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Randomized Controlled Trial
. 2019 Apr;26(3):e12530.
doi: 10.1111/micc.12530. Epub 2019 Feb 22.

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

Anna L Emanuel  1   2 , Eelco van Duinkerken  1   2 , Mike P Wattjes  3   4 , Martin Klein  5 , Frederik Barkhof  3 , Frank J Snoek  5 , Michaela Diamant  1 , Etto C Eringa  6 , Richard G IJzerman  1 , Erik H Serné  1
Affiliations
Randomized Controlled Trial

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

Anna L Emanuel et al. Microcirculation. 2019 Apr.

Abstract

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.

Keywords: cerebral microbleeds; cognitive performance; skin perfusion; type 1 diabetes; white matter lesions.

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Conflict of interest statement

There is no conflict of interests to declare.

Figures

Figure 1
Figure 1
Correlations between RCI of general cognitive ability with (A) WML and nail fold capillary density during (B) baseline capillary density (baseline), (C) peak hyperemia (peak), (D) VO, and (E) absolute capillary recruitment (CR) in type 1 diabetic patients. And, correlations between RCI of motor speed with WML (F) and the RCI of attention with nail fold capillary density during baseline (G) and peak (H) in type 1 diabetic patients. †Cook's distance analysis below 1
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