Reduced regional cerebral blood flow in aged noninsulin-dependent diabetic patients with no history of cerebrovascular disease: Evaluation by N-lsopropyl-123I-p-iodoamphetamine with single-photon emission computed tomography

Wakisaka, Masanori; Nagamachi, S; Inoue, Kentaro; Morotomi, Yasuyuki; Nunoi, Kiyohide; Fujishima, Masatoshi

doi:10.1016/0891-6632(90)90017-y

Cited by 43 publications

(28 citation statements)

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“…The ratio was inversely correlated with systolic blood pressure, total cholesterol, and the atherogenic index, and it was positively correlated with HDL and cholesterol. These observations suggest that the agerelated CBF reduction may be accelerated by a combination of hyperglycemia plus other risk factors for arteriosclerosis (26,27). The regional differences in cerebral metabolic capacity may explain increased sensitivity to hyperglycemia in the cerebral cortex (28).…”

Section: Regional Perfusion and Brain Volumes In Diabetesmentioning

confidence: 92%

Global and Regional Effects of Type 2 Diabetes on Brain Tissue Volumes and Cerebral Vasoreactivity

et al. 2007

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OBJECTIVE -The aim of this study was to evaluate the regional effects of type 2 diabetes and associated conditions on cerebral tissue volumes and cerebral blood flow (CBF) regulation.RESEARCH DESIGN AND METHODS -CBF was examined in 26 diabetic (aged 61.6 Ϯ 6.6 years) and 25 control (aged 60.4 Ϯ 8.6 years) subjects using continuous arterial spin labeling (CASL) imaging during baseline, hyperventilation, and CO 2 rebreathing. Regional gray and white matter, cerebrospinal fluid (CSF), and white matter hyperintensity (WMH) volumes were measured on a T1-weighted inversion recovery fast-gradient echo and a fluid attenuation inversion recovery magnetic resonance imaging at 3 Tesla.RESULTS -The diabetic group had smaller global white (P ϭ 0.006) and gray (P ϭ 0.001) matter and larger CSF (36.3%, P Ͻ 0.0001) volumes than the control group. Regional differences were observed for white matter (Ϫ13.1%, P ϭ 0.0008) and CSF (36.3%, P Ͻ 0.0001) in the frontal region, for CSF (20.9%, P ϭ 0.0002) in the temporal region, and for gray matter (Ϫ3.0%, P ϭ 0.04) and CSF (17.6%, P ϭ 0.01) in the parieto-occipital region. Baseline regional CBF (P ϭ 0.006) and CO 2 reactivity (P ϭ 0.005) were reduced in the diabetic group. Hypoperfusion in the frontal region was associated with gray matter atrophy (P Ͻ 0.0001). Higher A1C was associated with lower CBF (P Ͻ 0.0001) and greater CSF (P ϭ 0.002) within the temporal region.CONCLUSIONS -Type 2 diabetes is associated with cortical and subcortical atrophy involving several brain regions and with diminished regional cerebral perfusion and vasoreactivity. Uncontrolled diabetes may further contribute to hypoperfusion and atrophy. Diabetic metabolic disturbance and blood flow dysregulation that affects preferentially frontal and temporal regions may have implications for cognition and balance in elderly subjects with diabetes. Diabetes Care 30:1193-1199, 2007D iabetes is a prevalent condition associated with substantial morbidity attributed to vascular complications (1). Diabetes alters endothelial function (2) and permeability of the bloodbrain barrier, thus affecting microcirculation and regional metabolism (3).Studies in type 1 diabetes have shown that the fronto-temporal cortex and periventricular white matter (3) are more affected by diabetic metabolic disturbance. Single proton emission computed tomography (SPECT) studies suggest that chronic hyperglycemia alters cerebral blood flow (CBF) in the frontal, temporal, parietal, occipital, and cerebellar regions of interest (ROIs) (4,5). Vasoreactivity to acetazolamide is not homogeneous, with a majority of hypoperfused and some hyperperfused ROIs (6). White matter hyperintensities (WMHs) on T2-weighted magnetic resonance imaging (MRI) (7) have been associated with arteriolosclerosis, arising as consequences of aging, diabetes, and other cardiovascular risk factors (8,9). Vascular and neurodegenerative changes in these structures have consequences for regional perfusion, cognitive impairment, and balance in elderly people with type 2 diabetes (10,...

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Section: Regional Perfusion and Brain Volumes In Diabetesmentioning

confidence: 92%

Global and Regional Effects of Type 2 Diabetes on Brain Tissue Volumes and Cerebral Vasoreactivity

et al. 2007

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“…SPECT and MRI are capable of examining global CBF. Previous studies using mostly semiquantitative methods to compare regional cerebral flow with the global brain circulation in diabetic patients or with the same cerebral regions of healthy controls detected decreased CBF and reserve capacity in diabetic patients (9,10). In contrast to these studies, absolute values of brain circulation were examined in our study (mL/min/100 g of brain tissue).…”

Section: Discussionmentioning

confidence: 72%

“…Compared with other lobes, earlier and greater reductions in blood flow of the frontal and parietal lobes of diabetic patients were reported, together with a decrease in cognitive functions (9); however, studies comparing CBF of T1DM and T2DM patients were not performed before.…”

