Increased Burden of Cerebral Small Vessel Disease in Patients With Type 2 Diabetes and Retinopathy

Abstract

OBJECTIVEWe sought to examine the presence and severity of brain small vessel disease (SVD) in patients with type 2 diabetes and diabetic retinopathy (DR) compared with those without DR. RESEARCH DESIGN AND METHODSWe evaluated 312 patients with type 2 diabetes without previous cardiovascular disease (men 51%; mean age 57 years; age range 40-75 years); 153 patients (49%) had DR. MRI was performed to evaluate the presence and severity (age-related white matter changes scale) of white matter lesions (WMLs) and lacunes, and transcranial Doppler ultrasound was used to measure the Gosling pulsatility index (PI) of the middle cerebral artery (MCA). RESULTSThe prevalence of lesions of cerebral SVD (WML and/or lacunes) was higher in patients with DR (40.2% vs. 30.1% without DR, P = 0.04). Age (P < 0.01) and systolic blood pressure (P = 0.02) were associated with the presence of SVD. The severity of SVD was associated with age and the presence of DR (P < 0.01 and P = 0.01, respectively). Patients with DR showed a higher MCA PI compared with those without DR (P < 0.01). Age, systolic and diastolic blood pressure, and retinopathy and its severity were associated with an increased MCA PI (P < 0.01 for all variables). A positive correlation was found between MCA PI values and the presence and severity of SVD (P < 0.01 for both variables). CONCLUSIONSPatients with type 2 diabetes who have DR have an increased burden of cerebral SVD compared with those without DR. Our findings suggest that the brain is a target organ for microangiopathy, similar to other classic target organs, like the retina.Patients with type 2 diabetes mellitus have an increased risk of cardiovascular (CV) morbidity and mortality. The chronic deleterious effects of hyperglycemia are classically separated into microvascular and macrovascular complications. In addition to the classic target organs of microangiopathy, such as the retina or the kidneys, the brain has also been described more recently as a target organ for diabetic microvascular complications (1).Cerebral small vessel disease (SVD) is the term commonly used to describe a syndrome of clinical, cognitive, neuroimaging, and neuropathological findings that

The Association of Severe Diabetic Retinopathy With Cardiovascular Outcomes in Long-standing Type 1 Diabetes: A Longitudinal Follow-up

“…As the retinal microvasculature shares embryologic, anatomic, and regulatory characteristics with that of the cerebral circulation (35,36), one would expect that retinal changes parallel those in the cerebral vasculature, with the association of SDR with stroke being particularly strong. Nevertheless, such an association has been seen in individuals with type 2 diabetes (37,38), in the general population (3,5), and even in individuals with T1D, as previously shown by us (12). One possible explanation for this discrepancy could again be that the patients analyzed in the current study had a substantially longer diabetes duration, reflecting a changing picture of vascular risk factors at different stages of diabetes duration.…”

Retinopathy: A sign of cerebral small vessel disease in diabetes?

“…The main finding of the current study was that patients with type 2 diabetes and DR, without previous cardiovascular disease, more often had cerebral SVD in contrast to those patients without DR. Furthermore, patients with advanced grades of DR also had more severe grades of SVD and higher MCA PI values.…”

Individuals in the prediabetes stage exhibit reduced hippocampal tail volume and executive dysfunction

“…The arterial supply of the hippocampal tail originates from the P3 segment of the posterior cerebral artery, a peripheral artery that is often involved in diabetes (Umemura, Kawamura, & Hotta, 2017). Indeed, a prior clinical study showed that hyperglycemia can lead to small vascular and microvascular lesions in multiple brain regions, including the hippocampus (Sanahuja et al, 2016), while an experimental study using an animal model of diabetes demonstrated that antidiabetic drugs were able to partially restore abnormal amyloidbeta transport across the blood-brain barrier and improve memory function (Chen et al, 2016). Other studies have shown that the hippocampal tail volume of patients with major depression was significantly smaller than that of the controls (Maller et al, 2012) and that diabetes was one of the most important risk factors for senile depression (Semenkovich, Brown, Svrakic, & Lustman, 2015).…”