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Li L, Li C, Zhu J. The relationship between estimated glucose disposal rate and cognitive function in older individuals. Sci Rep 2025; 15:5874. [PMID: 39966445 PMCID: PMC11836112 DOI: 10.1038/s41598-025-89623-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Accepted: 02/06/2025] [Indexed: 02/20/2025] Open
Abstract
The estimated glucose disposal rate (eGDR) serves as a novel indicator of insulin resistance, which has been shown to correlate with cardiovascular disease risk; however, its relationship with cognitive function remains unclear.This article describes a cross-sectional study design based on data from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). The Weighted logistic regression and the restricted cubic spline were employed to examine the relationship between eGDR and cognitive ability.The subjects were divided into two categories: the normal group and the cognitive function decline (CFD) group, based on their cognitive scores. There were significant differences in eGDR levels between the two groups(P = 0.001).After adjusting for relevant covariates, notable differences were found between eGDR and cognitive function when eGDR was expressed in both continuous and categorical data forms (P < 0.05). The stability of these findings was further confirmed through sensitivity analyses.This difference persisted in subgroups, including women, individuals with education beyond high school, moderate drinkers, and those who had not been diagnosed with stroke (P < 0.05). A restricted cubic spline revealed a non-linear relationship with an inflection point between the two (P-for-non-linear < 0.05, P-overall < 0.001). This study contributes to the understanding of the relationship between eGDR and cognitive performance by identifying a potential non-linear association.
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Affiliation(s)
- Li Li
- Department of Neurology, Affiliated Hospital of Chengde Medical College, Hebei, China.
| | - Chengbo Li
- Department of Neurology, Affiliated Hospital of Chengde Medical College, Hebei, China
| | - Jiang Zhu
- Department of Neurology, Affiliated Hospital of Chengde Medical College, Hebei, China
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Oliel Y, Ravona‐Springer R, Harel M, Azuri J, Moshe CB, Tanne D, Haratz S, Bendlin BB, Beeri MS, Livny A. The role of cerebrovascular reactivity on brain activation during a working memory task in type 2 diabetes. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2025; 17:e70045. [PMID: 40078378 PMCID: PMC11899760 DOI: 10.1002/dad2.70045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 11/06/2024] [Accepted: 11/08/2024] [Indexed: 03/14/2025]
Abstract
INTRODUCTION Impaired cerebrovascular reactivity (CVR) is common in type 2 diabetes (T2D) patients and is a risk factor for dementia. However, most prior functional magnetic resonance imaging (fMRI) studies in T2D disregarded the impact of impaired CVR on brain activation patterns. This study investigated the relationship between CVR and brain activation during an fMRI task in T2D patients. METHODS Seventy-four T2D patients underwent a working-memory (WM) fMRI task. CVR was measured by the breath-holding index test using transcranial Doppler (TCD). Regression analyses examined associations between CVR and brain activation and between glycated hemoglobin (HbA1c) and activation with/without adjusting for CVR. RESULTS An association between CVR and brain activation was found in the left middle and inferior frontal gyri. Adjusting for CVR led to a different pattern of HbA1c-related activation. DISCUSSION The findings highlight methodological implications, emphasizing the importance of accounting for impaired CVR when analyzing and interpreting fMRI data in T2D patients. Highlights The study found that cerebrovascular reactivity impacts brain activation patterns during a working memory task in type 2 diabetes patients.Accounting for cerebrovascular reactivity altered the brain regions showing activation related to working memory and glycemic control.The findings highlight the importance of considering vascular factors when interpreting fMRI data in populations with vascular dysfunction.
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Affiliation(s)
- Yarden Oliel
- Division of Diagnostic ImagingSheba Medical CenterRamat GanIsrael
| | - Ramit Ravona‐Springer
- The Joseph Sagol Neuroscience CenterSheba Medical CenterRamat GanIsrael
- Memory ClinicSheba Medical CenterRamat GanIsrael
- Faculty of Medical & Health SciencesTel‐Aviv UniversityTel Aviv‐YafoIsrael
| | - Maayan Harel
- Division of Diagnostic ImagingSheba Medical CenterRamat GanIsrael
| | - Joseph Azuri
- Faculty of Medical & Health SciencesTel‐Aviv UniversityTel Aviv‐YafoIsrael
- Maccabi Healthcare ServicesTel AvivIsrael
| | - Chen Botvin Moshe
- The Joseph Sagol Neuroscience CenterSheba Medical CenterRamat GanIsrael
- Faculty of Medical & Health SciencesTel‐Aviv UniversityTel Aviv‐YafoIsrael
| | - David Tanne
- Stroke and Cognition InstituteRambam Health Care CampusHaifaIsrael
- Samson Assuta Ashdod University HospitalAshdodIsrael
| | - Salo Haratz
- Samson Assuta Ashdod University HospitalAshdodIsrael
| | - Barbara B Bendlin
- Wisconsin Alzheimer's Disease Research CenterSchool of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Michal Schnaider Beeri
- Krieger Klein Alzheimer's Research CenterBrain Health InstituteRutgers UniversityPiscatawayNew JerseyUSA
| | - Abigail Livny
- Division of Diagnostic ImagingSheba Medical CenterRamat GanIsrael
- Faculty of Medical & Health SciencesTel‐Aviv UniversityTel Aviv‐YafoIsrael
- Sagol School of NeuroscienceTel‐Aviv UniversityTel Aviv‐YafoIsrael
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Zhang JM, Liu XB, Li YX, Li HJ, Fan J, Xue C, Yin YF, Zhang Y, Nong YX, Wang YN, Zheng Z, Zhong DL, Li J, Jin RJ. 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. Neuroendocrinology 2024; 114:1112-1123. [PMID: 39471791 DOI: 10.1159/000542235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 10/08/2024] [Indexed: 11/01/2024]
Abstract
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.
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Affiliation(s)
- Jia-Ming Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China,
- Department for Neural Function Detection and Regulation, West China Xiamen Hospital, Sichuan University, Xiamen, China,
| | - Xiao-Bo Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu-Xi Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hui-Jing Li
- College of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jin Fan
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Chen Xue
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yun-Fang Yin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yuan Zhang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu-Xuan Nong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi-Nan Wang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhong Zheng
- Department for Neural Function Detection and Regulation, West China Xiamen Hospital, Sichuan University, Xiamen, China
| | - Dong-Ling Zhong
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Juan Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Rong-Jiang Jin
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Fullington H, Block M, Jose N, Peschka S, Brooks J, Price S, Monroe D, Dirisala K, Street A. Improving surgical wound classification accuracy through education and audit processes. BMJ Open Qual 2023; 12:e002325. [PMID: 37967995 PMCID: PMC10660414 DOI: 10.1136/bmjoq-2023-002325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/21/2023] [Indexed: 11/17/2023] Open
Abstract
Precise wound classification is essential for surgical site infection risk stratification and appropriate hospital reimbursement. We instituted a multifaceted approach to improve institutional wound class identification including an education and awareness bundle, as well as a formal audit process. Overall, we saw significant improvements in wound class accuracy, interprofessional collaboration and provider compliance.
