Diabetes and the Brain
Microvascular disease in type 1 diabetes and the impact on brain function and structure

Individuals with type 1 diabetes (DM1) show mild performance deficits on a range of neuropsychological tests compared to non-diabetic controls, but the mechanisms underlying cognitive deterioration in diabetes are poorly understood. In the past decades, several studies have addressed the effects of recurrent hypoglycaemia on cognition.

While retrospective studies in adult patients with DM1 have demonstrated an association between a history of recurrent severe hypoglycaemia and a modest degree of cognitive impairment, large prospective studies did not find such an association. Some evidence for a damaging effect of chronic hyperglycaemia on brain function and structure is now emerging. Two microvascular complications, in particular retinopathy and peripheral neuropathy, have been shown to be predictive of cognitive decline in patients with DM1. These two complications have a microvascular origin and it can be hypothesised that microvascular changes in the brain, as a result of chronic hyperglycaemia, are responsible for the cognitive decline in DM1.

The overall aim of our study program ‘Diabetes and the Brain’ is to establish a relationship between the presence of hyperglycaemia associated microvascular disease and brain function and brain structure in patients with DM1. Results of this program indicate the existence of an association between retinopathy (used as a marker of intracerebral microangiopathy) and functional and structural changes in the brain.