The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus

Groeneveld, Onno N.; Moneti, Costanza; Heinen, Rutger; Bresser, Jeroen de; Kuijf, Hugo J.; Exalto, Lieza G.; Boomsma, Jooske M.F.; Kappelle, L. Jaap; Barkhof, Frederik; Prins, Niels D.; Scheltens, Philip; Flier, Wiesje M. van der; Biessels, Geert Jan

doi:10.3233/jad-180914

Cited by 18 publications

(16 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A possible limitation of the study is that we obtained a measure of overall CBF at the level of the large extracranial arteries using two-dimensional phase-contrast MRI and did not measure CBF at the tissue level. Yet, the observed mean CBF values in our study are comparable to other studies that did use measures at the tissue level [1][2][3][4][5][6][7][8][9][10][11][12][13]. This does not exclude that there can be regional areas of abnormal perfusion at the site where lesions develop or have developed.…”

Section: Discussionsupporting

confidence: 84%

“…We found no relationship between CBF and MBs or lacunes after correction for age and sex in our primary or secondary analyses. A limited number of studies, both cross-sectional and longitudinal, have assessed the association between CBF and these features of SVD [5][6][7][8][9][10][11][12][13]. A single study on MBs, in a rather small and selected population of patients with symptomatic SVD, did show a relationship between multiple MBs (5 or more) and lower CBF in one of several brain regions tested [16].…”

Section: Discussionmentioning

confidence: 99%

“…The automated CAT12 segmentations for total brain and WMH volume were subsequently corrected for by hand segmentation of stroke lesion volume (e.g., lacunes, non-lacunar infarcts, and hemorrhages). An extended explanation of the semi-automated processing pipeline was previously published [9].…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Cerebral Perfusion and the Burden of Small Vessel Disease in Patients Referred to a Memory Clinic

et al. 2020

Self Cite

View full text Add to dashboard Cite

Background: Cerebral small vessel disease (SVD) lesions on MRI are common in patients with cognitive impairment. It has been suggested that cerebral hypoperfusion is involved in the etiology of these lesions. Objective: The aim of the study was to determine the relationship between cerebral blood flow (CBF) and SVD burden in patients referred to a memory clinic with SVD on MRI. Method: We included 132 memory clinic patients (mean age 73 ± 10, 56% male) with SVD on MRI. We excluded patients with large non-lacunar cortical infarcts. Global CBF (mL/min per 100 mL of brain tissue) was derived from 2-dimensional phase-contrast MRI focused on the internal carotid arteries and the basilar artery. SVD burden was defined as the sum of (each 1 point): white matter hyperintensities (WMHs) Fazekas 1 or more, lacunes, microbleeds (MBs), or enlarged perivascular spaces (PVS) presence, and each SVD feature separately. Linear regression analyses were performed to study the association between CBF and SVD burden, age- and sex-adjusted. Results: Median SVD burden score was 2, 36.4% of patients had MBs, 35.6% lacunar infarcts, 48.4% intermediate to severe enlarged PVS, and 57.6% a WMH Fazekas score 2 or more. Median WMH volume was 21.4 mL (25% quartile: 9.6 mL, 75% quartile: 32.5 mL). Mean CBF ± SD was 44.0 ± 11.9 mL/min per 100 mL brain. There was no relation between CBF and overall SVD burden (CBF difference per burden score point [95% CI]: −0.5 [−2.4; 1.4] mL/min/100 mL brain, p = 0.9). CBF did also not differ according to presence or absence or an high burden of any of the individual SVD features. Moreover, there was no significant relation between WMH volume and CBF (CBF difference per ml increase in WMH [95% CI] −0.6 [−1.5; 0.3] mL/min/100 mL brain p = 0.2). Conclusion: Global CBF was not related to overall SVD burden or with individual SVD features in this memory clinic cohort, indicating that in this setting these lesions were not primarily due to cerebral hypoperfusion.

show abstract

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Cerebral Perfusion and the Burden of Small Vessel Disease in Patients Referred to a Memory Clinic

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Ogama et al [28] found that postprandial hyperglycemia is related to WMH in diabetic patients with Alzheimer's disease while diabetic patients without dementia appeared to be less susceptible to the effects of hyperglycemia. Lacunar infarcts have been seen in patients with prediabetes and at an even higher number in patients with type 2 diabetes mellitus [29,30].…”

Section: Discussionmentioning

confidence: 99%

The association between intraoperative hyperglycemia and cerebrovascular markers

Knaak¹,

Kant²,

Lammers-Lietz³

et al. 2021

Int. J. Med. Sci.

