Brain Imaging in Type 2 Diabetes

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Type 2 diabetes mellitus (T2D) and dementia are highly prevalent and major public health problems in aging populations. There is a strong association between T2D and incident dementia, and it is possible that this is a causal association. Assuming causality, there may be two major pathways by which T2D increases the risk of developing dementia, namely cerebrovascular disease and neurodegeneration, which may be synergistic or additive. Brain imaging allows the study of these pathways in vivo and can assist in the planning of further mechanistic studies in the field. Brain magnetic resonance imaging (MRI) and positron emission tomography (PET) are the two most valuable modalities that can advance our knowledge in this field. In this chapter, we approach evidence from such studies from a clinical and mechanistic viewpoint rather than a technical imaging perspective. Overall, there appears to be consistent evidence linking T2D to the presence of brain atrophy, reduced white matter integrity, and altered functional brain activation both during resting state and task performance. The impact of cerebrovascular disease as measured by in vivo MRI surprisingly appears to be less consistent and may be influenced by duration and severity of the diabetic phenotype. What remains to be elucidated further is whether T2D can cause disruption of the blood-brain barrier, neuroinflammation, or microinfarction, and thus promote neurodegeneration. The advent of high-field MRI, advanced dynamic contrast imaging, and new PET neuroinflammation ligands may resolve these issues. Large cohort studies using multimodality imaging may assist in clarifying many uncertainties.

Original languageEnglish
Title of host publicationType 2 Diabetes and Dementia
EditorsVelandai Srikanth, Zoe Arvanitakis
Place of PublicationUnited Kingdom
PublisherAcademic Press
Number of pages18
ISBN (Electronic)9780128096949
ISBN (Print)9780128094549
Publication statusPublished - 6 Mar 2018


  • Magnetic resonance imaging
  • Neuroimaging
  • Positron emission tomography
  • Type 2 diabetes

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