Einor Ben Assayag1, Roy Eldor2, Amos D Korczyn2, Efrat Kliper2, Shani Shenhar-Tsarfaty2, Oren Tene2, Jeremy Molad2, Itzhak Shapira2, Shlomo Berliner2, Viki Volfson2, Ludmila Shopin2, Yehuda Strauss2, Hen Hallevi2, Natan M Bornstein2, Eitan Auriel2. 1. From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.). einorba@tlvmc.gov.il. 2. From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and Carmel Medical Center, Haifa, Israel (E.A.).
Abstract
BACKGROUND AND PURPOSE: Type 2 diabetes mellitus (T2DM) is associated with diseases of the brain, kidney, and vasculature. However, the relationship between T2DM, chronic kidney disease, brain alterations, and cognitive function after stroke is unknown. We aimed to evaluate the inter-relationship between T2DM, impaired renal function, brain pathology on imaging, and cognitive decline in a longitudinal poststroke cohort. METHODS: The TABASCO (Tel Aviv brain acute stroke cohort) is a prospective cohort of stroke/transient ischemic attack survivors. The volume and white matter integrity, ischemic lesions, and brain and hippocampal volumes were measured at baseline using 3-T MRI. Cognitive tests were performed on 507 patients, who were diagnosed as having mild cognitive impairment, dementia, or being cognitively intact after 24 months. RESULTS: At baseline, T2DM and impaired renal function (estimated creatinine clearance [eCCl] <60 mL/min) were associated with smaller brain and hippocampal volumes, reduced cortical thickness, and worse white matter microstructural integrity. Two years later, both T2DM and eCCl <60 mL/min were associated with poorer cognitive scores, and 19.7% of the participants developed cognitive decline (mild cognitive impairment or dementia). Multiple analysis, controlling for age, sex, education, and apolipoprotein E4, showed a significant association of both T2DM and eCCl <60 mL/min with cognitive decline. Having both conditions doubled the risk compared with patients with T2DM or eCCl <60 mL/min alone and almost quadrupled the risk compared with patients without either abnormality. CONCLUSIONS: T2DM and impaired renal function are independently associated with abnormal brain structure, as well as poorer performance in cognitive tests, 2 years after stroke. The presence of both conditions quadruples the risk for cognitive decline. T2DM and lower eCCl have an independent and additive effect on brain atrophy and the risk of cognitive decline. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
BACKGROUND AND PURPOSE:Type 2 diabetes mellitus (T2DM) is associated with diseases of the brain, kidney, and vasculature. However, the relationship between T2DM, chronic kidney disease, brain alterations, and cognitive function after stroke is unknown. We aimed to evaluate the inter-relationship between T2DM, impaired renal function, brain pathology on imaging, and cognitive decline in a longitudinal poststroke cohort. METHODS: The TABASCO (Tel Aviv brain acute stroke cohort) is a prospective cohort of stroke/transient ischemic attack survivors. The volume and white matter integrity, ischemic lesions, and brain and hippocampal volumes were measured at baseline using 3-T MRI. Cognitive tests were performed on 507 patients, who were diagnosed as having mild cognitive impairment, dementia, or being cognitively intact after 24 months. RESULTS: At baseline, T2DM and impaired renal function (estimated creatinine clearance [eCCl] <60 mL/min) were associated with smaller brain and hippocampal volumes, reduced cortical thickness, and worse white matter microstructural integrity. Two years later, both T2DM and eCCl <60 mL/min were associated with poorer cognitive scores, and 19.7% of the participants developed cognitive decline (mild cognitive impairment or dementia). Multiple analysis, controlling for age, sex, education, and apolipoprotein E4, showed a significant association of both T2DM and eCCl <60 mL/min with cognitive decline. Having both conditions doubled the risk compared with patients with T2DM or eCCl <60 mL/min alone and almost quadrupled the risk compared with patients without either abnormality. CONCLUSIONS: T2DM and impaired renal function are independently associated with abnormal brain structure, as well as poorer performance in cognitive tests, 2 years after stroke. The presence of both conditions quadruples the risk for cognitive decline. T2DM and lower eCCl have an independent and additive effect on brain atrophy and the risk of cognitive decline. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
Authors: Minjie Wu; Omalara Fatukasi; Shaolin Yang; Jeffery Alger; Peter B Barker; Hoby Hetherington; Tae Kim; Andrew Levine; Eileen Martin; Cynthia A Munro; Todd Parrish; Ann Ragin; Ned Sacktor; Eric Seaberg; James T Becker Journal: AIDS Date: 2018-08-24 Impact factor: 4.177
Authors: Tali Cukierman-Yaffe; Leslie A McClure; Thomas Risoli; Jackie Bosch; Mike Sharma; Hertzel C Gerstein; Oscar Benavente Journal: J Clin Endocrinol Metab Date: 2021-03-25 Impact factor: 5.958
Authors: Catherine M Davis; Wenri H Zhang; Elyse M Allen; Thierno M Bah; Robert E Shangraw; Nabil J Alkayed Journal: Int J Mol Sci Date: 2021-05-21 Impact factor: 5.923