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Affiliation(s)
- Hannah Fullington
- Quality and Operational Excellence, UT Southwestern, Dallas, Texas, USA
| | - Morgan Block
- Quality and Operational Excellence, UT Southwestern, Dallas, Texas, USA
| | - Nisha Jose
- Quality and Operational Excellence, UT Southwestern, Dallas, Texas, USA
| | - Stephanie Peschka
- Quality and Operational Excellence, UT Southwestern, Dallas, Texas, USA
| | - Jessica Brooks
- Quality and Operational Excellence, UT Southwestern, Dallas, Texas, USA
| | - Steven Price
- Quality and Operational Excellence, UT Southwestern, Dallas, Texas, USA
| | - David Monroe
- Quality and Operational Excellence, UT Southwestern, Dallas, Texas, USA
| | | | - Austin Street
- Anesthesiology and Pain Management, UT Southwestern, Dallas, Texas, USA
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Pan X, Wang Z. Cortical and subcortical contributions to non-motor inhibitory control: an fMRI study. Cereb Cortex 2023; 33:10909-10917. [PMID: 37724423 DOI: 10.1093/cercor/bhad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/20/2023] Open
Abstract
Inhibition is a core executive cognitive function. However, the neural correlates of non-motor inhibitory control are not well understood. We investigated this question using functional Magnetic Resonance Imaging (fMRI) and a simple Count Go/NoGo task (n = 23), and further explored the causal relationships between activated brain regions. We found that the Count NoGo task activated a distinct pattern in the subcortical basal ganglia, including bilateral ventral anterior/lateral nucleus of thalamus (VA/VL), globus pallidus/putamen (GP/putamen), and subthalamic nucleus (STN). Stepwise regressions and mediation analyses revealed that activations in these region(s) were modulated differently by only 3 cortical regions i.e. the right inferior frontal gyrus/insula (rIFG/insula), along with left IFG/insula, and anterior cingulate cortex/supplementary motor area (ACC/SMA). The activations of bilateral VA/VL were modulated by both rSTN and rIFG/insula (with rGP/putamen as a mediator) independently, and the activation of rGP/putamen was modulated by ACC/SMA, with rIFG/insula as a mediator. Our findings provide the neural correlates of inhibitory control of counting and causal relationships between them, and strongly suggest that both indirect and hyperdirect pathways of the basal ganglia are involved in the Count NoGo condition.
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Affiliation(s)
- Xin Pan
- Key Laboratory of Brain Functional Genomics (Ministry of Education and Shanghai), Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Psychological Counseling Center, Shanghai University, Shanghai, China
| | - Zhaoxin Wang
- Key Laboratory of Brain Functional Genomics (Ministry of Education and Shanghai), Institute of Cognitive Neuroscience, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
- Shanghai Changning Mental Health Center, Shanghai, China
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Zhao F, Tomita M, Dutta A. Operational Modal Analysis of Near-Infrared Spectroscopy Measure of 2-Month Exercise Intervention Effects in Sedentary Older Adults with Diabetes and Cognitive Impairment. Brain Sci 2023; 13:1099. [PMID: 37509027 PMCID: PMC10377417 DOI: 10.3390/brainsci13071099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
The Global Burden of Disease Study (GBD 2019 Diseases and Injuries Collaborators) found that diabetes significantly increases the overall burden of disease, leading to a 24.4% increase in disability-adjusted life years. Persistently high glucose levels in diabetes can cause structural and functional changes in proteins throughout the body, and the accumulation of protein aggregates in the brain that can be associated with the progression of Alzheimer's Disease (AD). To address this burden in type 2 diabetes mellitus (T2DM), a combined aerobic and resistance exercise program was developed based on the recommendations of the American College of Sports Medicine. The prospectively registered clinical trials (NCT04626453, NCT04812288) involved two groups: an Intervention group of older sedentary adults with T2DM and a Control group of healthy older adults who could be either active or sedentary. The completion rate for the 2-month exercise program was high, with participants completing on an average of 89.14% of the exercise sessions. This indicated that the program was practical, feasible, and well tolerated, even during the COVID-19 pandemic. It was also safe, requiring minimal equipment and no supervision. Our paper presents portable near-infrared spectroscopy (NIRS) based measures that showed muscle oxygen saturation (SmO2), i.e., the balance between oxygen delivery and oxygen consumption in muscle, drop during bilateral heel rise task (BHR) and the 6 min walk task (6MWT) significantly (p < 0.05) changed at the post-intervention follow-up from the pre-intervention baseline in the T2DM Intervention group participants. Moreover, post-intervention changes from pre-intervention baseline for the prefrontal activation (both oxyhemoglobin and deoxyhemoglobin) showed statistically significant (p < 0.05, q < 0.05) effect at the right superior frontal gyrus, dorsolateral, during the Mini-Cog task. Here, operational modal analysis provided further insights into the 2-month exercise intervention effects on the very-low-frequency oscillations (<0.05 Hz) during the Mini-Cog task that improved post-intervention in the sedentary T2DM Intervention group from their pre-intervention baseline when compared to active healthy Control group. Then, the 6MWT distance significantly (p < 0.01) improved in the T2DM Intervention group at post-intervention follow-up from pre-intervention baseline that showed improved aerobic capacity and endurance. Our portable NIRS based measures have practical implications at the point of care for the therapists as they can monitor muscle and brain oxygenation changes during physical and cognitive tests to prescribe personalized physical exercise doses without triggering individual stress response, thereby, enhancing vascular health in T2DM.
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Affiliation(s)
- Fei Zhao
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Machiko Tomita
- Department of Rehabilitation Science, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
| | - Anirban Dutta
- School of Engineering, University of Lincoln, Lincoln LN67TS, UK
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7
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Zhang G, Liu T, Wei W, Zhang R, Wang H, Wang M. Evaluation of altered brain activity in type 2 diabetes using various indices of brain function: A resting-state functional magnetic resonance imaging study. Front Hum Neurosci 2023; 16:1032264. [PMID: 36699964 PMCID: PMC9870028 DOI: 10.3389/fnhum.2022.1032264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 01/11/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) has been identified as a risk factor that increases the rate of cognitive decline. Previous studies showed that patients with T2DM had brain function alterations based on a single index of resting-state functional magnetic resonance imaging (rs-fMRI). The present study aimed to explore spontaneous brain activity in patients with T2DM by comparing various rs-fMRI indices, and to determine the relationship between these changes and cognitive dysfunction. Methods A total of 52 patients with T2DM and age- and sex-matched control participants were included in this study. The amplitude of low-frequency fluctuation (ALFF), regional homogeneity (ReHo), and voxel-mirrored homotopic connectivity (VMHC) values were calculated to represent the status of spontaneous neural activity. The Montreal Cognitive Assessment (MoCA) was used for the rapid evaluation of cognition in all subjects. Pearson correlation and mediation analyses were conducted to investigate the relationship between rs-fMRI indices and clinical parameters such as fasting glucose, disease duration, and MoCA. Results Patients with T2DM had alterations of concordant spontaneous brain activity in brain areas including the bilateral cerebellum posterior lobe, the left inferior temporal gyrus (ITG.L), the parahippocampal gyrus, and the left supplementary motor area (SMA.L). The indices were significantly correlated to each other in most of the detected brain areas. Positive correlations were observed between fasting glucose and neural activity in the surrounding areas of the left insula and the inferior frontal gyrus. MoCA scores were negatively correlated with the ReHo values extracted from the left anterior occipital lobe and the superior cerebellar cortex and were positively correlated with VMHC values extracted from the left caudate and the precentral gyrus (PreCG). No significant mediation effect of abnormal brain activity was found in the relationship between clinical parameters and MoCA scores. Conclusion The current study demonstrated the functional concordance of abnormal brain activities in patients with T2DM by comparing ALFF, ReHo, and VMHC measurements. Widespread abnormalities mainly involved in motor and sensory processing functions may provide insight into examining T2DM-related neurological pathophysiology.
