Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Diabetes Care. 2023 Apr 1;46(4):819-827. doi: 10.2337/dc22-1998.
To investigate the contribution of alterations in brain structure and function to cognitive function and their interactions in individuals with diabetes and patients with type 2 diabetes mellitus (T2DM).
This population-based study included 2,483 participants who underwent structural MRI (n = 569 with normal glucose metabolism [NGM], n = 1,353 with prediabetes, and n = 561 with T2DM) and cognitive testing. Of these, 2145 participants also underwent functional MRI (n = 496 NGM, n = 1,170 prediabetes, and n = 479 T2DM). Multivariate linear regression models were used to assess the association of brain volume and functional connectivity with cognition, as well as the association of brain volume and functional connectivity.
Compared with NGM participants, those with T2DM had lower brain volume in a wide range of brain regions and stronger functional connectivity between the bilateral thalamus and brain functional network (visual network and default mode network), and those with prediabetes had lower brain volume in specific local regions (subcortical gray matter volume and subcortical subregions [bilateral thalamus, bilateral nucleus accumbens, and right putamen]) and stronger functional connectivity between the right thalamus and visual network. Cognition was associated with greater right thalamus volume and lower functional connectivity between the right thalamus and visual network. Functional connectivity between the right thalamus and visual network was associated with lower right thalamus volume.
Cognition was associated with greater brain volume and lower functional connectivity in T2DM. Increased functional connectivity may indicate a compensatory mechanism for reduced brain volume that begins in the prediabetic phase.
研究脑结构和功能改变对认知功能的影响，并探讨其在糖尿病个体和 2 型糖尿病患者中的相互作用。
本研究为基于人群的研究，共纳入 2483 名参与者，他们接受了结构磁共振成像（n=569 名血糖代谢正常[NGM]、n=1353 名糖尿病前期、n=561 名 2 型糖尿病）和认知测试。其中，2145 名参与者还接受了功能磁共振成像（n=496 NGM、n=1170 名糖尿病前期、n=479 名 2 型糖尿病）。多变量线性回归模型用于评估脑容量和功能连接与认知的关系，以及脑容量和功能连接的关系。
与 NGM 参与者相比，2 型糖尿病患者大脑多个区域的脑容量降低，双侧丘脑与大脑功能网络（视觉网络和默认模式网络）之间的功能连接增强，而糖尿病前期患者大脑特定局部区域（皮质下灰质体积和皮质下亚区[双侧丘脑、双侧伏隔核和右侧壳核]）的脑容量降低，右侧丘脑与视觉网络之间的功能连接增强。认知与较大的右侧丘脑体积和较低的右侧丘脑与视觉网络之间的功能连接相关。右侧丘脑与视觉网络之间的功能连接与较低的右侧丘脑体积相关。
认知与 2 型糖尿病患者大脑更大的脑容量和较低的功能连接相关。功能连接的增加可能表明在糖尿病前期阶段开始时，大脑体积减少的代偿机制。
