Magnetic resonance imaging of the brain in diabetes: the Cardiovascular Determinants of Dementia (CASCADE) Study.

Diabetic patients are at increased risk for stroke, but little is known about the presence of other brain lesions. We studied the association of magnetic resonance imaging-detected brain lesions to diabetes in 1,252 individuals aged 65-75 years who were randomly selected from eight European population registries or defined working populations. All scans were centrally read for brain abnormalities, including infarcts, white matter lesions, and atrophy. We used a three-point scale to rate periventricular white matter lesions, and the volume of subcortical lesions was calculated according to their number and size. Subjective grading of cortical atrophy by lobe and summation of the lobar grades resulted in a total cortical atrophy score. The mean of three linear measurements of the ventricular diameter relative to the intracranial cavity defined the severity of subcortical atrophy. After adjustment for possible confounders, diabetes was associated with cortical brain atrophy but not with any focal brain lesions or subcortical atrophy. There was a strong interaction of diabetes and hypertension, such that the association between diabetes and cortical atrophy existed only in hypertensive but not in normotensive participants. Cognitive and pathological data are needed to determine the clinical significance of these findings as well as to understand the mechanisms underlying these associations.

[1]  L. Nyberg,et al.  Betula: A Prospective Cohort Study on Memory, Health and Aging , 2004 .

[2]  M. Smith,et al.  Diabetes mellitus and Alzheimer's disease: glycation as a biochemical link , 1996, Diabetologia.

[3]  M. Nomura,et al.  MRI of the brain in diabetes mellitus , 2004, Neuroradiology.

[4]  P. Raskin,et al.  Report of the expert committee on the diagnosis and classification of diabetes mellitus. , 1999, Diabetes care.

[5]  L. Launer,et al.  Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: The Honolulu-Asia Aging Study. , 2002, Diabetes.

[6]  E Auffray,et al.  Longitudinal study of blood pressure and white matter hyperintensities , 2001, Neurology.

[7]  A Hofman,et al.  Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study. The Rotterdam Scan Study , 2001, Journal of neurology, neurosurgery, and psychiatry.

[8]  J M Wardlaw,et al.  Prevalence of cerebral white matter lesions in elderly people: a population based magnetic resonance imaging study: the Rotterdam Scan Study , 2001, Journal of neurology, neurosurgery, and psychiatry.

[9]  L. Rumbach,et al.  Role of a Stroke Data Bank in Evaluating Cerebral Infarction Subtypes: Patterns and Outcome of 1,776 Consecutive Patients from the Besançon Stroke Registry , 2000, Cerebrovascular Diseases.

[10]  A. Hofman,et al.  CASCADE: A European Collaborative Study on Vascular Determinants of Brain Lesions , 2000, Neuroepidemiology.

[11]  W. Markesbery,et al.  Midlife blood pressure and neuritic plaques, neurofibrillary tangles, and brain weight at death: the HAAS☆ , 2000, Neurobiology of Aging.

[12]  Nick Bryan,et al.  Clinical Correlates of Ventricular and Sulcal Size on Cranial Magnetic Resonance Imaging of 3,301 Elderly People , 1999, Neuroepidemiology.

[13]  Philip D. Harvey,et al.  Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38 , 1998, BMJ.

[14]  R. Holman,et al.  Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. UK Prospective Diabetes Study Group. , 1998 .

[15]  T. Manolio,et al.  Lacunar infarcts defined by magnetic resonance imaging of 3660 elderly people: the Cardiovascular Health Study. , 1998, Archives of neurology.

[16]  K. Blennow,et al.  A population study on blood-brain barrier function in 85-year-olds , 1998, Neurology.

[17]  T. Arinami,et al.  Subclinical cerebral lesion accumulation on serial magnetic resonance imaging (MRI) in patients with hypertension: risk factors , 1998, Acta neurologica Scandinavica.

[18]  R. D'Agostino,et al.  NIDDM and Blood Pressure as Risk Factors for Poor Cognitive Performance: The Framingham Study , 1997, Diabetes Care.

[19]  I. Deary,et al.  Brain Abnormalities Demonstrated by Magnetic Resonance Imaging in Adult IDDM Patients With and Without a History of Recurrent Severe Hypoglycemia , 1997, Diabetes Care.

[20]  F Barkhof,et al.  Qualitative Assessment of Cerebral Atrophy on MRI: Inter- and Intra-Observer Reproducibility in Dementia and Normal Aging , 1997, European Neurology.

[21]  S. Giampaoli,et al.  Change in cardiovascular risk factors during a 10-year community intervention program. , 1997, Acta cardiologica.

