![]() Brain images acquired from different scanners or with different scan parameters will thus lead to variation in volume estimates. The accuracy of the automated tissue segmentation depends on the image contrast and therefore on the quality of the MRI scans. To prevent the progression of subtle cognitive decrements in dementia in patients with diabetes, we need to develop an understanding of the causative mechanisms at the earliest stages of cognitive decline.Īutomated segmentation techniques, however, also have some limitations. A meta-analysis estimated that people with type 2 diabetes have a relative risk of vascular dementia of 2.5 (95% CI 2.1–3.0) and that of Alzheimer disease is 1.5 (95% CI 1.2–1.8) relative to individuals without diabetes ( 5). Data from large epidemiological surveys link diabetes to an increased dementia risk. In older people, however, particularly older than the age of 65, type 2 diabetes is also associated with more severe forms of cognitive impairment. Similar to type 1 diabetes, effect sizes are small to moderate (0.3 to 0.4 SD units) ( 4) and follow a slow progression over time, only modestly exceeding the rate of normal aging-related cognitive decline ( 3). Modest decrements in cognitive functioning, evident on the domains of verbal and visual memory, information processing speed, and executive functioning, have also been noted in people with type 2 diabetes across all age groups ( 3). A better understanding of the underlying mechanisms is necessary to establish interventions that will improve long-term cognitive outcomes for patients with type 1 and type 2 diabetes. Challenges are to further unravel the etiology of these cerebral complications by integrating findings from different imaging modalities and detailed clinical phenotyping and by linking structural MRI abnormalities to histology. Advanced imaging techniques detect microstructural lesions in the cerebral gray and white matter of patients with diabetes that affect structural and functional connectivity. These brain changes occur in the context of aging and often also in relation to an adverse vascular risk factor profile. Type 2 diabetes is associated with global brain atrophy and an increased burden of small-vessel disease. In those with a diabetes onset in childhood, these volume reductions are likely to reflect the sum of changes that occur during brain development and changes that occur later in life due to exposure to diabetes-related factors. Studies in adults with type 1 diabetes show regional reductions in brain volume. ![]() This article addresses findings with brain MRI that may underlie cognitive dysfunction in diabetes. Diabetes is associated with cognitive dysfunction and an increased risk of dementia. ![]()
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