Structural and functional connectivity alteration patterns of the cingulate gyrus in Type 2 diabetes

Structural alteration of hippocampal subfields in type 2 diabetes mellitus patients with dyslipidemia

OBJECTIVE

To explore alterations in hippocampal subfield volumes in type 2 diabetes mellitus (T2DM) patients with dyslipidemia using hippocampal subfield segmentation.

METHODS

A total of 99 T2DM patients were prospectively recruited and divided into two groups based on the presence or absence of dyslipidemia: the T2DM dyslipidemia group and the T2DM normal lipidemia group. Additionally, 57 healthy volunteers were recruited as the healthy control (HC) group. General clinical data and cognitive psychological scale scores were collected. Subgroup analyses of T2DM patients were conducted based on the presence or absence of mild cognitive impairment (MCI). Hippocampal subfield volumes were analyzed using a general linear model with post-hoc Bonferroni correction. Significant differential hippocampal subfields were further analyzed in subgroups using the general linear model with post-hoc Bonferroni tests. Partial correlation analyses were performed to assess correlations between subfield-specific volumes and lipid and glucose metabolism indicators, as well as cognitive psychological scale scores. P-values from partial correlation analyses were corrected using the false discovery rate (FDR).

RESULTS

Volumes of the bilateral hippocampal tail, left presubiculum_body, and right subiculum_body were significantly reduced in the T2DM dyslipidemia group compared to both the HC group and the T2DM normal lipidemia group. Post-hoc analyses revealed that the T2DM dyslipidemia group had the smallest hippocampal subfield volumes. Further subgroup analysis showed that T2DM dyslipidemia patients with MCI exhibited the most pronounced volume reductions in the bilateral hippocampal tail and right subiculum_body. After FDR correction, partial correlation analysis indicated that, in the T2DM dyslipidemia group, the left hippocampal tail volume was positively correlated with the Montreal Cognitive Assessment score. In the T2DM dyslipidemia without MCI group, the volume of the right subiculum_body was negatively correlated with fasting insulin levels and the insulin resistance index, but positively correlated with total cholesterol and low-density lipoprotein cholesterol levels. In T2DM patients with normal lipidemia without MCI, the volume of the right subiculum_body was positively correlated with TC levels.

CONCLUSION

T2DM patients with dyslipidemia, especially those with MCI, exhibit significant atrophy in hippocampal subfield volumes, with correlations observed between lipid levels and hippocampal subfield volume changes. These findings suggest that lipid alterations may play an essential role in hippocampal structural abnormalities and cognitive impairment in T2DM patients. This study provides new insights into the neuropathophysiological mechanisms underlying brain alterations and cognitive decline in T2DM.

Sequence of episodic memory-related behavioral and brain-imaging abnormalities in type 2 diabetes

BACKGROUND

Episodic memory decline is a common complication of type 2 diabetes (T2D). To comprehensively explore the neural mechanisms underlying it, we aimed to explore the sequence that episodic memory-related behavioral and brain-imaging biomarkers appear abnormal in the progression of T2D.

METHODS

We enrolled 62 healthy controls and 110 patients with T2D. The California Verbal Learning Test, Montreal cognitive assessment, and Stroop color word test was used to assess the episodic memory, general cognitive function, and executive function. Principal component analysis was applied to extract behavioral biomarkers. Imaging biomarkers included structural and functional MRI features of the entorhinal cortex-hippocampus and hippocampus-anterior cingulate cortex pathways. We used a novel discriminative event-based model to determine the sequence that memory-related biomarkers appear abnormal and estimate the stage of memory decline.

RESULTS

T2D patients exhibited poorer memory, general cognitive function, and executive function compared to healthy controls after controlling age, sex, and education level. In the progression of T2D, functional interaction between brain regions showed abnormalities first, followed by memory tests, the cerebral spontaneous neural activity, and finally the gray matter volume. Besides, abnormalities appeared earlier in the entorhinal cortex than in the anterior cingulate cortex. Later stage of memory decline was distributed in older patients with T2D and was associated with higher systolic blood pressure, postprandial blood glucose, and low-density lipoprotein.

CONCLUSIONS

In T2D, behavioral and brain imaging biomarkers of episodic memory appear abnormal in a specific sequence, and the stage of memory decline was closely associated with old age and vascular risk factors.

CLINICAL TRIAL REGISTRATION

NCT02420470, ClinicalTrials.gov ( https://www.

CLINICALTRIALS

gov/ ).

