Hertzel C Gerstein1,2,3, Eric E Smith4, Chinthanie Ramasundarahettige1,2, Dipika Desai1, Philip Awadalla5, Philippe Broet6,7, Sandra Black8, Trevor J B Dummer9, Jason Hicks10, Alan Moody11, Jean-Claude Tardif12, Koon K Teo1,2,3, Jennifer Vena13, Salim Yusuf1,2,3, Douglas S Lee14,15, Matthias G Friedrich16, Sonia S Anand1,2,3. 1. Population Health Research Institute, Hamilton Health Sciences, Hamilton, Ontario, Canada. 2. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 3. Department of Health Evidence and Impact, McMaster University, Hamilton, Ontario, Canada. 4. Hotchkiss Brain Institute, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. 5. Department of Molecular Genetics, Ontario Institute for Cancer Research, University of Toronto, Toronto, Ontario, Canada. 6. Department of Preventive and Social Medicine, École de santé publique, Université de Montréal, Montreal, Quebec, Canada. 7. Research Centre, CHU Sainte Justine, Montreal, Quebec, Canada. 8. Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 9. Cancer Control Research, BC Cancer, and the School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. 10. Atlantic PATH, Dalhousie University, Halifax, Nova Scotia, Canada. 11. Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. 12. Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada. 13. Alberta's Tomorrow Project, Cancer Research and Analytics, Cancer Control Alberta, Alberta Health Services, Edmonton, Alberta, Canada. 14. Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. 15. Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada. 16. Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada.
Abstract
BACKGROUND: Diabetes is a risk factor for cerebrovascular disease and cognitive impairment. The anatomical basis for this is uncertain. METHODS: The Canadian Alliance for Healthy Hearts and Minds collected brain and carotid magnetic resonance imaging (MRI) and 2 cognitive tests (the Digit Symbol Substitution Test and the Montreal Cognitive Assessment test) in a cross-sectional sample of men and women. Brain MRIs identified brain infarcts (BI), lacunar BI, high white matter hyperintensity (WMH), vascular brain injury (VBI; BI or high WMH), and small vessel VBI (lacunar BI or high WMH). Carotid MRIs estimated carotid wall volume, a measure of subclinical atherosclerosis. Cognitive scores were standardized to each site's mean score, and cognitive impairment was identified by 1 or both test scores ≤1 standard deviation below the site's mean score on that test. RESULTS: The 7733 participants included 495 participants (6.4%) with diabetes, of whom 388 were taking diabetes drugs. After age and sex adjustment, diabetes was independently associated with BI (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.05, 2.24), VBI (OR 1.64, 95% CI 1.26, 2.13), small vessel VBI (OR 1.67, 95% CI 1.28, 2.19), and cognitive impairment (OR 1.47, 95% CI 1.20, 1.80). The association between diabetes and small vessel VBI persisted after adjustment for cerebrovascular disease risk factors and nonlacunar infarcts (OR 1.52, 95% CI 1.15, 2.01), and the association with cognitive impairment persisted after adjustment for small vessel VBI (OR 1.27, 95% CI 1.03, 1.56). CONCLUSION: Small vessel disease characterizes much of the relationship between diabetes and VBI. However, additional factors are required to disentangle the relationship between diabetes and cognitive impairment.
BACKGROUND: Diabetes is a risk factor for cerebrovascular disease and cognitive impairment. The anatomical basis for this is uncertain. METHODS: The Canadian Alliance for Healthy Hearts and Minds collected brain and carotid magnetic resonance imaging (MRI) and 2 cognitive tests (the Digit Symbol Substitution Test and the Montreal Cognitive Assessment test) in a cross-sectional sample of men and women. Brain MRIs identified brain infarcts (BI), lacunar BI, high white matter hyperintensity (WMH), vascular brain injury (VBI; BI or high WMH), and small vessel VBI (lacunar BI or high WMH). Carotid MRIs estimated carotid wall volume, a measure of subclinical atherosclerosis. Cognitive scores were standardized to each site's mean score, and cognitive impairment was identified by 1 or both test scores ≤1 standard deviation below the site's mean score on that test. RESULTS: The 7733 participants included 495 participants (6.4%) with diabetes, of whom 388 were taking diabetes drugs. After age and sex adjustment, diabetes was independently associated with BI (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.05, 2.24), VBI (OR 1.64, 95% CI 1.26, 2.13), small vessel VBI (OR 1.67, 95% CI 1.28, 2.19), and cognitive impairment (OR 1.47, 95% CI 1.20, 1.80). The association between diabetes and small vessel VBI persisted after adjustment for cerebrovascular disease risk factors and nonlacunar infarcts (OR 1.52, 95% CI 1.15, 2.01), and the association with cognitive impairment persisted after adjustment for small vessel VBI (OR 1.27, 95% CI 1.03, 1.56). CONCLUSION: Small vessel disease characterizes much of the relationship between diabetes and VBI. However, additional factors are required to disentangle the relationship between diabetes and cognitive impairment.
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Authors: Hertzel C Gerstein; Eric E Smith; Chinthanie Ramasundarahettige; Dipika Desai; Philip Awadalla; Philippe Broet; Sandra Black; Trevor J B Dummer; Jason Hicks; Alan Moody; Jean-Claude Tardif; Koon K Teo; Jennifer Vena; Salim Yusuf; Douglas S Lee; Matthias G Friedrich; Sonia S Anand Journal: J Clin Endocrinol Metab Date: 2021-01-23 Impact factor: 5.958