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Affiliation(s)
- Ge Zhang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China,Department of Radiology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Taiyuan Liu
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Wei Wei
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Rui Zhang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Huilin Wang
- Department of Radiology, Bethune International Peace Hospital, Shijiazhuang, China,*Correspondence: Huilin Wang ✉
| | - Meiyun Wang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China,Laboratory of Brian Science and Brain-Like Intelligence Technology, Institute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, China,Meiyun Wang ✉
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Savelieff MG, Chen KS, Elzinga SE, Feldman EL. Diabetes and dementia: Clinical perspective, innovation, knowledge gaps. J Diabetes Complications 2022; 36:108333. [PMID: 36240668 PMCID: PMC10076101 DOI: 10.1016/j.jdiacomp.2022.108333] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 09/30/2022] [Indexed: 10/31/2022]
Abstract
The world faces a pandemic-level prevalence of type 2 diabetes. In parallel with this massive burden of metabolic disease is the growing prevalence of dementia as the population ages. The two health issues are intertwined. The Lancet Commission on dementia prevention, intervention, and care was convened to tackle the growing global concern of dementia by identifying risk factors. It concluded, along with other studies, that diabetes as well as obesity and the metabolic syndrome more broadly, which are frequently comorbid, raise the risk of developing dementia. Type 2 diabetes is a modifiable risk factor; however, it is uncertain whether anti-diabetic drugs mitigate risk of developing dementia. Reasons are manifold but constitute a critical knowledge gap in the field. This review outlines studies of type 2 diabetes on risk of dementia, illustrating key concepts. Moreover, it identifies knowledge gaps, reviews strategies to help fill these gaps, and concludes with a series of recommendations to mitigate risk and advance understanding of type 2 diabetes and dementia.
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Affiliation(s)
- Masha G Savelieff
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA
| | - Kevin S Chen
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA; Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Sarah E Elzinga
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA; Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Eva L Feldman
- NeuroNetwork for Emerging Therapies, University of Michigan, Ann Arbor, MI 48109, USA; Department of Neurology, University of Michigan, Ann Arbor, MI 48109, USA.
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Khambaty T, Leibel DK, Katzel LI, Evans MK, Zonderman AB, Waldstein SR. Synergistic Associations of Depressive Symptoms and Executive Functions With Longitudinal Trajectories of Diabetes Biomarkers Among Urban-Dwelling Adults Without Diabetes. Psychosom Med 2022; 84:478-487. [PMID: 35311806 PMCID: PMC9064939 DOI: 10.1097/psy.0000000000001069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Depressive symptoms and executive functions (EFs) have recently emerged as novel risk factors for type 2 diabetes, but it is unknown if these factors interact to influence diabetes pathophysiology across the life span. We examined the synergistic associations of depressive symptoms and EFs with longitudinal trajectories of diabetes diagnostic criteria among middle-aged and older adults without diabetes. METHODS Participants were 1257 African American and White, urban-dwelling adults from the Healthy Aging in Neighborhoods of Diversity across the Life Span study who were assessed up to three times over a 13-year period (2004-2017). At baseline, participants completed the Center for Epidemiological Studies-Depression scale and measures of EFs-Trail Making Test Part B, verbal fluency, and Digit Span Backward-for a composite EFs score, and provided blood samples at each follow-up for glycated hemoglobin and fasting serum glucose. RESULTS A total of 155 and 220 individuals developed diabetes or prediabetes at wave 3 and wave 4, respectively. Linear mixed-effects regression models adjusting for sociodemographic factors, diabetes risk factors, and antidepressant medications revealed significant three-way interactions of Center for Epidemiological Studies-Depression, EFs, and age on change in glycated hemoglobin (b = -0.0001, p = .005) and in fasting serum glucose (b = -0.0004, p < .001), such that among individuals with lower but not higher EFs, elevated depressive symptoms were associated with steeper age-related increases in diabetes biomarkers over time. CONCLUSIONS Depressive symptoms and lower EFs may interactively accelerate trajectories of key diagnostic criteria, thereby increasing the risk for earlier diabetes incidence. Identifying individuals in this high-risk group may be an important clinical priority for earlier intervention, which has the promise of preventing or delaying this debilitating disease.
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Affiliation(s)
- Tasneem Khambaty
- Department of Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, MD
| | - Daniel K. Leibel
- Department of Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, MD
| | - Leslie I. Katzel
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Shari R. Waldstein
- Department of Psychology, University of Maryland, Baltimore County (UMBC), Baltimore, MD
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Lei H, Hu R, Luo G, Yang T, Shen H, Deng H, Chen C, Zhao H, Liu J. Altered Structural and Functional MRI Connectivity in Type 2 Diabetes Mellitus Related Cognitive Impairment: A Review. Front Hum Neurosci 2022; 15:755017. [PMID: 35069149 PMCID: PMC8770326 DOI: 10.3389/fnhum.2021.755017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment in many domains. There are several pieces of evidence that changes in neuronal neuropathies and metabolism have been observed in T2DM. Structural and functional MRI shows that abnormal connections and synchronization occur in T2DM brain circuits and related networks. Neuroplasticity and energy metabolism appear to be principal effector systems, which may be related to amyloid beta (Aβ) deposition, although there is no unified explanation that includes the complex etiology of T2DM with cognitive impairment. Herein, we assume that cognitive impairment in diabetes may lead to abnormalities in neuroplasticity and energy metabolism in the brain, and those reflected to MRI structural connectivity and functional connectivity, respectively.
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Feng Y, Li Y, Tan X, Liang Y, Ma X, Chen Y, Lv W, Wu J, Kang S, Li M, Qiu S. Altered Gray Matter Volume, Functional Connectivity, and Degree Centrality in Early-Onset Type 2 Diabetes Mellitus. Front Neurol 2021; 12:697349. [PMID: 34566841 PMCID: PMC8459017 DOI: 10.3389/fneur.2021.697349] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Structural and functional brain alterations that underlie cognitive decline have been observed in elderly adults with type 2 diabetes mellitus (T2DM); however, whether these alterations can be observed in patients with early-onset T2DM remains unclear. Therefore, we aimed to describe the abnormalities in brain volume and functional patterns in patients with early-onset T2DM in the present study. Methods: We enrolled 20 patients with early-onset T2DM and 20 healthy controls (HCs). Changes in brain volume were assessed using voxel-based morphology (VBM), while changes in brain function were assessed using degree centrality (DC) and functional connectivity (FC). Results: Compared to HCs, patients with early-onset T2DM exhibited gray matter reductions in the left orbital superior, middle, and inferior frontal gyri as well as the right superior frontal gyrus. The gray matter reductions in the right superior frontal gyrus were negatively associated with the urine albumin to creatinine ratio. Furthermore, increased DC values were observed in the left superior temporal gyrus, left Heschl gyrus, and left hippocampus in patients with early-onset T2DM. An FC analysis of these regions revealed elevated connectivity in the right precuneus, left inferior parietal gyrus, left Heschl gyrus, bilateral post-central gyrus, bilateral insula, bilateral superior temporal gyrus, and bilateral medial and paracingulate gyrus. Furthermore, the FC of the hubs to the superior temporal gyrus, insula, and Heschl gyrus was increased and positively correlated with trail making test-B. Conclusion: Decreased local gray matter volume and increased DC and FC may represent the neurobiological mechanism underlying cognitive dysfunction in patients with early-onset T2DM.
