Brain perfusion in type 1 diabetes and cognitive dysfunction

The purpose. To evaluate brain microcirculation using contrast and non-contrast magnetic resonance perfusion in patients with type 1 diabetes and cognitive dysfunction.

Material and methods. The study complies with generally accepted ethical rules. The study included 45 patients with type 1 diabetes and cognitive dysfunction and 20 patients without. Every patient included in the study was continuously monitoring glycemia with evaluation of variability coefficients. MRI was performed using a magnetic resonance imaging scanner Signa Creator “E”, GE Healthcare, 1.5 Tl, China: methods – dynamic contrast (“Gadovist”, w/w, bolusno, 5 ml) and arterial spin marks. SPSS Statistic software package was used for statistical analysis.

Results. Blood flow decreased in patients with type 1 type and cognitive dysfunction in the areas of white and gray matter of frontal, occipital and temporal lobes, and shells (p ≤ 0.05). According to perfusion data, hyperglycemia and the following glycemic variability indices have the greatest influence on cortical structures: glycemic index of prolonged glycemia increase, risk of hyperglycemia and hypoglycemia, glycemic rate of change, glycemic control quality indicator, and in case of non-contrast glycemic control quality and glycemic rate of change, risks of hypo and hyperglycemia. The main factors of changes in brain microcirculation are episodes of severe hypoglycemia in the anamnesis, duration of the disease, arterial hypertension, high cholesterol levels. No separate markers for the evaluation of cognitive disturbances in type 1 diabetes were revealed.

Conclusions. The basis of microcirculatory brain disorders in type 1 diabetes is the level of HbA_1c and variability of glycemia as well as acute complications, duration of diabetes and associated conditions (arterial hypertension and hypercholesterolemia). The most important data were obtained during contrast perfusion.

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