Cerebral White Matter Hyperintensity in African Americans and European Americans with Type 2 Diabetes

Divers, Jasmin; Hugenschmidt, Christina E.; Sink, Kaycee M.; Williamson, Jeffrey D.; Ge, Yaorong; Smith, Susan; Bowden, Donald W.; Whitlow, Christopher T.; Lyders, Eric M.; Maldjian, Joseph A.; Freedman, Barry I.

doi:10.1016/j.jstrokecerebrovasdis.2012.03.019

Cited by 19 publications

(18 citation statements)

References 27 publications

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“…Self-described European Americans and African Americans with T2D were recruited at Wake Forest School of Medicine (WFSM) to the DHS MIND (9) and the AA-DHS MIND (10), respectively. The DHS is a cross-sectional study of European American and African American families with siblings concordant for T2D.…”

Section: Methodsmentioning

confidence: 99%

APOE Genotypes Associate With Cognitive Performance but Not Cerebral Structure: Diabetes Heart Study MIND

et al. 2016

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OBJECTIVEDementia is a debilitating illness with a disproportionate burden in patients with type 2 diabetes (T2D). Among the contributors, genetic variation at the apolipoprotein E locus (APOE) is posited to convey a strong effect. This study compared and contrasted the association of APOE with cognitive performance and cerebral structure in the setting of T2D.RESEARCH DESIGN AND METHODSEuropean Americans from the Diabetes Heart Study (DHS) MIND (n = 754) and African Americans from the African American (AA)-DHS MIND (n = 517) were examined. The cognitive battery assessed executive function, memory, and global cognition, and brain MRI was performed.RESULTSIn European Americans and African Americans, the APOE E4 risk haplotype group was associated with poorer performance on the modified Mini-Mental Status Examination (P < 0.017), a measure of global cognition. In contrast to the literature, the APOE E2 haplotype group, which was overrepresented in these participants with T2D, was associated with poorer Rey Auditory Verbal Learning Test performance (P < 0.032). Nominal associations between APOE haplotype groups and MRI-determined cerebral structure were observed.CONCLUSIONSCompared with APOE E3 carriers, E2 and E4 carriers performed worse in the cognitive domains of memory and global cognition. Identification of genetic contributors remains critical to understanding new pathways to prevent and treat dementia in the setting of T2D.

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Section: Methodsmentioning

confidence: 99%

APOE Genotypes Associate With Cognitive Performance but Not Cerebral Structure: Diabetes Heart Study MIND

et al. 2016

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“…[8] DHS is a cross-sectional study of European American (EA) and AA families with siblings concordant for T2D. AA-DHS was initiated after DHS and enrolls unrelated AAs with T2D.…”

Section: Methodsmentioning

confidence: 99%

“…[8] These individuals previously underwent intensive phenotyping for computed tomography to determine subclinical calcified atherosclerotic plaque for CVD, bone mineral density, and adipose tissue volumes. [9] Simultaneous with the current study, glycemic control and markers of kidney disease (and other metabolic parameters) were assessed.…”

Section: Introductionmentioning

confidence: 99%

Kidney Disease and Cognitive Function: African American-Diabetes Heart Study MIND