[22]  M. Fantone,et al.  Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus , 1997, Diabetes Care.

[23]  L. Fried,et al.  Clinical correlates of white matter findings on cranial magnetic resonance imaging of 3301 elderly people. The Cardiovascular Health Study. , 1996, Stroke.

[24]  Y. Yamada,et al.  Asymptomatic Cerebral Small Infarcts (Lacunae), Their Risk Factors and Intellectual Disturbances , 1996, Diabetes.

[25]  T. Inoue,et al.  Asymptomatic multiple lacunae in diabetics and non-diabetics detected by brain magnetic resonance imaging. , 1996, Diabetes research and clinical practice.

[26]  H. Fukuda,et al.  Differences between treated and untreated hypertensive subjects in the extent of periventricular hyperintensities observed on brain MRI. , 1995, Stroke.

[27]  Mark A. Smith,et al.  Early AGEing and Alzheimer's , 1995, Nature.

[28]  F. Udaka,et al.  Diabetes mellitus and cerebral vascular disease. , 1994, Diabetes research and clinical practice.

[29]  F. Fazekas,et al.  Assessment of cerebrovascular risk profiles in healthy persons: definition of research goals and the Austrian Stroke Prevention Study (ASPS). , 1994, Neuroepidemiology.

[30]  Evidence by magnetic resonance imaging of cerebral alterations of atrophy type in young insulin-dependent diabetic patients , 1994, Journal of endocrinological investigation.

[31]  U. Keil,et al.  Five-year changes in population blood pressure and hypertension prevalence. Results from the MONICA Augsburg surveys 1984/85 and 1989/90. , 1993, Annals of epidemiology.

[32]  A Hofman,et al.  Cerebral white matter lesions and atherosclerosis in the Rotterdam Study , 1993, The Lancet.

[33]  F. Fazekas,et al.  Magnetic resonance imaging signal hyperintensities in the deep and subcortical white matter. A comparative study between stroke patients and normal volunteers. , 1992, Archives of neurology.

[34]  Gower Street,et al.  Health inequalities among British civil servants: the Whitehall II study , 1991, The Lancet.

[35]  S. Sans,et al.  Recruitment methods and differences in early, late and non-respondents in the first MONICA-Catalonia population survey. , 1990, Revue d'epidemiologie et de sante publique.

[36]  H. Hendrie,et al.  Foci of increased T2 signal intensity on brain MR scans of healthy elderly subjects. , 1989, AJNR. American journal of neuroradiology.

[37]  R. Jarrett.  Epidemiology and public health aspects of non-insulin-dependent diabetes mellitus. , 1989, Epidemiologic reviews.

[38]  S. Black,et al.  Periventricular and subcortical hyperintensities on magnetic resonance imaging. 'Rims, caps, and unidentified bright objects'. , 1988, Archives of neurology.

[39]  Principal Investigators,et al.  The World Health Organization MONICA project (monitoring trends and determinants in cardiovascular disease): a major international collabaration , 1988 .

[40]  H. Tunstall-Pedoe,et al.  The World Health Organization MONICA Project (monitoring trends and determinants in cardiovascular disease): a major international collaboration , 1988 .

[41]  M. Kornitzer,et al.  The World Health Organization MONICA Project (Monitoring trends and determinants in cardiovascular disease): A major international Collaboration , 1988 .

[42]  G. Sarpel,et al.  Magnetic resonance imaging of periventricular hyperintensity in a Veterans Administration hospital population. , 1987, Archives of neurology.

[43]  J. Jakobsen,et al.  Quantitative Changes of Cerebral Neocortical Structure in Insulin-Treated Long-Term Streptozocin-lnduced Diabetes in Rats , 1987, Diabetes.

[44]  O. Paulson,et al.  Decreased Blood-Brain Barrier Permeability to Sodium in Early Experimental Diabetes , 1986, Diabetes.

[45]  R F Spetzler,et al.  Incidental subcortical lesions identified on magnetic resonance imaging in the elderly. I. Correlation with age and cerebrovascular risk factors. , 1986, Stroke.

[46]  W. Bradley.  Patchy, periventricular white matter lesions in the elderly : common observation during NMR imaging , 1984 .

[47]  A. Hofman,et al.  [An epidemiological study of risk indicators for cardiovascular diseases (EPOZ). I. Blood pressure, serum cholesterol level, Quetelet-index and smoking habits in an open population aged 5 years and older]. , 1980, Nederlands tijdschrift voor geneeskunde.

[48]  W. Kannel,et al.  Diabetes and cardiovascular disease. The Framingham study. , 1979, JAMA.