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Pathophysiology

Magnetic Resonance Imaging of the Brain in Diabetes

The Cardiovascular Determinants of Dementia (CASCADE) Study

  1. Reinhold Schmidt1,
  2. Lenore J. Launer23,
  3. Lars-Göran Nilsson4,
  4. Andrzej Pajak5,
  5. Susanna Sans6,
  6. Klaus Berger7,
  7. Monique M. Breteler3,
  8. Maria de Ridder3,
  9. Carole Dufouil8,
  10. Rebecca Fuhrer9,
  11. Simona Giampaoli10,
  12. Albert Hofman3 and
  13. for the CASCADE Consortium
  1. 1Department of Neurology, Medical University Graz, Graz, Austria
  2. 2Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, National Institutes of Health, Bethesda, Maryland
  3. 3Department of Epidemiology and Biometry, Erasmus Medical Center, Rotterdam, the Netherlands
  4. 4Department of Psychology, Stockholm University, Stockholm, Sweden
  5. 5Department of Epidemiology and Population Studies, Institute of Public Health, Jagiellonian University Medical School, Kraków, Poland
  6. 6Institute of Health Studies, Department of Health and Social Security, Barcelona, Spain
  7. 7Institute of Epidemiology and Social Medicine, University of Muenster, Muenster, Germany
  8. 8Institut National de la Santé et de la Recherche Médicale (INSERM) Unit 360, Epidemiological Research in Neurology and Psychopathology, Hopital La Salpetriere, Paris, France
  9. 9Department of Epidemiology and Public Health, University College, London, U.K
  10. 10Istituto Superiore di Sanità, Laboratory of Epidemiology and Biostatistics, Rome, Italy
  1. 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
Diabetes 2004 Mar; 53(3): 687-692. https://doi.org/10.2337/diabetes.53.3.687
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    FIG. 1.

    Results from linear regression analysis. The figure shows diabetes and cortical atrophy in CASCADE subcohorts and in the entire CASCADE cohort stratified by the absence and presence of hypertension. The black rectangles represent β-coefficients adjusted for age, sex, years of education, smoking status, coronary heart disease, BMI, and cholesterol level. 95% CIs are denoted by lines.

Tables

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  • TABLE 1

    Description of the study cohorts

    SitenSex (% male)Age (mean years)Education (mean years)DiabetesHyper-tension (%)CHD (%)Ever smoker (%)BMI (mean)Cholesterol (mean mmol/l)
    Austria16953.867.911.110.739.634.343.826.86.0
    France18639.268.410.77.038.211.841.925.96.3
    Italy16744.969.84.59.646.113.837.728.66.1
    The Netherlands22051.870.19.34.545.521.472.326.36.7
    Poland10256.970.57.417.674.536.342.228.45.4
    Spain11053.670.15.919.138.212.750.028.15.9
    Sweden13947.568.69.17.960.415.148.926.76.8
    U.K.15974.866.312.04.426.48.851.624.76.7
    Total1,25252.368.99.09.144.618.849.726.86.3
    • CHD, coronary heart disease.

  • TABLE 2

    Demographics and risk factors in nondiabetic and diabetic subjects

    FactorNondiabetic subjectsDiabetic subjectsP value
    n1,138114—
    Sex (% male)51.362.30.03*
    Age (years)68.8 ± 3.269.3 ± 3.00.08†
    Education (years)9.0 ± 4.28.5 ± 4.70.34†
    Hypertension (%)43.160.5<0.0001*
    Coronary heart disease (%)17.433.3<0.0001*
    Smoking status (%)
     Never51.344.6
     Former36.642.9
     Current12.112.50.37*
    BMI (kg/m2)26.7 ± 3.928.1 ± 3.8<0.0001†
    Total cholesterol (mmol/l)6.3 ± 1.26.3 ± 1.40.59†
    • *

      * χ2 test;

    • †

      † Mann-Whitney U test.

  • TABLE 3

    Magnetic resonance imaging findings in nondiabetic and diabetic subjects

    MRI findingNondiabetic subjectsDiabetic subjectsP value
    n1,138114
    Focal lesions
     Total periventricular WML-score2.0 (1.0–3.0)2.0 (1.0–4.0)0.10*
     Severe periventricular WML (%)18.725.40.08†
     Total volume of subcortical WML0.16 (0.02–1.07)0.31 (0.02–1.79)0.18*
     Severe subcortical WML (%)25.729.80.35†
     Presence of infarcts (%)7.29.60.34†
    Measures of brain atrophy
     Total cortical atrophy-score7.2 ± 3.08.2 ± 3.20.001*
     Severe cortical atrophy (%)22.635.10.003†
     Subcortical atrophy
      Ventricle-to-brain ratio0.32 ± 0.040.33 ± 0.040.03*
      Severe subcortical atrophy (%)23.829.80.16†
    • Data are median (interquartile range) or means±SE, unless otherwise noted.

    • *

      * Mann-Whitney U test,

    • †

      † χ2 test. Severe abnormalities were considered if the extent of changes belonged to the upper quintile of the distribution.

  • TABLE 4

    Results from linear regression analyses: interactions of diabetes and hypertension on cortical atrophy

    Interaction termß95% CIP*
    Total diabetes × hypertension†1.190.22–2.150.02
    Untreated diabetes × hypertension†2.200.88–3.510.001
    Treated diabetes × hypertension†0.10−1.24 to 1.440.88
    • *

      * Adjusted for age, sex, study, years of education, smoking status, coronary heart disease, BMI, and cholesterol level;

    • †

      † reference group is nondiabetic normotensive participants.

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Magnetic Resonance Imaging of the Brain in Diabetes
Reinhold Schmidt, Lenore J. Launer, Lars-Göran Nilsson, Andrzej Pajak, Susanna Sans, Klaus Berger, Monique M. Breteler, Maria de Ridder, Carole Dufouil, Rebecca Fuhrer, Simona Giampaoli, Albert Hofman
Diabetes Mar 2004, 53 (3) 687-692; DOI: 10.2337/diabetes.53.3.687

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Magnetic Resonance Imaging of the Brain in Diabetes
Reinhold Schmidt, Lenore J. Launer, Lars-Göran Nilsson, Andrzej Pajak, Susanna Sans, Klaus Berger, Monique M. Breteler, Maria de Ridder, Carole Dufouil, Rebecca Fuhrer, Simona Giampaoli, Albert Hofman
Diabetes Mar 2004, 53 (3) 687-692; DOI: 10.2337/diabetes.53.3.687
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