Prefrontal cortex brain damage and glycemic control in patients with type 2 diabetes

Abstract

Background: This study examined brain tissue integrity in sites that controls cognition (prefrontal cortices; PFC) and its relationships to glycemic outcomes in adults with type 2 diabetes mellitus (T2DM). Methods: We examined 28 T2DM patients (median age 57.1 years; median body mass index [BMI] 30.6 kg/m 2 ;11 males) and 47 healthy controls (median age 55.0 years; median BMI 25.8 kg/m 2 ; 29 males) for cognition (Montreal Cognitive Assessment [MoCA]), glycemic control (hemoglobin A1c [HbA1c]), and PFC tissue status via brain magnetic resonance imaging (MRI). High-resolution T1-weighted images were collected using a 3.0-Tesla MRI scanner, and PFC tissue changes (tissue density) were examined with voxel-based morphometry procedures. Results: Reduced PFC density values were observed in T2DM patients compared to controls (left, 0.41 ± 0.02 mm 3 /voxel vs 0.44 ± 0.02 mm 3 /voxel, P < 0.001; right, 0.41 ± 0.03 mm 3 /voxel vs 0.45 ± 0.02 mm 3 /voxel, P < 0.001).PFC density values were positively correlated with cognition; left PFC region (r = 0.53, P = 0.005) and right PFC region (r = 0.56, P = 0.003), with age and sex as covariates. Significant negative correlations were found between PFC densities and HbA1c values; left PFC region (r = −0.39, P = 0.049) and right PFC region (r = −0.48, P = 0.01), with age and sex as covariates. Conclusions: T2DM patients showed PFC brain tissue damage, which is asso-

Brain Structural Changes in Patients with Pulmonary Arterial Hypertension

“…We found significant cognitive impairment in PAH patients, especially in delayed recall, consistent with previous studies 7,32 . Multiple conditions with chronic disorders demonstrated loss of white and GM volume and tissue integrity 12,15,16,19,20,22 . At present, this is the first study that shows significant brain structural (GM volume and brain tissue integrity) changes in PAH patients, which could account for most of the symptomatology presented in the condition.…”

“…Among noninvasive brain MRI procedures, high‐resolution T1‐weighted and T2‐relaxometry can be used to examine brain tissue changes. High‐resolution T1‐weighted images are used for voxel‐based morphometry (VBM) analysis, which has been used to assess gray matter (GM) tissue changes in various conditions, including heart failure, obstructive sleep apnea, single ventricle heart disease, Type 2 Diabetes, liver cirrhosis, depression, optic neuritis, panic disorder, obesity, and chronic back pain 12,16–20 . T2 relaxometry measures free water content, and values demonstrate alterations in gray and white matter, with higher T2‐relaxation values indicating chronic tissue changes.…”

Altered Gray Matter Volume, Functional Connectivity, and Degree Centrality in Early-Onset Type 2 Diabetes Mellitus

“…Chronic hyperglycemia and oxidative stress may result in the dysregulation of the internal environment of the cerebral vasculature, resulting in structural changes of the affected areas. The findings of previous studies have demonstrated that patients with early-onset T2DM have lower GMV ( 33 , 34 ), GM density ( 9 , 32 ), and cerebral glucose metabolism ( 9 ). A previous study ( 32 ) on middle-aged to elderly adults also reported the association of reduced prefrontal cortex density with cognitive dysfunction and poor glycemic control, which is consistent with our findings.…”

“…The findings of previous studies have demonstrated that patients with early-onset T2DM have lower GMV ( 33 , 34 ), GM density ( 9 , 32 ), and cerebral glucose metabolism ( 9 ). A previous study ( 32 ) on middle-aged to elderly adults also reported the association of reduced prefrontal cortex density with cognitive dysfunction and poor glycemic control, which is consistent with our findings. Additionally, the SFG is a region located in the prefrontal cortex that connects other brain regions ( 35 ).…”

“…Our findings of superior/middle/inferior frontal gyri atrophy in early-onset T2DM were consistent with those of previous studies ( 6 , 30 ). Cognitive decline in patients with diabetes may be caused by hyperglycemia and insulin resistance, as these are known to induce neuroinflammation through the oxidative stress pathways ( 31 , 32 ). Chronic hyperglycemia and oxidative stress may result in the dysregulation of the internal environment of the cerebral vasculature, resulting in structural changes of the affected areas.…”