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Affiliation(s)
- Yue Feng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yifan Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xin Tan
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yi Liang
- Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaomeng Ma
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuna Chen
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenjiao Lv
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jinjian Wu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shangyu Kang
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Mingrui Li
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shijun Qiu
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,Department of Radiology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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12
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Backeström A, Papadopoulos K, Eriksson S, Olsson T, Andersson M, Blennow K, Zetterberg H, Nyberg L, Rolandsson O. Acute hyperglycaemia leads to altered frontal lobe brain activity and reduced working memory in type 2 diabetes. PLoS One 2021; 16:e0247753. [PMID: 33739980 PMCID: PMC7978337 DOI: 10.1371/journal.pone.0247753] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 02/15/2021] [Indexed: 01/23/2023] Open
Abstract
How acute hyperglycaemia affects memory functions and functional brain responses in individuals with and without type 2 diabetes is unclear. Our aim was to study the association between acute hyperglycaemia and working, semantic, and episodic memory in participants with type 2 diabetes compared to a sex- and age-matched control group. We also assessed the effect of hyperglycaemia on working memory–related brain activity. A total of 36 participants with type 2 diabetes and 34 controls (mean age, 66 years) underwent hyperglycaemic clamp or placebo clamp in a blinded and randomised order. Working, episodic, and semantic memory were tested. Overall, the control group had higher working memory (mean z-score 33.15 ± 0.45) than the group with type 2 diabetes (mean z-score 31.8 ± 0.44, p = 0.042) considering both the placebo and hyperglycaemic clamps. Acute hyperglycaemia did not influence episodic, semantic, or working memory performance in either group. Twenty-two of the participants (10 cases, 12 controls, mean age 69 years) were randomly invited to undergo the same clamp procedures to challenge working memory, using 1-, 2-, and 3-back, while monitoring brain activity by blood oxygen level–dependent functional magnetic resonance imaging (fMRI). The participants with type 2 diabetes had reduced working memory during the 1- and 2-back tests. fMRI during placebo clamp revealed increased BOLD signal in the left lateral frontal cortex and the anterior cingulate cortex as a function of working memory load in both groups (3>2>1). During hyperglycaemia, controls showed a similar load-dependent fMRI response, whereas the type 2 diabetes group showed decreased BOLD response from 2- to 3-back. These results suggest that impaired glucose metabolism in the brain affects working memory, possibly by reducing activity in important frontal brain areas in persons with type 2 diabetes.
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Affiliation(s)
- Anna Backeström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
- * E-mail:
| | - Konstantin Papadopoulos
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Sture Eriksson
- Department of Public Health and Clinical Medicine, Nutritional Research, Umeå University, Umeå, Sweden
| | - Tommy Olsson
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Micael Andersson
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, United Kingdom
- UK Dementia Research Institute at UCL, London, United Kingdom
| | - Lars Nyberg
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Umeå Center for Functional Brain Imaging, Umeå University, Umeå, Sweden
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Olov Rolandsson
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
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13
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Jones LM, Ginier E, Debbs J, Eaton JL, Renner C, Hawkins J, Rios-Spicer R, Tang E, Schertzing C, Giordani B. Exploring Representation of Diverse Samples in fMRI Studies Conducted in Patients With Cardiac-Related Chronic Illness: A Focused Systematic Review. Front Hum Neurosci 2020; 14:108. [PMID: 32477079 PMCID: PMC7240043 DOI: 10.3389/fnhum.2020.00108] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/11/2020] [Indexed: 01/14/2023] Open
Abstract
Introduction/Purpose: Cardiovascular disease (CVD) is the leading cause of death worldwide, and in the United States alone, CVD causes nearly 840,000 deaths annually. Using functional magnetic resonance imaging (fMRI), a tool to assess brain activity, researchers have identified some brain-behavior connections and predicted several self-management behaviors. The purpose of this study was to examine the sample characteristics of individuals with CVD who participated in fMRI studies. Methods: A literature search was conducted in PubMed, CINAHL, and Scopus. No date or language restrictions were applied and research methodology filters were used. In October 2017, 1659 titles and abstracts were identified. Inclusion criteria were: (1) utilized an empirical study design, (2) used fMRI to assess brain activity, and (3) focused on patients with CVD-related chronic illness. Articles were excluded if they: were theory or opinion articles, focused on mental or neuropathic illness, included non-human samples, or were not written in English. After duplicates were removed (230), 1,429 titles and abstracts were reviewed based on inclusion criteria; 1,243 abstracts were then excluded. A total of 186 studies were reviewed in their entirety; after additional review, 142 were further excluded for not meeting the inclusion criteria. Forty-four articles met criteria and were included in the final review. An evidence table was created to capture the demographics of each study sample. Results: Ninety eight percent of the studies did not report the racial or ethnic composition of their sample. Most studies (66%) contained more men than women. Mean age ranged from 38 to 78 years; 77% reported mean age ≥50 years. The most frequently studied CVD was stroke (86%), while hypertension was studied the least (2%). Conclusion: Understanding brain-behavior relationships can help researchers and practitioners tailor interventions to meet specific patient needs. These findings suggest that additional studies are needed that focus on populations historically underrepresented in fMRI research. Researchers should thoughtfully consider diversity and purposefully sample groups by including individuals that are: women, from diverse backgrounds, younger, and diagnosed with a variety of CVD-related illnesses. Identifying and addressing these gaps by studying more representative samples will help healthcare providers reduce disparities and tailor interventions for all CVD populations.
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Affiliation(s)
- Lenette M. Jones
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Emily Ginier
- Taubman Health Sciences Library, University of Michigan, Ann Arbor, MI, United States
| | - Joseph Debbs
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jarrod L. Eaton
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Catherine Renner
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jaclynn Hawkins
- School of Social Work, University of Michigan, Ann Arbor, MI, United States
| | | | - Emily Tang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | | | - Bruno Giordani
- Psychiatry, Neurology, Psychology, and Nursing, University of Michigan, Ann Arbor, MI, United States
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14
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Zhang Y, Cao Y, Xie Y, Liu L, Qin W, Lu S, Zhang Q. Altered brain structural topological properties in type 2 diabetes mellitus patients without complications. J Diabetes 2019; 11:129-138. [PMID: 30039563 DOI: 10.1111/1753-0407.12826] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/19/2018] [Accepted: 07/13/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is a risk factor for cognitive dysfunction, and white matter (WM) microstructural impairments play a critical role in T2DM-related cognitive decline. Disruptions to the WM have been detected in T2DM patients before clinical diagnosis of cognitive dysfunction. Herein, we investigated changes in brain structural topological properties and their correlation with behavior in T2DM patients without complications. METHODS Diffusion tensor imaging (DTI) structural network topological analysis was performed on T2DM patients and healthy controls. Intergroup differences in global and nodal parameters were analyzed, and correlations between the network parameters and behavioral performance were tested. RESULTS Type 2 diabetes mellitus patients exhibited preserved small-world properties, but altered nodal properties, including decreased efficiency in the right hippocampus, right amygdala, left pallidum, left postcentral gyrus, and right pole of the superior temporal gyrus, and increased degree in the right inferior frontal gyrus. Correlations were also found between the altered global and nodal parameters and behavioral performance. CONCLUSIONS The results verified the existence of WM structural network changes and the association between structural properties and cognitive state in T2DM patients before the occurrence of complications. Research of structural properties may contribute to our understanding of the intrinsic links between T2DM and cognition.
