Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Feb 17;6(1):55-67.
doi: 10.1159/000443497. eCollection 2016 Jan-Apr.

Factors Associated with Changes in Brain Atrophy during a Three-Year Observation in Elderly Diabetic Patients: Effect of Renal Impairment on Hippocampal Atrophy

Takahiko Kawamura  1 , Toshitaka Umemura  2 , Hiroyuki Umegaki  3 , Rui Imamine  4 , Naoko Kawano  5 , Hajime Mase  4 , Asako Mizoguchi  4 , Makiko Minatoguchi  4 , Minoru Kusama  4 , Yu Kouchi  4 , Atsuko Watarai  6 , Akio Kanai  6 , Eitaro Nakashima  4 , Nigishi Hotta  4
Affiliations

Factors Associated with Changes in Brain Atrophy during a Three-Year Observation in Elderly Diabetic Patients: Effect of Renal Impairment on Hippocampal Atrophy

Takahiko Kawamura et al. Dement Geriatr Cogn Dis Extra. .

Abstract

Background/aims: We conducted a 3-year longitudinal study concerning factors associated with changes in brain atrophy in elderly diabetic patients.

Methods: We evaluated hippocampal and global brain atrophy using automatic voxel-based morphometry of structural magnetic resonance images, 4 cognitive function tests, and cerebral small vessel disease (SVD) in 66 diabetic patients.

Results: During the 3-year follow-up, hippocampal and global brain atrophy advanced, and cognitive functions worsened. For changes in hippocampal atrophy, changes in estimated glomerular filtration rate (eGFR), albuminuria, and being an ApoE ε4 carrier were independent factors; change in the number of silent brain infarctions was an independent factor for changes in global brain atrophy. A significant association of changes in eGFR and albuminuria with hippocampal atrophy remained after adjusting for confounders including SVD. Both types of brain atrophy at baseline were significantly correlated with cognitive impairment at baseline and especially associated with changes in delayed word recall during the follow-up after adjusting for confounders.

Conclusion: Changes in eGFR and albuminuria during follow-up were independent risk factors for hippocampal atrophy, which was associated with decline in delayed word recall, suggesting that management of chronic kidney disease may prevent the progression of hippocampal atrophy.

Keywords: Brain atrophy; Cerebral small vessel disease; Cognitive impairment; Diabetes mellitus; Renal impairment.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Changes in severity of gray matter atrophy in the VOI (HAI) during the 3-year follow-up in the case of a 78-year-old female. a MRI. Progression of medial temporal lobe atrophy was observed on FLAIR MRI during the 3 years. b VSRAD. Colored areas (colors refer to the online version only) with z-scores of >2 are overlaid as significantly atrophied regions on the standardized MRI template. The target VOI is surrounded by purple lines (white arrows), and red areas indicate higher gray matter atrophy levels as compared with the control (normal database). The HAI (z-score) increased from 1.57 to 3.20, and the MMSE dropped from 23 to 17 after 3 years.
Fig. 2
Fig. 2
Association between changes in HAI (ΔHAI) and changes in eGFR (ΔeGFR) and albuminuria during the 3-year follow-up. Albuminuria was divided into 3 categories during the follow-up period: normoalbuminuria or regression to normoalbuminuria from albuminuria (‘none’), progression to albuminuria from normoalbuminuria (‘newly detected’), and persistent albuminuria during the follow-up period (‘persistent’). Comparisons between the 3 groups were conducted by ANOVA (mean ± SE, p = 0.087).
Fig. 3
Fig. 3
Association of changes (Δ) in delayed word recall with HAI and WBAI at baseline.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Ott A, Stolk RP, van Harskamp F, Pois HAP, Hofman A, Breteler MMB. Diabetes mellitus and the risk of dementia. The Rotterdam Study. Neurology. 1999;53:1937–1942. - PubMed
    1. Gudala K, Bansal D, Schifano F, Bhansali A. Diabetes mellitus and risk of dementia: a meta-analysis of prospective observational studies. J Diabetes Investig. 2013;4:640–650. - PMC - PubMed
    1. Biessels GJ, Staekenborg S, Brunner E, Brayne C, Scheltens P. Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurol. 2006;5:69–74. - PubMed
    1. Kawamura T, Umemura T, Hotta N. Cognitive impairment in diabetic patients: can diabetic control prevent cognitive decline? J Diabetes Investig. 2012;3:413–423. - PMC - PubMed
    1. den Heijer T, van der Lijin F, Koudstaal PJ, Hofman A, van der Lugt A, Krestin GP, Niessen WJ, Breteler MMB. A 10-year follow-up of hippocampal volume on magnetic resonance imaging in early dementia and cognitive decline. Brain. 2010;133:1163–1172. - PubMed