Evidence by magnetic resonance imaging of cerebral alterations of atrophy type in young insulin-dependent diabetic patients

Abstract

Aim of this study was to investigate a) if through Magnetic Resonance Imaging (MRI) it was possible to reveal cerebral alterations in patients with insulin-dependent diabetes mellitus (IDDM); b) if there was any correlation with hypoglycemic episodes, glycometabolic control, microvascular alterations and diabetic peripheral neuropathy. For this purpose ten ID-DM patients under treatment with human insulin, aged 19-30 yr with the disease, the duration being from 1 to 19 yr, were investigated by MRI using a Philips Gyroscan. Spin Echo sequences were used with images in T1 T2 in sagittal and axial planes. To measure the ventricular dilatation the cerebroventricular index (CVI) was evaluated. The MRI has put in evidence in 7/10 patients a dilatation in the lateral ventricles and subarachnoidal spaces of the cerebral vault and the cerebellum clearly due to cerebral atrophy. The CVI mean values (34.78 +/- 2.92) were statistically (p < 0.001) higher in diabetic patients respect to control subjects (CVI mean values 27.5 +/- 1.58). These alterations did not present clear correlations with the degree of glycometabolic control, duration of disease, number of symptomatic hypoglycemic episodes and threshold for hypoglycemic symptoms, retinal microvascular alterations, microalbuminuria, diabetic peripheral neuropathy. The clinical or functional relevance of CVI changes and the exact pathogenic mechanism remains to be clarified.

Voxel-based morphometry demonstrates reduced grey matter density on brain MRI in patients with diabetic retinopathy

“…Central and peripheral atrophy in type 1 diabetes [7,8,18] and subcortical white matter lesions [4,5] have been reported in the literature. The methods used in these studies are semiquantitative.…”

“…To date, the few neuroradiological studies that have assessed structural brain abnormalities in patients with type 1 diabetes have demonstrated conflicting results [4][5][6][7][8]. The majority of these studies have been based on manual or semi-automated region-of-interest-guided measurements, which may be inherently biased.…”

Type 1 diabetes mellitus and major depressive disorder: evidence for a biological link

“…Whether the neuroimaging findings in early-onset vs later onset type 1 diabetes in youth are specific to age at onset or are secondary to illness duration is unclear. Other neuroimaging findings in individuals with diabetes have reported cerebral atrophy [107] and reduced cortical cerebral blood flow and glucose metabolism [108] in type 1 diabetic patients compared with controls.…”

The effects of type 1 diabetes on cerebral white matter

“…The presence of microvascular complications has also been associated with white matter abnormalities, although again, there is not complete consensus. Retinopathy was associated with white matter hyperintensities in some [4,7], but not all reports [9,11]. In contrast, neither recurrent hypoglycaemia [8], nor early age at onset [5], predicted the occurrence of white matter abnormalities.…”

“…Neurocognitive research suggests that type 1 diabetes may be associated with psychomotor slowing and reductions in mental efficiency [2,3]-a pattern consistent with damage to brain white matter. However, studies investigating the impact of type 1 diabetes on white matter structure, neurophysiology and functional outcomes have been equivocal [4][5][6][7][8][9][10][11].…”