported reduced CBF in patients with T2DM (Xia et al 2015; Novak et al 2006; Last et al 2007; Nagamachi et al 1994). The cross-sectional design of these studies however, did not allow to investigate the association between T2DM and changes in brain perfusion or structure and cognitive or mobility functions over time.…”

Relação entre hipertensão arterial sistêmica e diabetes mellitus tipo 2

“…Ele baseia-se nos resultados do estudo de Framingham conduzido predominantemente entre a população caucasiana (Herath, Weerarathna e Umesh, 2015). Entre os principais fatores e hábitos que podem auxiliar no controle da doença estão a alimentação adequada e o controle do peso, que podem proporcionar melhoria no controle glicêmico, com consequente redução de riscos para doenças cardiovasculares e melhora da qualidade de vida (Cecílio, 2015 (Xia, 2015).…”

Cerebral Pathology and Cognition in Diabetes: The Merits of Multiparametric Neuroimaging

“…Thus far, some studies, one using phase contrast MRI (1.5T) (Tiehuis et al, 2008) and one using ASL (3T) (Rusinek et al, 2015), did not find any differences in global perfusion between patients with type 2 diabetes and controls, while other studies (ASL, Novak et al, 2014; Xia et al, 2015a and IVIM, van Bussel et al, 2015, all at 3T) observed regional differences in perfusion. Possibly, differences in MRI methodology could explain these conflicting results.…”