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Affiliation(s)
- Yang Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yujuan Cao
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Yingjie Xie
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Linlin Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - Shan Lu
- Department of Radiology, Tianjin Medical University Metabolic Diseases Hospital, Tianjin, China
| | - Quan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
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15
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Rosenberg J, Lechea N, Pentang GN, Shah NJ. What magnetic resonance imaging reveals - A systematic review of the relationship between type II diabetes and associated brain distortions of structure and cognitive functioning. Front Neuroendocrinol 2019; 52:79-112. [PMID: 30392901 DOI: 10.1016/j.yfrne.2018.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 10/11/2018] [Accepted: 10/22/2018] [Indexed: 12/19/2022]
Abstract
Due to its increasing prevalence, Type 2 diabetes mellitus (T2DM) represents a major health challenge for modern society. Despite it being of fundamental interest, only a few MRI studies have conducted statistical analyses to draw scientifically valid conclusions about the complex interplay of T2DM and its associated clinical, structural, functional, metabolite, as well as cognitive distortions. Therefore, a systematic review of 68 manuscripts, following the PRISMA guidelines, was conducted. Notably, although the associations between imaging, clinical, and cognitive variables are not fully homogeneous, findings show a clear trend towards a link between altered brain structure and a decline in cognitive processing ability. The results of the review highlight the heterogeneity of the methods used across manuscripts in terms of assessed clinical variables, imaging, and data analysis methods. This is particularly significant as, if the subjects' criteria are not carefully considered, results are easily prone to confounding factors.
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Affiliation(s)
- Jessica Rosenberg
- Institute of Neuroscience and Medicine (INM-4), Medical Imaging Physics, Forschungszentrum Jülich GmbH, 52425 Jülich, Germany; JARA - Translational Brain Medicine & INM-11, RWTH Aachen University, 52074 Aachen, Germany; Department of Neurology, University Clinic Aachen, 52074 Aachen, Germany.
| | - Nazim Lechea
- Institute of Neuroscience and Medicine (INM-4), Medical Imaging Physics, Forschungszentrum Jülich GmbH, 52425 Jülich, Germany
| | - Gael N Pentang
- Institute of Neuroscience and Medicine (INM-4), Medical Imaging Physics, Forschungszentrum Jülich GmbH, 52425 Jülich, Germany
| | - Nadim J Shah
- Institute of Neuroscience and Medicine (INM-4), Medical Imaging Physics, Forschungszentrum Jülich GmbH, 52425 Jülich, Germany; JARA - Translational Brain Medicine & INM-11, RWTH Aachen University, 52074 Aachen, Germany; Department of Neurology, University Clinic Aachen, 52074 Aachen, Germany; Department of Electrical and Computer Systems Engineering, and Monash Biomedical Imaging, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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16
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Liu D, Duan S, Zhou C, Wei P, Chen L, Yin X, Zhang J, Wang J. Altered Brain Functional Hubs and Connectivity in Type 2 Diabetes Mellitus Patients: A Resting-State fMRI Study. Front Aging Neurosci 2018; 10:55. [PMID: 29563869 PMCID: PMC5845755 DOI: 10.3389/fnagi.2018.00055] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 02/19/2018] [Indexed: 01/23/2023] Open
Abstract
Type 2 diabetes mellitus (T2DM) affects a vast population and is closely associated with cognitive impairment. However, the mechanisms of cognitive impairment in T2DM patients have not been unraveled. Research on the basic units (nodes or hubs and edges) of the brain functional network on the basis of neuroimaging may advance our understanding of the network change pattern in T2DM patients. This study investigated the change patterns of brain functional hubs using degree centrality (DC) analysis and the connectivity among these hubs using functional connectivity and Granger causality analysis. Compared to healthy controls, the DC values were higher in the left anterior cingulate gyrus (ACG) and lower in the bilateral lateral occipital cortices (LOC) and right precentral gyrus (PreCG) in T2DM patients. The functional connectivity between the left ACG and the right PreCG was stronger in T2DM patients, whereas the functional connectivity among the right PreCG and bilateral LOC was weaker. A negative causal effect from the left ACG to left LOC and a positive effect from the left ACG to right LOC were observed in T2DM patients, while in healthy controls, the opposite occurred. Additionally, the reserve of normal brain function in T2DM patients was negatively associated with the elevated glycemic parameters. This study demonstrates that there are brain functional hubs and connectivity alterations that may reflect the aberrant information communication in the brain of T2DM patients. The findings may advance our understanding of the mechanisms of T2DM-related cognitive impairment.
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Affiliation(s)
- Daihong Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Shanshan Duan
- Department of Endocrinology, The Third Affiliation Hospital of Chongqing Medical University, Chongqing, China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ping Wei
- Department of Endocrinology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lihua Chen
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xuntao Yin
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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17
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Marseglia A, Fratiglioni L, Laukka EJ, Santoni G, Pedersen NL, Bäckman L, Xu W. Early Cognitive Deficits in Type 2 Diabetes: A Population-Based Study. J Alzheimers Dis 2018; 53:1069-78. [PMID: 27314527 PMCID: PMC4981902 DOI: 10.3233/jad-160266] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Evidence links type 2 diabetes to dementia risk. However, our knowledge on the initial cognitive deficits in diabetic individuals and the factors that might promote such deficits is still limited. This study aimed to identify the cognitive domains initially impaired by diabetes and the factors that play a role in this first stage. Within the population-based Swedish National Study on Aging and Care–Kungsholmen, 2305 cognitively intact participants aged ≥60 y were identified. Attention/working memory, perceptual speed, category fluency, letter fluency, semantic memory, and episodic memory were assessed. Diabetes (controlled and uncontrolled) and prediabetes were ascertained by clinicians, who also collected information on vascular disorders (hypertension, heart diseases, and stroke) and vascular risk factors (VRFs, including smoking and overweight/obesity). Data were analyzed with linear regression models. Overall, 196 participants (8.5%) had diabetes, of which 144 (73.5%) had elevated glycaemia (uncontrolled diabetes); 571 (24.8%) persons had prediabetes. In addition, diabetes, mainly uncontrolled, was related to lower performance in perceptual speed (β – 1.10 [95% CI – 1.98, – 0.23]), category fluency (β – 1.27 [95% CI – 2.52, – 0.03]), and digit span forward (β – 0.35 [95% CI – 0.54, – 0.17]). Critically, these associations were present only among APOEɛ4 non–carriers. The associations of diabetes with perceptual speed and category fluency were present only among participants with VRFs or vascular disorders. Diabetes, especially uncontrolled diabetes, is associated with poorer performance in perceptual speed, category fluency, and attention/primary memory. VRFs, vascular disorders, and APOE status play a role in these associations.