Self Cite

View full text Add to dashboard Cite

BACKGROUND AND PURPOSE: Hyperglycemia can lead to an increased rate of apoptosis of microglial cells and to damaged neurons. The relation between hyperglycemia and cerebrovascular markers on MRI is unknown. Our aim was to study the association between intraoperative hyperglycemia and cerebrovascular markers. METHODS: In this further analysis of a subgroup investigation of the BIOCOG study, 65 older non-demented patients (median 72 years) were studied who underwent elective surgery of ≥ 60 minutes. Intraoperative blood glucose maximum was determined retrospectively in each patient. In these patients, preoperatively and at 3 months follow-up a MRI scan was performed and white matter hyperintensity (WMH) volume and shape, infarcts, and perfusion parameters were determined. Multivariable logistic regression analyses were performed to determine associations between preoperative cerebrovascular markers and occurrence of intraoperative hyperglycemia. Linear regression analyses were performed to assess the relation between intraoperative hyperglycemia and pre- to postoperative changes in WMH volume. Associations between intraoperative hyperglycemia and postoperative WMH volume at 3 months follow-up were also assessed by linear regression analyses. RESULTS: Eighteen patients showed intraoperative hyperglycemia (glucose maximum ≥ 150 mg/dL). A preoperative more smooth shape of periventricular and confluent WMH was related to the occurrence of intraoperative hyperglycemia [convexity: OR 33.318 (95 % CI (1.002 - 1107.950); p = 0.050]. Other preoperative cerebrovascular markers were not related to the occurrence of intraoperative hyperglycemia. Intraoperative hyperglycemia showed no relation with pre- to postoperative changes in WMH volume nor with postoperative WMH volume at 3 months follow-up. CONCLUSIONS: We found that a preoperative more smooth shape of periventricular and confluent WMH was related to the occurrence of intraoperative hyperglycemia. These findings may suggest that a similar underlying mechanism leads to a certain pattern of vascular brain abnormalities and an increased risk of hyperglycemia.

show abstract

“…The automated segmentations for total brain, white/gray matter, and WMH volumes were subsequently corrected for manually created segmentations of infarcts or hemorrhages and incidental findings (eg, meningioma). A total of 823 (95.7%) scans passed quality control and were evaluated through the pipeline 27 …”

Section: Methodsmentioning

confidence: 99%

Sex differences in memory clinic patients with possible vascular cognitive impairment

Exalto

Boomsma

Mofrad

et al. 2020

Alzheimer's & Dementia: Diagnosis, Assessment &

Self Cite

View full text Add to dashboard Cite

Introduction We aimed to establish sex differences in vascular brain damage of memory clinic patients with possible vascular cognitive impairment (VCI). Methods A total of 860 memory clinic patients (aged 67.7 ± 8.5; 46% female) with cognitive complaints and vascular brain damage (ie, possible VCI) from the prospective TRACE‐VCI (Utrecht‐Amsterdam Clinical Features and Prognosis in Vascular Cognitive Impairment) cohort study with 2‐year follow‐up were included. Age‐adjusted female‐to‐male differences were calculated with general linear models, for demographic variables, vascular risk factors, clinical diagnosis, cognitive performance, and brain magnetic resonance imaging markers. Results We found no difference in age nor distribution of clinical diagnoses between females and males. Females performed worse on the MMSE (Mini‐Mental State Examination) and CAMCOG (Cognitive and Self‐Contained Part of the Cambridge Examination for Mental Disorders of the Elderly). Females had a larger white matter hyperintensity volume, while males more often showed (lacunar) infarcts. There was no difference in microbleed prevalence. Males had smaller normalized total brain and gray matter volumes. During follow‐up, occurrence of cognitive decline and institutionalization was comparable, but mortality was higher in males. Discussion Our results suggest that susceptibility and underlying etiology of VCI might differ by sex. Males seem to have more large vessel brain damage compared to females that have more small vessel brain damage.

show abstract

The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus

Abstract: The clinical phenotype of vascular cognitive impairment in patients with type 2 diabetes mellitus.

Cited by 18 publications

References 49 publications

Cerebral Perfusion and the Burden of Small Vessel Disease in Patients Referred to a Memory Clinic

Cerebral Perfusion and the Burden of Small Vessel Disease in Patients Referred to a Memory Clinic

The association between intraoperative hyperglycemia and cerebrovascular markers

Sex differences in memory clinic patients with possible vascular cognitive impairment

Contact Info

Product

Resources

About