Association of individual-based morphological brain network alterations with cognitive impairment in type 2 diabetes mellitus

Objective

To investigate the altered characteristics of cortical morphology and individual-based morphological brain networks in type 2 diabetes mellitus (T2DM), as well as the neural network mechanisms underlying cognitive impairment in T2DM.

Methods

A total of 150 T2DM patients and 130 healthy controls (HCs) were recruited in this study. The study used voxel- and surface-based morphometric analyses to investigate morphological alterations (including gray matter volume, cortical thickness, cortical surface area, and localized gyrus index) in the brains of T2DM patients. Then two methods, Jensen-Shannon divergence-based similarities (JSDs) and Kullback-Leibler divergence-based similarities (KLDs), were used to construct individual morphometric brain networks based on gray matter volume, to discover altered features of the topological network and extract abnormal key brain regions. Subsequently, partial correlation analyses were performed to explore the relationship between clinical biochemical indices, neuropsychological test scores, and altered cortical morphology and network indices.

Results

Brain regions with reduced gray matter volume and cortical thickness in T2DM patients were mainly concentrated in the frontal lobe, temporal lobe, parietal lobe, anterior cingulate gyrus, insula, lingual gyrus, and cerebellar hemispheres. The global attributes of the Individual-based morphological brain network were significantly reduced (Cp, Eloc, σ), with an increase in the nodal efficiency of the hippocampus and the nodal local efficiency of the anterior cingulate gyrus, and the nodal local efficiency of the parahippocampal gyrus and transverse temporal gyrus were reduced. There was a correlation between these node attributes and cognitive scale scores.

Conclusion

This study demonstrated that patients with T2DM exhibit generalized cortical atrophy and damage to individual morphologic brain networks. It also identified overlapping and cognitively relevant key brain regions, primarily within the limbic/paralimbic network (especially the hippocampus and cingulate gyrus), which may serve as imaging markers for identifying cognitive deficits in T2DM. These findings offer new insights into the neural network mechanisms underlying T2DM-associated brain damage and cognitive impairment.

Altered Density of Resting-State Long- and Short-Range Functional Connectivity in Patients with Moderate-to-Severe Obstructive Sleep Apnea

PURPOSE

This study is to evaluate the altered number of functional connection (s) in patients with obstructive sleep apnea (OSA) by functional connectivity density (FCD), to investigate its relationship with cognitive function, and to explore whether these features could be used to distinguish OSA from healthy controls (HCs).

METHODS

Seventy-six OSA patients and 72 HCs were included in the analysis. All participants underwent resting-state functional magnetic resonance imaging scan. Subsequently, intergroup differences between long-and short-range FCD groups were obtained in the Matlab platform by using the degree centrality option with a 75 mm cutoff. The partial correlation analysis were used to assess the relationship between the altered FCD value and clinical assessments in OSA patients. The FCD values of the different brain regions were used as classification features to distinguish the two groups by support vector machine (SVM).

RESULTS

Compared to HCs, OSA patients had decreased long-range FCD in the right superior frontal gyrus (SFG), right precuneus, and left middle frontal gyrus (MFG). Simultaneously, increased long-range FCD in the right cingulate gyrus (CG). Meanwhile, the short-range FCD were decreased in the right postcentral gyrus (PoCG), right SFG, left MFG, and right CG. The short-range FCD values of the right PoCG were correlated with the Montreal Cognitive Assessment scores in OSA patients. SVM analysis showed that FCD in differential brain regions could differentiate OSA patients from HCs.

CONCLUSION

Long- and short-range FCD values in different brain regions of OSA patients may be related to cognitive decline, and also be effective in distinguishing OSA patients from HCs. These findings provide new perspectives on neurocognition in OSA patients.

