Accelerated Aging of the Brain and Cognition in Type 1 Diabetes

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Accelerated Aging of the Brain and Cognition in Type 1 Diabetes
Accelerated Aging of the Brain and Cognition in Type 1 Diabetes

Signs of accelerated aging that are related to slower information processing were evident in the brains of middle-aged adults with childhood-onset type 1 diabetes, researchers from the University of Pittsburgh Graduate School of Public Health reported in Neurology.

“The severity of cognitive complications and cerebral small vessel disease — which can starve the brain of oxygen — is much more intense than we expected, but it can be measured in a clinical setting,” Caterina Rosano, MD, MPH, senior study author and associate professor in Pitt Public Health's Department of Epidemiology, said in a press release.

“Further study in younger patients is needed, but it stands to reason that early detection and intervention — such as controlling cardiometabolic factors and tighter glycemic control, which help prevent microvascular complications — also could reduce or delay these cognitive complications.”

For their study, Rosano and colleagues evaluated the severity and volume of white matter hyperintensities, which are present in normal aging and neurological disorders, and infarcts, along with cognitive and health-related measures using MRIs, cognitive assessments, physical exams and medical histories.

A total of 97 people with type 1 diabetes (mean age, 50 years; mean duration of diabetes, 41 years) and 81 people without diabetes (mean age, 48 years) were included in the researchers' analyses. The cohort with type 1 diabetes was composed of participants in the ongoing Pittsburgh Epidemiology of Diabetes Complications Study.

Compared with 7% of people without diabetes, 33% of those with type 1 diabetes exhibited moderate to severe levels of white matter hyperintensities on MRIs. The white matter hyperintensities were also more severe in the type 1 diabetes group vs. the group without diabetes (P<.0001).

Additionally, those with type 1 diabetes had lower average scores on the three cognitive tests designed to assess information-processing speed, manual dexterity and verbal intelligence, among other factors, than those without the condition (P<.0001).

These results were independent of age, education or other factors.

White matter hyperintensities also appeared to be associated with slower information processing speed, with adjustment for white matter hyperintensities weakening the differences in processing speed between groups (P≤.05).

The researchers also found that prevalent neuropathies and smoking tripled the odds of high white matter hyperintensity burden, independent of age or disease duration. However, data linking blood pressure or hyperglycemia to white matter hyperintensities were not significant.

"People with type 1 diabetes are living longer than ever before, and the incidence of type 1 diabetes is increasing annually," lead author Karen A. Nunley, PhD, postdoctoral fellow in Pitt Public Health's neuroepidemiology program, said in the release.

"We must learn more about the impact of this disease as patients age. Long-term studies are needed to better detect potential issues and determine what interventions may reduce or prevent accelerated brain aging and cognitive decline."

Reference

  1. Nunley KA et al. Neurology. 2015;doi:10.1212/WNL.0000000000001582.
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