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Diabetes 53:687-692, 2004
© 2004 by the American Diabetes Association, Inc.

Magnetic Resonance Imaging of the Brain in Diabetes

The Cardiovascular Determinants of Dementia (CASCADE) Study

Reinhold Schmidt1, Lenore J. Launer2,3, Lars-Göran Nilsson4, Andrzej Pajak5, Susanna Sans6, Klaus Berger7, Monique M. Breteler3, Maria de Ridder3, Carole Dufouil8, Rebecca Fuhrer9, Simona Giampaoli10, and Albert Hofman3 for the CASCADE Consortium

1 Department of Neurology, Medical University Graz, Graz, Austria
2 Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
3 Department of Epidemiology and Biometry, Erasmus Medical Center, Rotterdam, the Netherlands
4 Department of Psychology, Stockholm University, Stockholm, Sweden
5 Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical School, Kraków, Poland
6 Institute of Health Studies, Department of Health and Social Security, Barcelona, Spain
7 Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
8 Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 360, Epidemiological Research in Neurology and Psychopathology, Hopital La Salpetriere, Paris, France
9 Department of Epidemiology and Public Health, University College, London, U.K
10 Istituto Superiore di Sanità, Laboratory of Epidemiology and Biostatistics, Rome, Italy

Diabetic patients are at increased risk for stroke, but little is known about the presence of other brain lesions. We studied the association of magnetic resonance imaging–detected brain lesions to diabetes in 1,252 individuals aged 65–75 years who were randomly selected from eight European population registries or defined working populations. All scans were centrally read for brain abnormalities, including infarcts, white matter lesions, and atrophy. We used a three-point scale to rate periventricular white matter lesions, and the volume of subcortical lesions was calculated according to their number and size. Subjective grading of cortical atrophy by lobe and summation of the lobar grades resulted in a total cortical atrophy score. The mean of three linear measurements of the ventricular diameter relative to the intracranial cavity defined the severity of subcortical atrophy. After adjustment for possible confounders, diabetes was associated with cortical brain atrophy but not with any focal brain lesions or subcortical atrophy. There was a strong interaction of diabetes and hypertension, such that the association between diabetes and cortical atrophy existed only in hypertensive but not in normotensive participants. Cognitive and pathological data are needed to determine the clinical significance of these findings as well as to understand the mechanisms underlying these associations.

Address correspondence and reprint requests to Dr. Reinhold Schmidt, Department of Neurology, Medical University Graz, Auenbruggerplatz 22, A-8036 Graz, Austria. E-mail: reinhold.schmidt{at}uni-graz.at


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Copyright © 2004 by the American Diabetes Association.