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Cerebral Blood Flow Velocity and Periventricular White Matter Hyperintensities in Type 2 Diabetes

¹ Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
² Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
³ Department of Radiology, The Ohio State University, Columbus, Ohio
⁴ Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts
⁵ Hebrew SeniorLife, Boston, Massachusetts

Address correspondence and reprint requests to Vera Novak, Division of Gerontology, Beth Israel Deaconess Medical Center, 110 Francis St., Boston, MA 02215. E-mail: vnovak{at}bidmc.harvard.edu

OBJECTIVE—Diabetes increases the risk for cerebromicrovascular disease, possibly through its effects on blood flow regulation. The aim of this study was to assess the effects of type 2 diabetes on blood flow velocities (BFVs) in the middle cerebral arteries and to determine the relationship between white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) and BFVs.

RESEARCH DESIGN AND METHODS—We measured BFVs in 28 type 2 diabetic and 22 control subjects (aged 62.3 ± 7.2 years) using transcranial Doppler ultrasound during baseline, hyperventilation, and CO₂ rebreathing. WMHs were graded, and their volume was quantified from fluid-attenuated inversion recovery images on a 3.0 Tesla MRI.

RESULTS—The diabetic group demonstrated decreased mean BFVs and increased cerebrovascular resistance during baseline, hypo- and hypercapnia (P < 0.0001), and impaired CO₂ reactivity (P = 0.05). WMH volume was negatively correlated with baseline BFV (P < 0.0001). A regression model revealed that baseline BFVs were negatively associated with periventricular WMHs, HbA_1c (A1C), and inflammatory markers and positively associated with systolic blood pressure (R² = 0.86, P < 0.0001).

CONCLUSIONS—Microvascular disease in type 2 diabetes, which manifests as white matter abnormalities on MRI, is associated with reduced cerebral BFVs, increased resistance in middle cerebral arteries, and inflammation. These findings are clinically relevant as a potential mechanism for cerebrovascular disease in elderly with type 2 diabetes.

Abbreviations: BFV, blood flow velocity • CRP, C-reactive protein • CVR, cerebrovascular resistance • FLAIR, fluid-attenuated inversion recovery • IR-FGR, inversion recovery fast gradient-recalled echo • MCA, middle cerebral artery • MCAl, left MCA • MCAr, right MCA • MRI, magnetic resonance imaging • sICAM-1, soluble intracellular adhesion molecule-1 • TCD, transcranial Doppler ultrasound • WBC, white blood cell count • WMH, white matter hyperintensity

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