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Affiliation(s)
- Anna Marseglia
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Erika J Laukka
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Giola Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Nancy L Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lars Bäckman
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Weili Xu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.,Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, China
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18
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Macpherson H, Formica M, Harris E, Daly RM. Brain functional alterations in Type 2 Diabetes - A systematic review of fMRI studies. Front Neuroendocrinol 2017; 47:34-46. [PMID: 28687473 DOI: 10.1016/j.yfrne.2017.07.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 06/30/2017] [Accepted: 07/02/2017] [Indexed: 02/07/2023]
Abstract
Type 2 Diabetes (T2DM) is emerging as a major global health issue. T2DM can adversely affect cognition and increase dementia risk. This systematic review aimed to examine the functional brain changes that may underlie cognitive dysfunction in adults with T2DM. Studies were restricted to those which used functional magnetic resonance imaging (fMRI). Nineteen independent studies were identified, mostly comprised of middle aged or older adults. Resting-state studies demonstrated that compared to controls, connectivity of the Default Mode Network (DMN) was reduced and the majority of task-based studies identified reduced activation in T2DM patients in regions relevant to task performance. Abnormalities of low frequency spontaneous brain activity were observed, particularly in visual regions. As most studies demonstrated that alterations in fMRI were related to poorer neuropsychological task performance, these results indicate that functional brain abnormalities in T2DM have consequences for cognition.
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Affiliation(s)
- Helen Macpherson
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.
| | - Melissa Formica
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Elizabeth Harris
- Centre for Human Psychopharmacology, Swinburne University, Hawthorn, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
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19
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Sun DM, Ma Y, Sun ZB, Xie L, Huang JZ, Chen WS, Duan SX, Lin ZR, Guo RW, Le HB, Xu WC, Ma SH. Decision-making in primary onset middle-age type 2 diabetes mellitus: a BOLD-fMRI study. Sci Rep 2017; 7:10246. [PMID: 28860463 PMCID: PMC5579021 DOI: 10.1038/s41598-017-10228-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 08/02/2017] [Indexed: 02/05/2023] Open
Abstract
Although type 2 diabetes mellitus (T2DM) is a well-recognized risk factor for dementia, the neural mechanisms that underlying cognitive impairment in T2DM remain unclear. We used functional magnetic resonance imaging (fMRI) during a computerized version of the Iowa Gambling Task to investigate the neural basis of decision making at the initial onset stage of T2DM. Eighteen newly diagnosed middle-aged T2DM patients, with no previous diabetic treatment history, and 18 matched controls were recruited. Results indicated that T2DM patients made more disadvantageous decisions than controls. Compared to healthy subjects, T2DM patients showed decreased activation in the ventral medial prefrontal cortex (VMPFC), orbitofrontal cortex (OFC) and anterior cingulate cortex, and increased activity in the dorsolateral prefrontal cortex, posterior cingulate cortex, insula and occipital lobes. IGT performance positively correlated with changes in brain activation in the VMPFC and OFC in both groups. Moreover, poor glycemic control was associated with decision-making function both in behavioral and brain activity in the VMPFC and OFC in patients. Conclusively, T2DM patients may suffer from weaknesses in their prefrontal cortex functions that lead to poorer decision-making under ambiguity, at least as assessed by the IGT.
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Affiliation(s)
- Dan-Miao Sun
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China
| | - Ye Ma
- Graduate School of Beijing Normal University, 519087, Zhuhai, China
| | - Zong-Bo Sun
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China
| | - Lei Xie
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China
| | - Jin-Zhuang Huang
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China
| | - Wei-Song Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
| | - Shou-Xing Duan
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China
| | - Zhi-Rong Lin
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
| | - Rui-Wei Guo
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China
| | - Hong-Bo Le
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China
| | - Wen-Can Xu
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China
| | - Shu-Hua Ma
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong Province, 515041, China.
- Guang dong Key Laboratory of Medical Molecular Imaging, 515041, Shantou, China.
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20
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van Bussel FCG, Backes WH, Hofman PAM, van Oostenbrugge RJ, van Boxtel MPJ, Verhey FRJ, Steinbusch HWM, Schram MT, Stehouwer CDA, Wildberger JE, Jansen JFA. Cerebral Pathology and Cognition in Diabetes: The Merits of Multiparametric Neuroimaging. Front Neurosci 2017; 11:188. [PMID: 28424581 PMCID: PMC5380729 DOI: 10.3389/fnins.2017.00188] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 03/21/2017] [Indexed: 12/19/2022] Open
Abstract
Type 2 diabetes mellitus is associated with accelerated cognitive decline and various cerebral abnormalities visible on MRI. The exact pathophysiological mechanisms underlying cognitive decline in diabetes still remain to be elucidated. In addition to conventional images, MRI offers a versatile set of novel contrasts, including blood perfusion, neuronal function, white matter microstructure, and metabolic function. These more-advanced multiparametric MRI contrasts and the pertaining parameters are able to reveal abnormalities in type 2 diabetes, which may be related to cognitive decline. To further elucidate the nature of the link between diabetes, cognitive decline, and brain abnormalities, and changes over time thereof, biomarkers are needed which can be provided by advanced MRI techniques. This review summarizes to what extent MRI, especially advanced multiparametric techniques, can elucidate the underlying neuronal substrate that reflects the cognitive decline in type 2 diabetes.
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Affiliation(s)
- Frank C G van Bussel
- Department of Radiology, Maastricht University Medical CenterMaastricht, Netherlands.,School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands
| | - Walter H Backes
- Department of Radiology, Maastricht University Medical CenterMaastricht, Netherlands.,School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands
| | - Paul A M Hofman
- Department of Radiology, Maastricht University Medical CenterMaastricht, Netherlands.,School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands
| | - Robert J van Oostenbrugge
- School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands.,Department of Neurology, Maastricht University Medical CenterMaastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical CenterMaastricht, Netherlands
| | - Martin P J van Boxtel
- School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University Medical CenterMaastricht, Netherlands
| | - Frans R J Verhey
- School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University Medical CenterMaastricht, Netherlands
| | - Harry W M Steinbusch
- School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands.,Department of Psychiatry and Neuropsychology, Maastricht University Medical CenterMaastricht, Netherlands
| | - Miranda T Schram
- Cardiovascular Research Institute Maastricht, Maastricht University Medical CenterMaastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical CenterMaastricht, Netherlands
| | - Coen D A Stehouwer
- Cardiovascular Research Institute Maastricht, Maastricht University Medical CenterMaastricht, Netherlands.,Department of Internal Medicine, Maastricht University Medical CenterMaastricht, Netherlands
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical CenterMaastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University Medical CenterMaastricht, Netherlands
| | - Jacobus F A Jansen
- Department of Radiology, Maastricht University Medical CenterMaastricht, Netherlands.,School for Mental Health and Neuroscience, Maastricht University Medical CenterMaastricht, Netherlands
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Liu D, Duan S, Zhang J, Zhou C, Liang M, Yin X, Wei P, Wang J. Aberrant Brain Regional Homogeneity and Functional Connectivity in Middle-Aged T2DM Patients: A Resting-State Functional MRI Study. Front Hum Neurosci 2016; 10:490. [PMID: 27729856 PMCID: PMC5037166 DOI: 10.3389/fnhum.2016.00490] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 09/15/2016] [Indexed: 11/16/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) has been associated with cognitive impairment. However, its neurological mechanism remains elusive. Combining regional homogeneity (ReHo) and functional connectivity (FC) analyses, the present study aimed to investigate brain functional alterations in middle-aged T2DM patients, which could provide complementary information for the neural substrates underlying T2DM-associated brain dysfunction. Twenty-five T2DM patients and 25 healthy controls were involved in neuropsychological testing and structural and resting-state functional magnetic resonance imaging (rs-fMRI) data acquisition. ReHo analysis was conducted to determine the peak coordinates of brain regions with abnormal local brain activity synchronization. Then, the identified brain regions were considered as seeds, and FC between these brain regions and global voxels was computed. Finally, the potential correlations between the imaging indices and neuropsychological data were also explored. Compared with healthy controls, T2DM patients exhibited higher ReHo values in the anterior cingulate gyrus (ACG) and lower ReHo in the right fusiform gyrus (FFG), right precentral gyrus (PreCG) and right medial orbit of the superior frontal gyrus (SFG). Considering these areas as seed regions, T2DM patients displayed aberrant FC, mainly in the frontal and parietal lobes. The pattern of FC alterations in T2DM patients was characterized by decreased connectivity and positive to negative or negative to positive converted connectivity. Digital Span Test (DST) forward scores revealed significant correlations with the ReHo values of the right PreCG (ρ = 0.527, p = 0.014) and FC between the right FFG and middle temporal gyrus (MTG; ρ = -0.437, p = 0.048). Our findings suggest that T2DM patients suffer from cognitive dysfunction related to spatially local and remote brain activity synchronization impairment. The patterns of ReHo and FC alterations shed light on the mechanisms underlying T2DM-associated brain dysfunction and might serve as imaging biomarkers for diagnosis and evaluation.
