Abstract
White matter (WM) disease is recognized as an important cause of cognitive decline and dementia. White matter lesions (WMLs) appear as white matter hyperintensities (WMH) on T2-weighted magnetic resonance imaging (MRI) scans of the brain. Previous studies have shown that type 2 diabetes (T2DM) is associated with WMH. In this review, we reviewed the literature on the relationship between T2DM and WMH in PubMed and Cochrane over the past five years and explored the possible links among the presence of T2DM, the course or complications of diabetes, and WMH. We found that: (1) Both from a macro- and micro-scopic point of view, most studies support the relationship of a larger WMH and a decrease in the integrity of WMH in T2DM; (2) From the relationship between brain structural changes and cognition in T2DM, the poor performance in memory, attention, and executive function tests associated with abnormal brain structure is consistent; (3) Diabetic microangiopathy or peripheral neuropathy may be associated with WMH, suggesting that the brain may be a target organ for T2DM microangiopathy; (4) Laboratory markers such as insulin resistance and fasting insulin levels were significantly associated with WMH. High HbA1c and high glucose variability were associated with WMH but not glycemic control.
Highlights
In 1987, Hachinski et al first used the low density of computed tomography to represent diffuse white matter changes, called leukoaraiosis (LA) or rare white matter [1]
Exclusion criteria: [1] Articles not focusing on the relationship between Type 2 diabetes mellitus (T2DM) and white matter lesions; [2] The same literature retrieved by different search terms; [3] Articles on the relationship between type 1 diabetes mellitus and white matter lesions; [4] Duplicate publications or review articles of the same data set; [5] Articles dealing with animal research and genetic factors; [6] Review articles
A recent cross-sectional studies [32, 40, 42, 55] using conventional magnetic resonance imaging (MRI) sequences and double inversion recovery (DIR) sequences have shown that patients with diabetes had more White matter hyperintensities (WMH) than the control group
Summary
In 1987, Hachinski et al first used the low density of computed tomography to represent diffuse white matter changes, called leukoaraiosis (LA) or rare white matter [1]. White matter hyperintensities (WMH) are defined as patchy areas of signal hyperintensity scattered in the deep or periventricular white matter evident on brain magnetic resonance imaging (MRI) T2weighted or Fluid Attenuation Inversion Recovery (FLAIR) sequences [2]. This high signal on MRI is caused by cerebral small vessel disease (CSVD), known as white matter lesions (WML) [3,4,5].
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