TY - JOUR
T1 - The presence of cerebral white matter lesions and lower skin microvascular perfusion predicts lower cognitive performance in type 1 diabetes patients with retinopathy but not in healthy controls—A longitudinal study
AU - Emanuel, Anna L
AU - van Duinkerken, Eelco
AU - Wattjes, Mike P
AU - Klein, Martin
AU - Barkhof, Frederik
AU - Snoek, Frank J
AU - Diamant, Michaela
AU - Eringa, Etto C
AU - IJzerman, Richard G
AU - Serné, Erik H
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Objective: Cognitive impairments in type 1 diabetes may result from hyperglycemia-associated cerebral microangiopathy. We aimed to identify cerebral microangiopathy and skin microvascular dysfunction—as a surrogate marker for generalized microvascular function—as predictors of cognitive performance over time. Methods: In this prospective cohort study, 25 type 1 diabetes patients with proliferative retinopathy and 25 matched healthy controls underwent neurocognitive testing at baseline and after follow-up (3.8 ± 0.8 years). At baseline, 1.5-T cerebral magnetic resonance imaging was used to detect WML and cerebral microbleeds. Skin capillary perfusion was assessed by means of capillary microscopy. Results: In type 1 diabetes patients, but not in healthy controls, the presence of WML (ß = −0.419; P = 0.037) as well as lower skin capillary perfusion (baseline: ß = 0.753; P < 0.001; peak hyperemia: ß = 0.743; P = 0.001; venous occlusion: ß = 0.675; P = 0.003; capillary recruitment: ß = 0.549; P = 0.022) at baseline was associated with lower cognitive performance over time, independent of age, sex, HbA1c, and severe hypoglycemia. The relationship between WML and lower cognitive performance was significantly reduced after adjusting for capillary perfusion. Conclusions: These data fit the hypothesis that cerebral microangiopathy is a manifestation of generalized microvascular dysfunction, leading to lower cognitive performance.
AB - Objective: Cognitive impairments in type 1 diabetes may result from hyperglycemia-associated cerebral microangiopathy. We aimed to identify cerebral microangiopathy and skin microvascular dysfunction—as a surrogate marker for generalized microvascular function—as predictors of cognitive performance over time. Methods: In this prospective cohort study, 25 type 1 diabetes patients with proliferative retinopathy and 25 matched healthy controls underwent neurocognitive testing at baseline and after follow-up (3.8 ± 0.8 years). At baseline, 1.5-T cerebral magnetic resonance imaging was used to detect WML and cerebral microbleeds. Skin capillary perfusion was assessed by means of capillary microscopy. Results: In type 1 diabetes patients, but not in healthy controls, the presence of WML (ß = −0.419; P = 0.037) as well as lower skin capillary perfusion (baseline: ß = 0.753; P < 0.001; peak hyperemia: ß = 0.743; P = 0.001; venous occlusion: ß = 0.675; P = 0.003; capillary recruitment: ß = 0.549; P = 0.022) at baseline was associated with lower cognitive performance over time, independent of age, sex, HbA1c, and severe hypoglycemia. The relationship between WML and lower cognitive performance was significantly reduced after adjusting for capillary perfusion. Conclusions: These data fit the hypothesis that cerebral microangiopathy is a manifestation of generalized microvascular dysfunction, leading to lower cognitive performance.
KW - cerebral microbleeds
KW - cognitive performance
KW - skin perfusion
KW - type 1 diabetes
KW - white matter lesions
UR - http://www.scopus.com/inward/record.url?scp=85061995269&partnerID=8YFLogxK
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85061995269&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30659710
U2 - https://doi.org/10.1111/micc.12530
DO - https://doi.org/10.1111/micc.12530
M3 - Article
C2 - 30659710
SN - 1073-9688
VL - 26
SP - e12530
JO - Microcirculation
JF - Microcirculation
IS - 3
M1 - e12530
ER -