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Affiliation(s)
- Daihong Liu
- Department of Radiology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Shanshan Duan
- Department of Endocrinology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Minglong Liang
- Department of Radiology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Xuntao Yin
- Department of Radiology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Ping Wei
- Department of Endocrinology, Southwest Hospital, Third Military Medical UniversityChongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical UniversityChongqing, China
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22
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Raffield LM, Cox AJ, Freedman BI, Hugenschmidt CE, Hsu FC, Wagner BC, Xu J, Maldjian JA, Bowden DW. Analysis of the relationships between type 2 diabetes status, glycemic control, and neuroimaging measures in the Diabetes Heart Study Mind. Acta Diabetol 2016; 53:439-47. [PMID: 26525870 PMCID: PMC4853281 DOI: 10.1007/s00592-015-0815-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/01/2015] [Indexed: 01/21/2023]
Abstract
AIMS To examine the relationships between type 2 diabetes (T2D) status, glycemic control, and T2D duration with magnetic resonance imaging (MRI)-derived neuroimaging measures in European Americans from the Diabetes Heart Study (DHS) Mind cohort. METHODS Relationships were examined using marginal models with generalized estimating equations in 784 participants from 514 DHS Mind families. Fasting plasma glucose, glycated hemoglobin, and diabetes duration were analyzed in 682 participants with T2D. Models were adjusted for potential confounders, including age, sex, history of cardiovascular disease, smoking, educational attainment, and use of statins or blood pressure medications. Association was tested with gray and white matter volume, white matter lesion volume, gray matter cerebral blood flow, and white and gray matter fractional anisotropy and mean diffusivity. RESULTS Adjusting for multiple comparisons, T2D status was associated with reduced white matter volume (p = 2.48 × 10(-6)) and reduced gray and white matter fractional anisotropy (p ≤ 0.001) in fully adjusted models, with a trend toward increased white matter lesion volume (p = 0.008) and increased gray and white matter mean diffusivity (p ≤ 0.031). Among T2D-affected participants, neither fasting glucose, glycated hemoglobin, nor diabetes duration were associated with the neuroimaging measures assessed (p > 0.05). CONCLUSIONS While T2D was significantly associated with MRI-derived neuroimaging measures, differences in glycemic control in T2D-affected individuals in the DHS Mind study do not appear to significantly contribute to variation in these measures. This supports the idea that the presence or absence of T2D, not fine gradations of glycemic control, may be more significantly associated with age-related changes in the brain.
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Affiliation(s)
- Laura M Raffield
- Molecular Genetics and Genomics Program, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amanda J Cox
- Molecular Basis of Disease, Griffith University, Southport, QLD, Australia
| | - Barry I Freedman
- Department of Internal Medicine-Nephrology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Christina E Hugenschmidt
- Department of Gerontology and Geriatrics, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Benjamin C Wagner
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jianzhao Xu
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joseph A Maldjian
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Donald W Bowden
- Center for Human Genomics, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Center for Diabetes Research, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Department of Biochemistry, Wake Forest School of Medicine, Winston-Salem, NC, USA.
- Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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23
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Zhang Y, Lu S, Liu C, Zhang H, Zhou X, Ni C, Qin W, Zhang Q. Altered brain activation and functional connectivity in working memory related networks in patients with type 2 diabetes: An ICA-based analysis. Sci Rep 2016; 6:23767. [PMID: 27021340 PMCID: PMC4810460 DOI: 10.1038/srep23767] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 03/15/2016] [Indexed: 11/09/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) can cause multidimensional cognitive deficits, among which working memory (WM) is usually involved at an early stage. However, the neural substrates underlying impaired WM in T2DM patients are still unclear. To clarify this issue, we utilized functional magnetic resonance imaging (fMRI) and independent component analysis to evaluate T2DM patients for alterations in brain activation and functional connectivity (FC) in WM networks and to determine their associations with cognitive and clinical variables. Twenty complication-free T2DM patients and 19 matched healthy controls (HCs) were enrolled, and fMRI data were acquired during a block-designed 1-back WM task. The WM metrics of the T2DM patients showed no differences compared with those of the HCs, except for a slightly lower accuracy rate in the T2DM patients. Compared with the HCs, the T2DM patients demonstrated increased activation within their WM fronto-parietal networks, and activation strength was significantly correlated with WM performance. The T2DM patients also showed decreased FC within and between their WM networks. Our results indicate that the functional integration of WM sub-networks was disrupted in the complication-free T2DM patients and that strengthened regional activity in fronto-parietal networks may compensate for the WM impairment caused by T2DM.
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Affiliation(s)
- Yang Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Shan Lu
- Department of Radiology, Tianjin Medical University Metabolic Diseases Hospital, Tianjin, 300060, China
| | - Chunlei Liu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Huimei Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Xuanhe Zhou
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Changlin Ni
- Department of Cardiology, Tianjin Medical University Metabolic Diseases Hospital, Tianjin, 300060, China
| | - Wen Qin
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Quan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin 300052, China
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Wood AG, Chen J, Moran C, Phan T, Beare R, Cooper K, Litras S, Srikanth V. Brain Activation during Memory Encoding in Type 2 Diabetes Mellitus: A Discordant Twin Pair Study. J Diabetes Res 2016; 2016:3978428. [PMID: 27314047 PMCID: PMC4903142 DOI: 10.1155/2016/3978428] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/22/2016] [Accepted: 04/17/2016] [Indexed: 11/17/2022] Open
Abstract
Type 2 diabetes mellitus increases the risk of dementia and neuronal dysfunction may occur years before perceptible cognitive decline. We aimed to study the impact of type 2 diabetes on brain activation during memory encoding in middle-aged people, controlling for age, sex, genes, and early-shared environment. Twenty-two twin pairs discordant for type 2 diabetes mellitus (mean age 60.9 years) without neurological disease were recruited from the Australian Twin Registry (ATR) and underwent functional magnetic resonance imaging (fMRI) during a memory encoding task, cognitive tests, and structural MRI. Type 2 diabetes was associated with significantly reduced activation in left hemisphere temporoparietal regions including angular gyrus, supramarginal gyrus, and middle temporal gyrus and significantly increased activation in bilateral posteriorly distributed regions. These findings were present in the absence of within-pair differences in standard cognitive test scores, brain volumes, or vascular lesion load. Differences in activation were more pronounced among monozygotic (MZ) pairs, with MZ individuals with diabetes also displaying greater frontal activation. These results provide evidence for preclinical memory-related neuronal dysfunction in type 2 diabetes. They support the search for modifiable later-life environmental factors or epigenetic mechanisms linking type 2 diabetes and cognitive decline.
