Cognitive Performance in type 1 Diabetes Patients is associated with Cerebral White Matter Volume
Abstract Number: 0003-OR
Authors: ALETTE M. WESSELS, SERGE A. ROMBOUTS, PETER L. REMIJNSE, YVETTE BOOM, PHILIP SCHELTENS, FREDERIK BARKHOF, ROBERT J. HEINE, FRANK J. SNOEK, Amsterdam, The Netherlands, Leiden, The Netherlands
Results: Cognitive performance in type 1 diabetes may be compromised as a result of chronic hyperglycemia. It is well known that whole brain gray and white matter volume is more closely related to neuropsychological performance than lesion burden and whole brain atrophy may indirectly indicate total disease burden. The aim of this study was to investigate cognitive functioning of patients with type 1 diabetes (including a subgroup with a microvascular complication; i.e., proliferative retinopathy) and healthy controls, and to assess the relationship between cognition and cerebral gray and white matter volume. Twenty-five patients with type 1 diabetes (of whom 10 had proliferative retinopathy) and nine gender, age and education matched healthy controls underwent a neuropsychological examination and magnetic resonance imaging (MRI) of the brain. Fractional brain tissue volumes (tissue volume relative to total intracranial volume) were obtained from each participant. Compared with healthy controls, patients with diabetes performed worse on tests measuring speed of information processing and visuoconstruction. Patients with a microvascular complication performed worse on the former cognitive domain (P = 0.03), whereas patients without a complication performed worse on the latter domain (P = 0.01), both compared to healthy controls. Patients with a microvascular complication had a significantly smaller white matter volume than healthy controls (P = 0.04) and smaller white matter volume was associated with worse performance on the domain of speed of information processing (r = 0.57; P < 0.01) and attention and executive functioning (r = 0.51; P < 0.01). Patients with diabetes demonstrated several subtle neuropsychological deficits, which were found to be related to white matter volume. Since patients with diabetic retinopathy had a smaller white matter volume, this suggests that cognitive decline is at least partly mediated by microvascular disease. This hypothesis needs to be addressed in future studies.