The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus

Onno N. Groeneveld, Costanza Moneti, Rutger Heinen, Jeroen de Bresser, Hugo J. Kuijf, Lieza G. Exalto, Jooske M. F. Boomsma, L. Jaap Kappelle, Frederik Barkhof, Niels D. Prins, Philip Scheltens, Wiesje M. van der Flier, Geert Jan Biessels

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background: Type 2 diabetes mellitus (T2DM) increases the risk of vascular cognitive impairment (VCI). It is unknown which type of vascular lesions and co-morbid etiologies, in particular Alzheimer's disease pathology, are associated with T2DM in patients with VCI, and how this relates to cognition and prognosis. Objective: To compare brain MRI and cerebrospinal fluid (CSF) markers, cognition, and prognosis in patients with possible VCI with and without T2DM. Methods: We included 851 memory clinic patients with vascular brain injury on MRI (i.e., possible VCI) from a prospective cohort study (T2DM: n = 147, 68.4±7.9 years, 63% men; no T2DM: n = 704, 67.6±8.5 years, 52% men). At baseline, we assessed between-group differences in brain MRI abnormalities, CSF markers of Alzheimer's disease, and cognitive profile. After two years follow-up, we compared occurrence of cognitive decline, stroke, and death. Results: The distribution of clinical diagnoses did not differ between patients with and without T2DM. T2DM patients had more pronounced brain atrophy (total and white matter volume), and more lacunar infarcts, whereas microbleeds were less common (all p < 0.05). CSF amyloid-β levels were similar between the groups. T2DM patients performed worse on working memory (effect size: - 0.17, p = 0.03) than those without, whereas performance on other domains was similar. During follow-up, risk of further cognitive decline was not increased in T2DM. Conclusion: In patients with possible VCI, presence of T2DM is related to more pronounced brain atrophy and a higher burden of lacunar infarcts, but T2DM does not have a major impact on cognitive profile or prognosis.

Original languageEnglish
Pages (from-to)311-322
Number of pages12
JournalJournal of Alzheimer's Disease
Volume68
Issue number1
DOIs
Publication statusPublished - 1 Jan 2019

Cite this

Groeneveld, O. N., Moneti, C., Heinen, R., de Bresser, J., Kuijf, H. J., Exalto, L. G., ... Biessels, G. J. (2019). The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus. Journal of Alzheimer's Disease, 68(1), 311-322. https://doi.org/10.3233/JAD-180914
Groeneveld, Onno N. ; Moneti, Costanza ; Heinen, Rutger ; de Bresser, Jeroen ; Kuijf, Hugo J. ; Exalto, Lieza G. ; Boomsma, Jooske M. F. ; Kappelle, L. Jaap ; Barkhof, Frederik ; Prins, Niels D. ; Scheltens, Philip ; van der Flier, Wiesje M. ; Biessels, Geert Jan. / The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus. In: Journal of Alzheimer's Disease. 2019 ; Vol. 68, No. 1. pp. 311-322.
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title = "The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus",
abstract = "Background: Type 2 diabetes mellitus (T2DM) increases the risk of vascular cognitive impairment (VCI). It is unknown which type of vascular lesions and co-morbid etiologies, in particular Alzheimer's disease pathology, are associated with T2DM in patients with VCI, and how this relates to cognition and prognosis. Objective: To compare brain MRI and cerebrospinal fluid (CSF) markers, cognition, and prognosis in patients with possible VCI with and without T2DM. Methods: We included 851 memory clinic patients with vascular brain injury on MRI (i.e., possible VCI) from a prospective cohort study (T2DM: n = 147, 68.4±7.9 years, 63{\%} men; no T2DM: n = 704, 67.6±8.5 years, 52{\%} men). At baseline, we assessed between-group differences in brain MRI abnormalities, CSF markers of Alzheimer's disease, and cognitive profile. After two years follow-up, we compared occurrence of cognitive decline, stroke, and death. Results: The distribution of clinical diagnoses did not differ between patients with and without T2DM. T2DM patients had more pronounced brain atrophy (total and white matter volume), and more lacunar infarcts, whereas microbleeds were less common (all p < 0.05). CSF amyloid-β levels were similar between the groups. T2DM patients performed worse on working memory (effect size: - 0.17, p = 0.03) than those without, whereas performance on other domains was similar. During follow-up, risk of further cognitive decline was not increased in T2DM. Conclusion: In patients with possible VCI, presence of T2DM is related to more pronounced brain atrophy and a higher burden of lacunar infarcts, but T2DM does not have a major impact on cognitive profile or prognosis.",
keywords = "Cerebrospinal fluid, magnetic resonance imaging, prognosis, type 2 diabetes mellitus, vascular brain injury",
author = "Groeneveld, {Onno N.} and Costanza Moneti and Rutger Heinen and {de Bresser}, Jeroen and Kuijf, {Hugo J.} and Exalto, {Lieza G.} and Boomsma, {Jooske M. F.} and Kappelle, {L. Jaap} and Frederik Barkhof and Prins, {Niels D.} and Philip Scheltens and {van der Flier}, {Wiesje M.} and Biessels, {Geert Jan}",
year = "2019",
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Groeneveld, ON, Moneti, C, Heinen, R, de Bresser, J, Kuijf, HJ, Exalto, LG, Boomsma, JMF, Kappelle, LJ, Barkhof, F, Prins, ND, Scheltens, P, van der Flier, WM & Biessels, GJ 2019, 'The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus' Journal of Alzheimer's Disease, vol. 68, no. 1, pp. 311-322. https://doi.org/10.3233/JAD-180914