Section: Discussionmentioning

confidence: 99%

“…Line across box indicates median. blood circulation (9,18). CBF is affected primarily by systolic blood pressure.…”

Section: Discussionmentioning

confidence: 99%

“…Fülesdi et al found that the decrease in circulation became pronounced 10 y after the diagnosis of both types of diabetes (5,6). Other studies used the SPECT method to measure semiquantitatively the CBF and reserve capacity and found a significant decrease in both parameters (7)(8)(9). Keymeulen et al found an association among CBF, hemoglobin A1c (HbA1c), and the duration of T1DM (10).…”

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Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Káplár¹,

Paragh²,

Erdei³

et al. 2009

J Nucl Med

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Although macrovascular complications are typical for type 2 diabetes mellitus (T2DM), cerebral microvascular damage develops both in type 1 diabetes mellitus (T1DM) and T2DM. Color Doppler ultrasound is widely used for the examination of large-and medium-sized arteries, whereas SPECT and MRI are capable of identifying disturbances in the circulation of microvessels. Former studies using semiquantitative methods showed reduced reactivity and reserve capacity of cerebral vessels in both T1DM and T2DM patients. Our aim was to investigate whether there was any difference in the effects of the 2 types of diabetes mellitus on the global or regional cerebral blood flow, influenced by microvascular damage. Methods: In our study, the circulation and reserve capacity of cerebral arteries was examined using 99m Tc-hexamethylpropylene amine oxime SPECT. A total of 17 individuals with T1DM and 43 individuals with T2DM were involved in the study. Results: Both basal and acetazolamide-challenged brain circulation were significantly lower in T2DM patients than in T1DM patients. We did not find a significant difference in the reserve capacity. However, the circulation of the frontal and occipital lobes changed differently in the 2 groups. The ratio of the circulation of the frontal and occipital lobes was significantly reduced both in basal and in acetazolamide-stimulated states in T2DM patients, independently of age (P , 0.0005 and P , 0.017), showing a greater relative decrease in the circulation of the frontal lobe in T2DM patients. Conclusion: There was a significant association between basal brain circulation and age, body mass index, and high-density lipoprotein (HDL), whereas acetazolamide-stimulated circulation showed a significant association with serum triglyceride and HDL.Key Words: diabetes mellitus; cerebral perfusion; SPECT; reserve capacity; frontooccipital ratio Nucl Med 2009; 50:1993 50: -1998 50: DOI: 10.2967 Di abetes mellitus considerably increases the risk of stroke due to the damage of cerebral arteries (1,2). Macrovascular complications are typical for type 2 diabetes mellitus (T2DM); however, the injury of cerebral microvessels can be detected in both type 1 diabetes mellitus (T1DM) and T2DM. Hyperglycemia leads to structural damage of capillaries and endothelial dysfunction, and the permeability of the blood-brain barrier is also altered in diabetics (3). These factors significantly affect the regional and global cerebral blood flow (CBF) and the metabolism of the brain. The damage of the vessels can be demonstrated even before the appearance of clinical symptoms. B-mode ultrasound can be useful in the examination of large and medium arteries, whereas SPECT, MRI, and transcranial Doppler are able to recognize disturbances of the microcirculation. Previous studies using Doppler ultrasound found decreased reactivity and reserve capacity of large and medium arteries in both types of diabetes (4-6). Fülesdi et al. found that the decrease in circulation became pronounced 10 y after the diagnosis of both typ...

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Why is learning and memory dysfunction in Type 2 diabetes limited to older adults?

Ryan

Geckle

2000

Diabetes Metab. Res. Rev.

166

119

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Review of the literature on the cognitive correlates and consequences of Type 2 diabetes reveals two very intriguing findings. Not only are verbal learning and memory skills most likely to be disrupted as compared to other cognitive skills (e.g. attention, executive function; psychomotor efficiency), but these mnestic deficits appear to be restricted to individuals with diabetes who are older than 60-65 years of age. Middle-aged adults with either Type 2 or Type 1 diabetes are apparently protected insofar as researchers have only infrequently reported learning and memory impairments in that age group. Why do older adults have such an increased risk of diabetes-associated memory dysfunction? In our view, this phenomenon is a consequence of a synergistic interaction between diabetes-related metabolic derangements and the structural and functional changes occurring in the central nervous system (CNS) that are part of the normal ageing process. To critically evaluate that possibility, we summarise what is known about learning and memory dysfunction in the adult with diabetes, examine the extent to which chronic hyperglycaemia may adversely affect the integrity of the CNS, and selectively review the literature on age-associated changes in brain morphology and cognitive function, paying special attention to the threshold theory of cognitive impairment.

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Reduced regional cerebral blood flow in aged noninsulin-dependent diabetic patients with no history of cerebrovascular disease: Evaluation by N-lsopropyl-123I-p-iodoamphetamine with single-photon emission computed tomography

Cited by 43 publications

References 9 publications

Global and Regional Effects of Type 2 Diabetes on Brain Tissue Volumes and Cerebral Vasoreactivity

Global and Regional Effects of Type 2 Diabetes on Brain Tissue Volumes and Cerebral Vasoreactivity

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Why is learning and memory dysfunction in Type 2 diabetes limited to older adults?

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