PAPER

Increased cortical atrophy in patients with Alzheimer’s disease and type 2 diabetes mellitus

G J Biessels^1,4, F-E De Leeuw¹, J Lindeboom¹, F Barkhof² and P Scheltens¹

¹ The Alzheimer Center, Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
² Department of Radiology, VU Medical Center, Amsterdam, the Netherlands
³ Department of Neurology, University Medical Center St. Radboud, Nijmegen, the Netherlands
⁴ Department of Neurology, University Medical Center Utrecht, the Netherlands

Correspondence to:
Correspondence to:
Dr G Biessels
Department of Neurology G03.228, UMC Utrecht, PO Box 85500, 3508GA Utrecht, the Netherlands; g.j.biessels{at}umcutrecht.nl

Background: The risk of Alzheimer’s disease (AD) is increased in type 2 diabetes (DM2). This increased risk has been attributed to vascular comorbidity, but other mechanisms, such as accelerated ageing of the brain, have also been implicated.

Objective: To determine whether AD in patients with DM2 is associated with an increased occurrence of vascular lesions in the brain, by increased cerebral atrophy, or a combination of both.

Methods: In total, 29 patients with AD and DM2 and 58 patients with AD and without DM2 were included in the study. Clinical characteristics were recorded, and a neuropsychological examination and magnetic resonance imaging (MRI) scan were performed. MRI scans were rated for cortical and subcortical atrophy, medial temporal lobe atrophy, white matter lesions, and infarcts.

Results: The neuropsychological profiles of the two groups were identical. Patients with AD and DM2 had increased cortical atrophy on MRI (p<0.05) compared with the non-DM2 group. In addition, infarcts were more common (odds ratio 2.4; 95% CI 0.8 to 7.8), but this effect did not account for the increased atrophy. The other MR measures did not differ between the groups.

Conclusion: The results suggest that non-vascular mechanisms, leading to increased cortical atrophy, are also involved in the increased risk of AD in DM2.

Keywords: type 2 diabetes mellitus; dementia; Alzheimer’s disease; cortical atrophy

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