Abstract
ObjectiveArterial spin labeling (ASL) studies have revealed inconsistent regional cerebral blood flow (CBF) alterations in patients with type 2 diabetes mellitus (T2DM). The aim of this systematic review and meta-analysis was to identify concordant regional CBF alterations in T2DM.MethodsA systematic review was conducted to the published literatures comparing cerebral perfusion between patients with T2DM and healthy controls using ASL. The seed-based d mapping (SDM) was further used to perform quantitative meta-analysis on voxel-based literatures and to estimate the regional CBF alterations in patients with T2DM. Metaregression was performed to explore the associations between clinical characteristics and cerebral perfusion alterations.ResultsA total of 13 studies with 14 reports were included in the systematic review and 7 studies with 7 reports were included in the quantitative meta-analysis. The qualitative review found widespread CBF reduction in cerebral lobes in T2DM. The meta-analysis found increased regional CBF in right supplementary motor area and decreased regional CBF in bilateral middle occipital gyrus, left caudate nucleus, right superior parietal gyrus, and left calcarine fissure/surrounding cortex in T2DM.ConclusionThe patterns of cerebral perfusion alterations, characterized by the decreased CBF in occipital and parietal lobes, might be the neuropathology of visual impairment and cognitive aging in T2DM.
Highlights
Type 2 diabetes mellitus (T2DM) is a common metabolic disease in middle-aged and older adults characterized by chronic hyperglycemia, which leads to long-term macrovascular and microvascular complications of various organ systems
T2DM, type 2 diabetes mellitus; Cerebral blood flow (CBF), cerebral blood flow; ROI, region of interest; VBA, voxel-based analysis; NA, not available; R, right; L, left; n.s., no significant difference between T2DM and healthy controls; downward arrow (↓), decreased CBF in T2DM; upward arrow (↑), increased CBF in T2DM
These findings indicated the potential neuropathology of visual impairment and cognitive aging in T2DM (Meusel et al, 2014)
Summary
Type 2 diabetes mellitus (T2DM) is a common metabolic disease in middle-aged and older adults characterized by chronic hyperglycemia, which leads to long-term macrovascular and microvascular complications of various organ systems. Cerebral Perfusion Alterations in T2DM that T2DM is a significant risk factor of developing certain mental disorders, including cognitive dysfunction, dementia, and depression (Biessels and Despa, 2018; van Sloten and Schram, 2018; Xue et al, 2019), and older individuals with T2DM progress to dementia at faster rates (Xu et al, 2010; Morris et al, 2014). Characterizing the phenotype of cerebral perfusion alterations may advance our understanding of the underlying mechanisms of cognitive aging and mental impairments in T2DM. The cerebral perfusion impairment may cause oxidative metabolism dysfunction of brain and neuronal damage, leading to mental disorders in T2DM
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