Article Text

Increased cortical atrophy in patients with Alzheimer’s disease and type 2 diabetes mellitus
  1. G J Biessels1,4,
  2. F-E De Leeuw1,
  3. J Lindeboom1,
  4. F Barkhof2,
  5. P Scheltens1
  1. 1The Alzheimer Center, Department of Neurology, VU Medical Center, Amsterdam, the Netherlands
  2. 2Department of Radiology, VU Medical Center, Amsterdam, the Netherlands
  3. 3Department of Neurology, University Medical Center St. Radboud, Nijmegen, the Netherlands
  4. 4Department of Neurology, University Medical Center Utrecht, the Netherlands
  1. Correspondence to:
 Dr G Biessels
 Department of Neurology G03.228, UMC Utrecht, PO Box 85500, 3508GA Utrecht, the Netherlands; g.j.biessels{at}


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.

  • AD, Alzheimer’s disease
  • CT, computed tomography
  • DM2, diabetes mellitus type 2
  • MMSE, Mini-Mental State Examination
  • MRI, magnetic resonance imaging
  • WML, white matter lesions
  • type 2 diabetes mellitus
  • dementia
  • Alzheimer’s disease
  • cortical atrophy

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  • Competing interests: PS is an associate editor of the JNNP but has had no role in the review or acceptance of this paper

  • Ethics approval: All patients provided written informed consent for their clinical data being used for research

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