J.ophthalmol.(Ukraine).2016;3:49-53.

https://doi.org/10.31288/oftalmolzh201814953

Relationship between diabetic retinopathy and cerebral perfusion in type 2 diabetes mellitus

Zherdiova N.M., Cand Sc (Med), Medvedovska N.V., Dr Sc (Med), Makeev S.K., Dr Sc (Med), Mankovsky BN, NAMS Corr Member, Prof, Dr Sc (Med)

Shupyk National Medical Academy of Postgraduate Education;

Kyiv (Ukraine)

E-mail: nadejda05.1977@gmail.com                 

Background: Compared to patients without diabetic retinopathy (DR), those with DR demonstrate better cognitive performance. It is therefore reasonable to hypothesize that retinal microcirculatory changes might be a marker of impaired cerebral microcirculation.

Purpose: To examine the association between the presence of diabetic retinopathy and cerebral perfusion in patients with type 2 diabetes mellitus (T2DM).

Materials and Methods: Ninety-five T2DM patients aged 50-70 years were enrolled. They were divided into two groups, those with DR (DR group) and without DR (non-DR group). Regional cerebral blood flows (rCBF) were measured with 99mTc-HMPAO single-photon emission computed tomography (SPECT).

Results: Linear regression analysis revealed negative relationships between DR and cerebral perfusion impairments in right frontal lobe (B (95% CI) = 0.58 (-0.98/-0.18); P = 0.01), left frontal (B (95% CI) = -0.55 (-0.99/-0.12); P = 0.02) lobe, right parietal lobe (B (95% CI) = -0.68 (-1.19/-0.16); P = 0.01), left parietal lobe (B (95% CI) = -0.79 (-1.31/-0.27); P = 0.00); right occipital lobe (B (95% CI) = -0.61(-1.17/-0.06); P = 0.03), left occipital lobe (B (95% CI) = -0.81 (-1.35/-0.26); P = 0.00); right cerebral cortex (B (95% CI) = -0,58 (-0.98/-0.18); P = 0.01) and left cerebral cortex (B (95% CI) = -0.54 (-91/-0.17); P = 0.01).

Conclusions: The findings might indicate that, in diabetic patients, damage to retinal microvessels develops somewhat in parallel with that to the brain.

Keywords:  diabetic retinopathy, type 2 diabetes mellitus, cerebral blood flow

 

References

  1. Holman RR, Paul SK, Bethel AM et al. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. Engl J Med. 2008;359:1577–89
  2. van den Berg E, Kloppenborg RP, Kessels RP, Kappelle LJ, Biessels GJ. Type 2 diabetes mellitus, hypertension, dyslipidemia and obesity: a systematic comparison of their impact on cognition. Biochim Biophys Acta. 2009 May;1792(5):470–81
  3. Palta P, Schneider ALC, Biessels GJ, Touradji P, Hill-Briggs F. Magnitude of Cognitive Dysfunction in Adults with Type 2 Diabetes: A Meta-analysis of Six Cognitive Domains and the Most Frequently Reported Neuropsychological Tests Within Domains. J Int Neuropsychol Soc. 2014;20(3):278–91
  4. Ott A, Stolk RP, van Harskamp F, et al. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology. 1999 Dec 10;53(9):1937-42.
  5. Ohara T, Doi Y, Ninomiya T et al. Glucose tolerance status and risk of dementia in the community: the Hisayama study. Neurology. 2011 Sep 20;77(12):1126-34.
  6. Moreira RO, Campos SC, Soldera AL. Diabetes Mellitus and Alzheimer’s Disease: from physiopathology to treatment implications. Diabetes Metab Res Rev. 2013 Jul 18. Available from: https://www.ncbi.nlm.nih.gov/pubmed/23868462
  7. Espeland, MA, Bryan, RN, Goveas, JS et al;and the WHIMS-MRI Study Group. Influence of type 2 diabetes on brain volumes and changes in brain volumes: results from the Women's Health Initiative Magnetic Resonance Imaging studies. Diabetes Care. 2013 Jan;36(1):90-7.
  8. Falvey CM, Rosano C, Simonsick EM et al. Macro- and microstructural magnetic resonance imaging indices associated with diabetes among community-dwelling older adults. Diabetes Care. 2013 Mar;36(3):677-82.
  9. Qiu C., Sigurdsson S., Zhang Q. et al. Diabetes, markers of brain pathology and cognitive function: the Age, Gene / Environment Susceptibility-Reykjavik Study. Ann Neurol. 2014 Jan;75(1):138-46.
  10. Moran C, Phan TG, Chen J et al. Brain atrophy in type 2 diabetes: regional distribution and influence on cognition. Diabetes Care. 2013 Dec;36(12):4036-42.
  11. Exalto LG, Biessels GJ, Karter AJ et al.  Risk score for prediction of 10 year dementia risk in individuals with type 2 diabetes: a cohort study. Lancet Diabetes Endocrinol. 2013 Nov;1(3):183-90.
  12. Biessels GJ, Strachan MW, Visseren FL et al. Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions. Lancet Diabetes Endocrinol. 2014 Mar;2(3):246-55.
  13. Zherdiova NM, Medvedovska NV, Mankovsky B.N. [Relationship between diabetic retinopathy and cognitive impairment in patients with type 2 diabetes mellitus]. Oftalmol Zh. 2017;2: 8-11. Ukrainian
  14. International Council of Ophthalmology | Guidelines for Diabetic Eye Care. 2017. Available from: http://www.icoph.org/downloads/ICOGuidelinesforDiabeticEyeCare.pdf
  15. Cappelletti M, Lee HL, Freeman ED, Price GC. The role of the right and left parietal lobes in the Conceptual processing of numbers. J Cogn Neurosci. 2010; 22(2): 331–6.
  16. Quirce R, Carril JM, Jiménez-Bonilla JF, et al.Semi-quantitative assessment of cerebral blood flow with 99mTc-HMPAO SPET in type I diabetic patients with no clinical history of cerebrovascular disease. Eur J Nucl Med. 1997 Dec;24(12):1507-13.
  17. Káplár M, Paragh G, Erdei A, et al. Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patient. J Nucl Med. 2009 Dec;50(12):1993-8