Palmer

Sink²,

Smith³

et al. 2014

Am J Nephrol

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Aims: Albuminuria and reduced estimated glomerular filtration rate (eGFR) are linked with poorer cognitive performance in European-ancestry populations with advanced nephropathy; relationships in African Americans (AAs) with type 2 diabetes (T2D) are less clear. Tests of cognitive performance, urine albumin:creatinine ratio (UACR), and CKD-EPI eGFR were performed in unrelated AAs with T2D to determine relationships. Methods: Cross-sectional analysis of 263 unrelated AAs with T2D recruited in the African American-Diabetes Heart Study (AA-DHS) MIND. Global cognitive function (mini-mental state exam [3MSE] and Montreal Cognitive Assessment [MoCA]), memory (Rey Auditory Verbal Learning Test [RAVLT]), executive function (Stroop, verbal fluency for animals, and Digit Symbol Copy [DSC]), UACR, and eGFR were determined. Relationships between cognitive tests and renal parameters were assessed using multivariate models, adjusted for age, gender, body mass index, hemoglobin A1c, level of education, hypertension, and LDL cholesterol. Results: Participants had a mean ± SD age of 60.2 ± 9.7 years, 62.7% were female, T2D duration was 14.3 ± 8.9 years, eGFR 86.0 ± 23.2 ml/min/1.73 m², and UACR 155.8 ± 542.1 (median 8.1) mg/g. In adjusted models, higher UACR was associated with worse 3MSE (p = 0.014), MoCA (p = 0.0089), DSC (p = 0.0004), Stroop performance time (p = 0.003), Stroop errors (p = 0.032), and Stroop interference (p = 0.026). Higher eGFR was associated with better performance on DSC (p = 0.0071). Conclusions: In AAs with T2D, albuminuria and eGFR were associated with cognitive function, even in mild kidney disease. These data stress the need for interventions to prevent cognitive decline well before the late stages of kidney disease.

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“…Few studies, however, have characterized the association between brain structure and cognitive function in a large comprehensively phenotyped cohort of African Americans with T2D, particularly those with relatively well-controlled vascular disease risk factors (hypertension and hyperlipidemia) and access to adequate health care. 11 The purpose of this investigation was to determine the relationship between MR imaging measures of brain structure and cognitive function in an African American population with T2D enrolled in the African American–Diabetes Heart Study MIND. We hypothesized that lower brain volume and a higher burden of WM disease would be associated with poorer performance on tests spanning a variety of cognitive domains.…”

mentioning

confidence: 99%

Effects of Type 2 Diabetes on Brain Structure and Cognitive Function: African American–Diabetes Heart Study MIND

Whitlow

Sink²,

Divers

et al. 2015

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE Rates of type 2 diabetes are higher among African Americans compared with individuals of European ancestry. The purpose of this investigation was to determine the relationship between MR imaging measures of brain structure (volume of GM, WM, WM lesions) and cognitive function in a population of African Americans with type 2 diabetes. These MR imaging measures of brain structure are affected by type 2 diabetes–associated macrovascular and microvascular disease and may be associated with performance on tasks of cognitive function in the understudied African American population. MATERIALS AND METHODS African Americans with type 2 diabetes enrolled in the African American–Diabetes Heart Study MIND study (n = 263) were evaluated across a broad range of cognitive domains and imaged with brain MR imaging. Associations between cognitive parameters and MR imaging measures of whole-brain GM, WM, and WM lesion volumes were assessed by using adjusted multivariate models. RESULTS Lower GM volume was associated with poorer performance on measures of general cognitive function, working memory, and executive function. Higher WM lesion volume was associated with poorer performance on a smaller subset of cognitive domains compared with GM volume but included aspects of working memory and executive function. There were no statistically significant associations with WM volume. CONCLUSIONS Markers of cortical atrophy and WM lesion volume are associated with cognitive function in African Americans with type 2 diabetes. These associations are described in an African American cohort with disease control similar to that of individuals of European ancestry, rather than underserved African Americans with poor access to health care. Interventions to reduce cortical atrophy and WM disease may improve cognitive outcomes in this understudied population.

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Cerebral White Matter Hyperintensity in African Americans and European Americans with Type 2 Diabetes

Cited by 19 publications

References 27 publications

APOE Genotypes Associate With Cognitive Performance but Not Cerebral Structure: Diabetes Heart Study MIND

APOE Genotypes Associate With Cognitive Performance but Not Cerebral Structure: Diabetes Heart Study MIND

Kidney Disease and Cognitive Function: African American-Diabetes Heart Study MIND

Effects of Type 2 Diabetes on Brain Structure and Cognitive Function: African American–Diabetes Heart Study MIND

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