Characterization of changes in the resting-state intrinsic network in patients with diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is the most common complication of type 2 diabetes mellitus (T2DM) and is often accompanied by a variety of cognitive and emotional deficits, but the neurologic mechanisms underlying these deficits have not been fully elucidated. Therefore, this study aimed to use independent component analysis to explore the changes in the characteristics within the intrinsic network and to reveal patterns of interactions between networks in patients with DPN. Forty-one patients with T2DM who showed DPN, 37 patients with T2DM who did not show DPN (NDPN group), and 43 healthy controls (HC) underwent a neuropsychological assessment and resting-state functional magnetic resonance imaging examinations to examine the patterns of intra- and inter-network variations in the patients with T2DM at different clinical stages (with and without DPN). The relationships of intra- and inter-network functional connectivity (FC) with clinical/cognitive variables were also examined. In comparison with the NDPN group and HC, patients with DPN showed decreased FC within the visual network and sensorimotor network (SMN). Moreover, in comparison with the HC group, patients with DPN showed decreased FC within the anterior default mode network and increased FC within the basal ganglia network. Inter-network analysis showed decreased FC between the SMN and salience network in patients with DPN relative to the NDPN and HC groups. The decreased FC within the bilateral paracentral lobule (BA 6) of SMN was associated with Color Trails Test part 1 scores (r = -0.302, P = 0.007) and disease duration (r = -0.328, P = 0.003) in all patients with T2DM. In conclusion, the results revealed that patients with DPN have abnormal FC in multiple resting-state intrinsic networks in addition to the SMN, and that decreased FC between the SMN and salience network may be involved in the neural basis of abnormal sensorimotor function in patients with DPN.

Potential effects of peripheral neuropathy on brain function in patients with type 2 diabetes mellitus

Background

The mechanisms associated between diabetic peripheral neuropathy (DPN) and various brain function abnormalities in patients remains unclear. This study attempted to indirectly evaluate the effect of DPN on brain function in patients with type 2 diabetes mellitus (T2DM) by characterizing the resting-state functional connectivity (FC) of the lower limb sensorimotor cortex (LSM).

Methods

Forty-four T2DM patients with diabetic peripheral neuropathy (DPN), 39 T2DM patients without diabetic peripheral neuropathy (ND), and 43 healthy controls (HCs) underwent a neuropsychological assessment and resting-state functional magnetic resonance imaging examinations to examine the differences in FC between the LSM and the whole brain. The relationships of FC with clinical/cognitive variables were examined.

Results

In comparison with the HCs group, the ND group showed reduced FC of the LSM with the right lateral occipitotemporal cortex (LOTC) and increased FC with the medial superior frontal gyrus (SFGmed), while the DPN group showed reduced FC of the LSM with the right cerebellar lobule VI, the right LOTC, the rostral prefrontal cortex (rPFC), and the anterior cingulate gyrus (ACC). Moreover, in comparison with the ND group, the DPN group showed reduced FC of the LSM with the ACC, SFGmed, and rPFC. In the DPN group, the FC between the LSM and right cerebellar lobule VI was significantly correlated with fasting blood glucose levels (r = -0.490, p = 0.001), and that between the LSM and ACC was significantly correlated with the Montreal Cognitive Assessment score (r = 0.479, p = 0.001).

Conclusions

Patients with T2DM may show abnormal motion-related visual perceptual function before the appearance of DPN. Importantly, DPN can influence the brain regions that maintain motion and motor control, and this effect is not limited to motor function, which may be the central neuropathological basis for diabetic peripheral neuropathy.

Characteristic Activation Pattern and Network Connectivity of Prefrontal Cortex in Patients with Type 2 Diabetes Mellitus and Major Depressive Disorder during a Verbal Fluency Task: A Functional Near-Infrared Spectroscopy Study Based on Network-Based Statistic Prediction

INTRODUCTION

Type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) together occur frequently among the elderly population. However, the inconsistency in assessments and limited medical resources in the community make it challenging to identify depression in patients with T2DM. This cross-sectional study aimed to investigate the activation pattern and network connectivity of prefrontal cortex (PFC) during a verbal fluency task (VFT) in patients with T2DM and MDD using functional near-infrared spectroscopy (fNIRS).

METHODS

Three parallel groups (T2DM with MDD group, T2DM group, and healthy group) with 100 participants in each group were included in the study. Recruitment took place from August 1, 2020, to December 31, 2023. Due to the close association between the PFC and depressive emotions, fNIRS was used to monitor brain activation and network connectivity of PFC in all participants during a task of Chinese-language phonological VFT. Network-based statistic prediction was adopted as data analysis method.

RESULTS

Patients in the T2DM with MDD group showed characteristic activation pattern and network connectivity in contrast with patients with T2DM and healthy controls, including decreased activation in PFC, and decreased network connectivity of right dorsolateral prefrontal cortex (DLPFC). Furthermore, the network connectivity of the right DLPFC in patients with T2DM and MDD was negatively correlated with scores of Hamilton Depression Scale-24 (HAMD-24).

CONCLUSIONS

There was a distinctive activation pattern and network connectivity of the PFC in patients with T2DM and MDD. The right DLPFC could serve as a potential target for the diagnosis and intervention of MDD in patients with T2DM.

