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Long-Term Effects of Type 2 Diabetes on the

Brain and Cognition


Neuroscience News
July 8, 2015
Featured , Neurology

In just two years, people with type 2 diabetes experienced negative


changes in their ability to regulate blood flow in the brain, which was
associated with lower scores on tests of cognition skills and their ability
to perform their daily activities, according to a new study published in
the July 8, 2015, online issue of Neurology, the medical journal of the
American Academy of Neurology.
Normal blood flow regulation allows the brain to redistribute blood to areas of
the brain that have increased activity while performing certain tasks, said
study author Vera Novak, MD, PhD, of Harvard Medical School in Boston.
People with type 2 diabetes have impaired blood flow regulation. Our results
suggest that diabetes and high blood sugar impose a chronic negative effect
on cognitive and decision-making skills.
The study involved 40 people with an average age of 66. Of those, 19 had
type 2 diabetes and 21 did not have diabetes. Those with diabetes had been
treated for the disease for an average of 13 years. The participants were
tested at the beginning of the study and again two years later. Tests included
cognition and memory tests, MRI scans of the brain to look at brain volume
and blood flow, and blood tests to measure control of blood sugar and
inflammation.

After two years, the people with diabetes had decreases in their
ability to regulate blood flow in the brain. They also had lower scores
on several tests of memory and thinking skills.e is for illustrative
purposes only. Image credit: Mikael Hggstrm.
After two years, the people with diabetes had decreases in their ability to
regulate blood flow in the brain. They also had lower scores on several tests
of memory and thinking skills. People with lower ability to regulate blood flow
at the beginning of the study had greater declines in a measure of how well
they could complete daily activities such as bathing and cooking.
Higher levels of inflammation were also associated with greater decreases in
blood flow regulation, even if people had good control of their diabetes and
blood pressure, Novak said.

On a test of learning and memory, the scores of the people with diabetes
decreased by 12 percent, from 46 points to 41 points over the two years of the
study, while the scores of those without diabetes stayed the same, at 55
points. Blood flow regulation in the brain was decreased by 65 percent in
people with diabetes.
Early detection and monitoring of blood flow regulation may be an important
predictor of accelerated changes in cognitive and decision-making skills,
Novak said.
She said additional studies involving more people and extending for a longer
time period are needed to better understand the relationship and timing with
blood flow regulation and changes in thinking and memory skills.
About this neurology research

Funding: The study was supported by the National Institute on Aging,


American Diabetes Association, Harvard Clinical and Translational Science
Center and National Center for Research Resources.
Source: Rachel Seroka AAN
Image Credit: Image is credited to Mikael Hggstrm and is in the public
domain
Original Research: Abstract for Inflammation-associated declines in cerebral
vasoreactivity and cognition in type 2 diabetes by Chen-Chih Chung, Daniela
Pimentel, Azizah J. Jordan, Ying Hao, William Milberg, and Vera Novak
in Neuron. Published online July 8 2015
doi:10.1212/WNL.0000000000001820
Abstract
Inflammation-associated declines in cerebral vasoreactivity and
cognition in type 2 diabetes

Objective: The aim of this prospective study was to investigate the


relationships between inflammation, cerebral vasoregulation, and cognitive
decline in type 2 diabetes mellitus (T2DM) over a 2-year span.
Methods: Sixty-five participants (aged 66 9.2 years, 35 with T2DM, 33
women) were enrolled for this 2-year prospective study. Continuous arterial
spin labeling at 3-tesla MRI was used to measure global and regional cerebral
perfusion and vasoreactivity. Neuropsychological measures were evaluated at
the beginning and completion of the study. The associations between serum
inflammatory markers, regional cerebral vasoreactivity, and cognitive functions
were examined using least squares models.
Results: After 2 years of follow-up, participants with T2DM had diminished
global and regional cerebral vasoreactivity and a decline in multiple cognitive
tasks compared with baseline (p < 0.00010.012). In the T2DM group, lower
cerebral vasoreactivity was associated with a greater decrease in daily living
activities score (r2adj = 0.35, p = 0.04), and lower global vasodilation was
associated with a greater decline in executive function (r2adj = 0.6, p = 0.047).
Higher serum soluble intercellular and vascular adhesion molecules, higher
cortisol, and higher C-reactive protein levels at baseline were associated with
greater decreases in cerebral vasoreactivity and vasodilation only in the T2DM
group (r2adj = 0.160.53, p = 0.0070.048), independent of diabetes control
and 24-hour blood pressure. Higher glycated hemoglobin A1c levels were
associated with a greater increase in vasoconstriction in the T2DM group.
Conclusions: Inflammation may further impair cerebral vasoregulation, which
consequently accelerates decline in executive function and daily activities
performance in older people with T2DM.
Inflammation-associated declines in cerebral vasoreactivity and cognition in
type 2 diabetes by Chen-Chih Chung, Daniela Pimentel, Azizah J. Jordan,
Ying Hao, William Milberg, and Vera Novak in Neuron. Published online July 8
2015 doi:10.1212/WNL.0000000000001820