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Affiliation(s)
- Amanda G. Wood
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
- School of Psychology, University of Birmingham, Edgbaston B152TT, UK
| | - Jian Chen
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, VIC 3052, Australia
| | - Christopher Moran
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Thanh Phan
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Richard Beare
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
- Developmental Imaging, Murdoch Childrens Research Institute, Melbourne, VIC 3052, Australia
| | - Kimberley Cooper
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Stacey Litras
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
| | - Velandai Srikanth
- Stroke and Ageing Research Group, Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC 3168, Australia
- Menzies Research Institute, Hobart, TAS 7000, Australia
- *Velandai Srikanth:
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25
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Hwang M, Tudorascu DL, Nunley K, Karim H, Aizenstein HJ, Orchard TJ, Rosano C. Brain Activation and Psychomotor Speed in Middle-Aged Patients with Type 1 Diabetes: Relationships with Hyperglycemia and Brain Small Vessel Disease. J Diabetes Res 2016; 2016:9571464. [PMID: 26998494 PMCID: PMC4779538 DOI: 10.1155/2016/9571464] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 12/17/2015] [Accepted: 12/22/2015] [Indexed: 01/26/2023] Open
Abstract
Slower psychomotor speed is very common in patients with type 1 diabetes mellitus (T1D), but the underlying mechanisms are not clear. We propose that hyperglycemia is associated with slower psychomotor speed via disruption of brain activation. Eighty-five adults (48% women, mean age: 49.0 years, mean duration: 40.8) with childhood onset T1D were recruited for this cross-sectional study. Median response time in seconds (longer = worse performance) and brain activation were measured while performing a psychomotor speed task. Exposure to hyperglycemia, measured as glycosylated hemoglobin A1c, was associated with longer response time and with higher activation in the inferior frontal gyrus and primary sensorimotor and dorsal cingulate cortex. Higher activation in inferior frontal gyrus, primary sensorimotor cortex, thalamus, and cuneus was related to longer response times; in contrast, higher activation in the superior parietal lobe was associated with shorter response times. Associations were independent of small vessel disease in the brain or other organs. In this group of middle-aged adults with T1D, the pathway linking chronic hyperglycemia with slower processing speed appears to include increased brain activation, but not small vessel disease. Activation in the superior parietal lobe may compensate for dysregulation in brain activation in the presence of hyperglycemia.
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Affiliation(s)
- Misun Hwang
- Department of Radiology, University of Pittsburgh, 3600 Forbes Avenue, Plaza Level, Pittsburgh, PA 15213, USA
| | - Dana L. Tudorascu
- Department of Internal Medicine, Department of Psychiatry, and Department of Biostatistics, University of Pittsburgh, 200 Meyran Avenue, Suite 326, Pittsburgh, PA 15213, USA
| | - Karen Nunley
- Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Suite 443, Pittsburgh, PA 15213, USA
| | - Helmet Karim
- Department of Bioengineering, University of Pittsburgh, 253 Sterling Plaza, Pittsburgh, PA 15213, USA
| | - Howard J. Aizenstein
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15213, USA
| | - Trevor J. Orchard
- Department of Epidemiology, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Caterina Rosano
- Department of Epidemiology, University of Pittsburgh, 130 N. Bellefield Avenue, Suite 467, Pittsburgh, PA 15213, USA
- *Caterina Rosano:
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26
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Xia W, Zhang B, Yang Y, Wang P, Yang Y, Wang S. Poorly controlled cholesterol is associated with cognitive impairment in T2DM: a resting-state fMRI study. Lipids Health Dis 2015; 14:47. [PMID: 25989796 PMCID: PMC4490615 DOI: 10.1186/s12944-015-0046-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 05/13/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Debate remains on whether hypercholesterolemia is associated with cognitive impairment. Hence, we investigated whether poorly controlled cholesterol impairs functional connectivity among patients with type 2 diabetes mellitus (T2DM). METHODS Resting-state functional connectivity infers to an interregional cooperation characterized by synchronous and low-frequency (<0.08 Hz) fluctuations on blood oxygen level-dependent functional magnetic resonance imaging (fMRI). We used resting-state fMRI to investigate the functional connectivity of 25 T2DM patients with poorly controlled cholesterol, 22 patients with target cholesterol and 26 healthy controls. Further correlation analysis was conducted between the functional connectivity and clinical data as well as neuropsychological tests. RESULTS The three groups did not statistically differ in age, sex, education level, body mass index, blood pressure, fasting C-peptides, and triglyceride. Compared with target cholesterol patients, patients with poorly controlled cholesterol showed significantly increased levels of serum cholesterol, low-density lipoprotein (LDL), and LDL/high-density lipoproteins (HDL) ratio, as well as poor performance in Trail Making Test B (TMT-B) (p<0.05). Disordered functional connectivity of bilateral hippocampus-middle frontal gyrus (MFG) in the poorly controlled group consistently existed when compared with the two other groups. Moreover, the aberrant functional connectivity was associated with the TMT-B scores and the LDL/HDL index in T2DM patients with poorly controlled cholesterol. CONCLUSIONS T2DM patients with poorly controlled cholesterol showed impaired attention and executive function. The resting-state connectivity disturbance of the hippocampus-MFG may be involved in this process. Decreasing the LDL/HDL ratio can be taken as precaution against cognitive decrements.
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Affiliation(s)
- Wenqing Xia
- Department of Endocrinology, ZhongDa Hospital of Southeast University, No.87 Dingjiaqiao Road, Nanjing, 210009, PR China.
- Medical school of Southeast University, No.87 Dingjiaqiao Road, Nanjing, 210009, PR China.
- Center for functional Neuroimaging, University of Pennsylvania, 3710 Hamilton Walk, Philadelphia, PA, 19104, USA.
| | - Bin Zhang
- Outpatient Depart, Panda Group Community Health Service Centre, No.4 Qingxi Road, Nanjing, 210009, PR China.
| | - Yang Yang
- Outpatient Depart, Panda Group Community Health Service Centre, No.4 Qingxi Road, Nanjing, 210009, PR China.
| | - Pin Wang
- Department of Endocrinology, ZhongDa Hospital of Southeast University, No.87 Dingjiaqiao Road, Nanjing, 210009, PR China.
| | - Yue Yang
- Department of Endocrinology, ZhongDa Hospital of Southeast University, No.87 Dingjiaqiao Road, Nanjing, 210009, PR China.
| | - Shaohua Wang
- Department of Endocrinology, ZhongDa Hospital of Southeast University, No.87 Dingjiaqiao Road, Nanjing, 210009, PR China.
- Medical school of Southeast University, No.87 Dingjiaqiao Road, Nanjing, 210009, PR China.
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