Aberrant Modular Segregation of Brain Networks in Patients with Diabetic Retinopathy

Background

Diabetic retinopathy (DR) is a prevalent ocular manifestation of diabetic microvascular complications and a primary driver of irreversible blindness. Existing studies have illuminated the presence of aberrant brain activity in individuals affected by DR. However, the alterations in the modular segregation of brain networks among DR patients remain inadequately understood. The study aims to explore the modular segregation of brain networks in patients with DR.

Methods

We examined the blood oxygen levels dependent (BOLD) signals using resting-state functional magnetic resonance imaging (R-fMRI) in a cohort of 46 DRpatients and 43 age-matched healthy controls (HC). Subsequently, Modular analysis utilizing graph theory method was applied to quantify the degree of brain network segregation by computing the participation coefficient (PC). Deviations from typical PC values were further elucidated through intra- and inter-module connectivity analyses.

Results

The DR group demonstrated significantly lower mean PC in the frontoparietal network (FPN), sensorimotor network (SMN), and visual network (VN) compared to the HCgroup. Moreover, increased inter-module connections were observed between the default-mode network (DMN) and SMN, as well as between FPN and VN within the DR group. In terms of nodal analysis, higher PC values were detected in the left thalamus, right frontal lobe, and right precentral gyrus in the DR group compared to the HC group.

Conclusion

Patients with DR show impairments in primary sensory networks and higher cognitive networks within their functional brain networks. These changes may provide essential insights into the neurobiological mechanisms of DR by identifying alterations in the brain networks of DR patients and pinpointing sensitive neurobiological markers that could serve as vital imaging references for future treatments of diabetic retinopathy.

A systematic review of the impact of type 2 diabetes on brain cortical thickness

Introduction

Type 2 diabetes (T2D) has been linked to cognitive impairment and dementia, but its impact on brain cortical structures in individuals prior to or without cognitive impairment remains unclear.

Methods

We conducted a systematic review of 2,331 entries investigating cerebral cortical thickness changes in T2D individuals without cognitive impairment, 55 of which met our inclusion criteria.

Results

Most studies (45/55) reported cortical brain atrophy and reduced thickness in the anterior cingulate, temporal, and frontal lobes between T2D and otherwise cognitively healthy controls. However, the balance of studies (10/55) reported no significant differences in either cortical or total brain volumes. A few reports also noticed changes in the occipital cortex and its gyri. As part of the reports, less than half of studies (18/55) described a correlation between T2D and hippocampal atrophy. Variability in sample characteristics, imaging methods, and software could affect findings on T2D and cortical atrophy.

Discussion

In conclusion, T2D appears linked to reduced cortical thickness, possibly impacting cognition and dementia risk. Microvascular disease and inflammation in T2D may also contribute to this risk. Further research is needed to understand the underlying mechanisms and brain health implications.

Aberrant Brain Triple-Network Effective Connectivity Patterns in Type 2 Diabetes Mellitus

INTRODUCTION

Aberrant brain functional connectivity network is thought to be related to cognitive impairment in patients with type 2 diabetes mellitus (T2DM). This study aims to investigate the triple-network effective connectivity patterns in patients with T2DM within and between the default mode network (DMN), salience network (SN), and executive control network (ECN) and their associations with cognitive declines.

METHODS

In total, 92 patients with T2DM and 98 matched healthy controls (HCs) were recruited and underwent resting-state functional magnetic resonance imaging (rs-fMRI). Spectral dynamic causal modeling (spDCM) was used for effective connectivity analysis within the triple network. The posterior cingulate cortex (PCC), medial prefrontal cortex (mPFC), lateral prefrontal cortex (LPFC), supramarginal gyrus (SMG), and anterior insula (AINS) were selected as the regions of interest. Group comparisons were performed for effective connectivity calculated using the fully connected model, and the relationships between effective connectivity alterations and cognitive impairment as well as clinical parameters were detected.

RESULTS

Compared to HCs, patients with T2DM exhibited increased or decreased effective connectivity patterns within the triple network. Furthermore, diabetes duration was significantly negatively correlated with increased effective connectivity from the r-LPFC to the mPFC, while body mass index (BMI) was significantly positively correlated with increased effective connectivity from the l-LPFC to the l-AINS (r = - 0.353, p = 0.001; r = 0.377, p = 0.004).

CONCLUSION

These results indicate abnormal effective connectivity patterns within the triple network model in patients with T2DM and provide new insight into the neurological mechanisms of T2DM and related cognitive dysfunction.