The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus. / Groeneveld, Onno N.; Moneti, Costanza; Heinen, Rutger; de Bresser, Jeroen; Kuijf, Hugo J.; Exalto, Lieza G.; Boomsma, Jooske M. F.; Kappelle, L. Jaap; Barkhof, Frederik; Prins, Niels D.; Scheltens, Philip; van der Flier, Wiesje M.; Biessels, Geert Jan.

In: Journal of Alzheimer's Disease, Vol. 68, No. 1, 01.01.2019, p. 311-322.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The Clinical Phenotype of Vascular Cognitive Impairment in Patients with Type 2 Diabetes Mellitus

AU - Groeneveld, Onno N.

AU - Moneti, Costanza

AU - Heinen, Rutger

AU - de Bresser, Jeroen

AU - Kuijf, Hugo J.

AU - Exalto, Lieza G.

AU - Boomsma, Jooske M. F.

AU - Kappelle, L. Jaap

AU - Barkhof, Frederik

AU - Prins, Niels D.

AU - Scheltens, Philip

AU - van der Flier, Wiesje M.

AU - Biessels, Geert Jan

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Type 2 diabetes mellitus (T2DM) increases the risk of vascular cognitive impairment (VCI). It is unknown which type of vascular lesions and co-morbid etiologies, in particular Alzheimer's disease pathology, are associated with T2DM in patients with VCI, and how this relates to cognition and prognosis. Objective: To compare brain MRI and cerebrospinal fluid (CSF) markers, cognition, and prognosis in patients with possible VCI with and without T2DM. Methods: We included 851 memory clinic patients with vascular brain injury on MRI (i.e., possible VCI) from a prospective cohort study (T2DM: n = 147, 68.4±7.9 years, 63% men; no T2DM: n = 704, 67.6±8.5 years, 52% men). At baseline, we assessed between-group differences in brain MRI abnormalities, CSF markers of Alzheimer's disease, and cognitive profile. After two years follow-up, we compared occurrence of cognitive decline, stroke, and death. Results: The distribution of clinical diagnoses did not differ between patients with and without T2DM. T2DM patients had more pronounced brain atrophy (total and white matter volume), and more lacunar infarcts, whereas microbleeds were less common (all p < 0.05). CSF amyloid-β levels were similar between the groups. T2DM patients performed worse on working memory (effect size: - 0.17, p = 0.03) than those without, whereas performance on other domains was similar. During follow-up, risk of further cognitive decline was not increased in T2DM. Conclusion: In patients with possible VCI, presence of T2DM is related to more pronounced brain atrophy and a higher burden of lacunar infarcts, but T2DM does not have a major impact on cognitive profile or prognosis.

AB - Background: Type 2 diabetes mellitus (T2DM) increases the risk of vascular cognitive impairment (VCI). It is unknown which type of vascular lesions and co-morbid etiologies, in particular Alzheimer's disease pathology, are associated with T2DM in patients with VCI, and how this relates to cognition and prognosis. Objective: To compare brain MRI and cerebrospinal fluid (CSF) markers, cognition, and prognosis in patients with possible VCI with and without T2DM. Methods: We included 851 memory clinic patients with vascular brain injury on MRI (i.e., possible VCI) from a prospective cohort study (T2DM: n = 147, 68.4±7.9 years, 63% men; no T2DM: n = 704, 67.6±8.5 years, 52% men). At baseline, we assessed between-group differences in brain MRI abnormalities, CSF markers of Alzheimer's disease, and cognitive profile. After two years follow-up, we compared occurrence of cognitive decline, stroke, and death. Results: The distribution of clinical diagnoses did not differ between patients with and without T2DM. T2DM patients had more pronounced brain atrophy (total and white matter volume), and more lacunar infarcts, whereas microbleeds were less common (all p < 0.05). CSF amyloid-β levels were similar between the groups. T2DM patients performed worse on working memory (effect size: - 0.17, p = 0.03) than those without, whereas performance on other domains was similar. During follow-up, risk of further cognitive decline was not increased in T2DM. Conclusion: In patients with possible VCI, presence of T2DM is related to more pronounced brain atrophy and a higher burden of lacunar infarcts, but T2DM does not have a major impact on cognitive profile or prognosis.

KW - Cerebrospinal fluid

KW - magnetic resonance imaging

KW - prognosis

KW - type 2 diabetes mellitus

KW - vascular brain injury

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30775988

U2 - 10.3233/JAD-180914

DO - 10.3233/JAD-180914

M3 - Article

VL - 68

SP - 311

EP - 322

JO - Journal of Alzheimer's Disease

JF - Journal of Alzheimer's Disease

SN - 1387-2877

IS - 1

ER -