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J Diabetes. 2018 Nov;10(11):835-846. doi: 10.1111/1753-0407.12773. Epub 2018 May 30.

Accelerated executive functions decline and gray matter structural changes in middle-aged type 1 diabetes mellitus patients with proliferative retinopathy.

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Amsterdam Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands.
Center for Epilepsy, State Brain Institute Paulo Niemeyer, Rio de Janeiro, Brazil.
Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands.
Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands.
Department of Psychology, Institute of Psychiatry, Kings College, London, UK.
Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.



The aim of the present study was to determine trajectories of cognitive and cortical changes over time in middle-aged patients with type 1 diabetes mellitus (T1DM) and proliferative retinopathy.


Twenty-five patients and 25 controls underwent neuropsychological assessment and neuroimaging twice in a mean (±SD) of 3.56 ± 0.65 and 3.94 ± 0.91 years, respectively (P = 0.098). Cognitive assessment included the domains of general cognitive ability, memory, information processing speed, executive functions, attention, and motor and psychomotor speed. Symmetrized percentage change in local cortical thickness, surface area, and volume was determined using the FreeSurfer 6 vertex-wise general linear model method. Analyses were performed uncorrected and corrected for baseline systolic blood pressure and depressive symptoms.


In patients versus controls, accelerated executive function decline was accompanied by, but not related to, lower left frontal and temporal surface area, left parietal and right frontal thickness, and bilateral frontal and right posterior cingulate volume (family-wise error [FWE]-corrected P < 0.05 for all). In patients, lower executive performance was related to loss of right precuneus surface area (PFWE  = 0.005). Higher HbA1c during follow-up was related to executive function decline (r = -0.509, P = 0.016) and loss of left hemisphere surface area (rcorrected analysis  = -0.555, P = 0.007).


After 3.5 years of follow-up, middle-aged T1DM patients with proliferative retinopathy, mild focal changes in executive functions, and cortical structure were found, which may indicate accelerated aging.


1型糖尿病; brain structure; cognition; glycemic control; neuroimaging; type 1 diabetes; 神经影像学; 脑结构; 血糖控制; 认知

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