Objective: Type 2 diabetes mellitus (T2DM) is associated with cognitive impairment, but the underlying cerebral small vessel disease (CSVD)-related structural brain correlates are unclear. The aim of this study was to investigate the relationship between various imaging markers of CSVD and mild cognitive impairment (MCI) in patients with T2DM.
Methods: A total of 228 eligible participants with T2DM who were divided into MCI group and normal cognitive group based on neuropsychological assessment were enrolled in this retrospective study. White matter hyperintensity (WMH), lacunes, cerebral microbleeds (CMBs) and enlarged perivascular spaces (EPVS) were evaluated based on brain magnetic resonance imaging (MRI). The total CSVD burden score was calculated by combining the above four markers of CSVD. Binary logistic regression analysis was used to evaluate the relationship between different imaging markers of CSVD and MCI in patients with T2DM. Kruskal–Wallis test and Jonckheere–Terpstra test were used to compare mean MoCA scores among individuals with varying CSVD markers.
Results: In the multivariate binary logistic regression analyses, moderate or severe total CSVD burden (OR: 3.29, 95% CI: 1.63– 7.38, P =0.004; OR: 10.97, 95% CI: 4.94– 24.34, P < 0.001, respectively), moderate dWMH (OR: 3.26, 95% CI: 1.43– 7.41, P =0.005), extensive lacunes (OR: 4.97, 95% CI: 1.79– 13.81, P =0.002), and moderate BG-EPVS (OR: 3.84, 95% CI: 1.81– 8.13, P < 0.001) were associated with MCI in patients with T2DM related to MCI after adjusting for potential confounders. There was a trend for significant decrease in MoCA scores with increase severity of dWMH, pWMH, lacunes, BG-EPVS, deep CMBs, or total CSVD burden (P for trend < 0.05).
Conclusion: Different imaging markers of CSVD, particularly total CSVD burden, were associated with an increased risk of MCI and decline in MoCA scores in patients with T2DM. These findings may provide clues for future studies to explore early diagnostic imaging markers of cognitive impairment in relation to T2DM.
Keywords: type 2 diabetes mellitus, mild cognitive impairment, cerebral small vessel disease