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There is a direct link between diabetes, a leaky blood–brain barrier, leukoaraiosis, and cognitive impairment
Diabetes has an important and readily demonstrable association with cognitive impairment and stroke. Starr et al, in their paper on page,1 have concentrated on a more subtle pathology, that of leukoaraiosis. They have shown increased blood–brain barrier permeability in well controlled diabetic patients and in association with leukoaraiosis in both patients and controls. The authors also draw attention to the poorly recognised association between diabetes, impaired cognition, and leukoaraiosis. When leukoaraiosis was first seen on CT and later on MRI it was routinely dismissed as unimportant. However, leukoaraiosis is associated with cognitive impairment and increases the risk …