PMID- 28801477
OWN - NLM
STAT- MEDLINE
DCOM- 20170926
LR  - 20180307
IS  - 1524-4628 (Electronic)
IS  - 0039-2499 (Linking)
VI  - 48
IP  - 9
DP  - 2017 Sep
TI  - Type 2 Diabetes Mellitus and Impaired Renal Function Are Associated With Brain 
      Alterations and Poststroke Cognitive Decline.
PG  - 2368-2374
LID - 10.1161/STROKEAHA.117.017709 [doi]
AB  - BACKGROUND AND PURPOSE: Type 2 diabetes mellitus (T2DM) is associated with 
      diseases of the brain, kidney, and vasculature. However, the relationship between 
      T2DM, chronic kidney disease, brain alterations, and cognitive function after 
      stroke is unknown. We aimed to evaluate the inter-relationship between T2DM, 
      impaired renal function, brain pathology on imaging, and cognitive decline in a 
      longitudinal poststroke cohort. METHODS: The TABASCO (Tel Aviv brain acute stroke 
      cohort) is a prospective cohort of stroke/transient ischemic attack survivors. 
      The volume and white matter integrity, ischemic lesions, and brain and 
      hippocampal volumes were measured at baseline using 3-T MRI. Cognitive tests were 
      performed on 507 patients, who were diagnosed as having mild cognitive 
      impairment, dementia, or being cognitively intact after 24 months. RESULTS: At 
      baseline, T2DM and impaired renal function (estimated creatinine clearance [eCCl] 
      <60 mL/min) were associated with smaller brain and hippocampal volumes, reduced 
      cortical thickness, and worse white matter microstructural integrity. Two years 
      later, both T2DM and eCCl <60 mL/min were associated with poorer cognitive 
      scores, and 19.7% of the participants developed cognitive decline (mild cognitive 
      impairment or dementia). Multiple analysis, controlling for age, sex, education, 
      and apolipoprotein E4, showed a significant association of both T2DM and eCCl <60 
      mL/min with cognitive decline. Having both conditions doubled the risk compared 
      with patients with T2DM or eCCl <60 mL/min alone and almost quadrupled the risk 
      compared with patients without either abnormality. CONCLUSIONS: T2DM and impaired 
      renal function are independently associated with abnormal brain structure, as 
      well as poorer performance in cognitive tests, 2 years after stroke. The presence 
      of both conditions quadruples the risk for cognitive decline. T2DM and lower eCCl 
      have an independent and additive effect on brain atrophy and the risk of 
      cognitive decline. CLINICAL TRIAL REGISTRATION: URL: 
      http://www.clinicaltrials.gov. Unique identifier: NCT01926691.
CI  - (c) 2017 American Heart Association, Inc.
FAU - Ben Assayag, Einor
AU  - Ben Assayag E
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.). einorba@tlvmc.gov.il.
FAU - Eldor, Roy
AU  - Eldor R
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Korczyn, Amos D
AU  - Korczyn AD
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Kliper, Efrat
AU  - Kliper E
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Shenhar-Tsarfaty, Shani
AU  - Shenhar-Tsarfaty S
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Tene, Oren
AU  - Tene O
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Molad, Jeremy
AU  - Molad J
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Shapira, Itzhak
AU  - Shapira I
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Berliner, Shlomo
AU  - Berliner S
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Volfson, Viki
AU  - Volfson V
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Shopin, Ludmila
AU  - Shopin L
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Strauss, Yehuda
AU  - Strauss Y
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Hallevi, Hen
AU  - Hallevi H
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Bornstein, Natan M
AU  - Bornstein NM
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
FAU - Auriel, Eitan
AU  - Auriel E
AD  - From the Departments of Neurology, Psychiatry, and the Diabetes Unit, Tel Aviv 
      Medical Center, Israel (E.B.A., R.E., E.K., S.S.-T., O.T., J.M., I.S., S.B., 
      V.V., L.S., H.H., N.M.B., E.A.); Sackler Faculty of Medicine, Tel Aviv 
      University, Israel (E.B.A., A.D.K., I.S., S.B., Y.S., H.H., N.M.B., E.A.); and 
      Carmel Medical Center, Haifa, Israel (E.A.).
LA  - eng
SI  - ClinicalTrials.gov/NCT01926691
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20170811
PL  - United States
TA  - Stroke
JT  - Stroke
JID - 0235266
SB  - IM
MH  - Aged
MH  - Brain/diagnostic imaging/pathology
MH  - Cerebral Cortex/diagnostic imaging/pathology
MH  - Cognitive Dysfunction/diagnostic imaging/epidemiology/etiology/*psychology
MH  - Cohort Studies
MH  - Comorbidity
MH  - Dementia/diagnostic imaging/epidemiology/etiology/*psychology
MH  - Diabetes Mellitus, Type 2/*epidemiology
MH  - Executive Function
MH  - Female
MH  - Hippocampus/diagnostic imaging/pathology
MH  - Humans
MH  - Israel/epidemiology
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Middle Aged
MH  - Motor Skills
MH  - Neuropsychological Tests
MH  - Organ Size
MH  - Prospective Studies
MH  - Renal Insufficiency, Chronic/*epidemiology
MH  - Risk Factors
MH  - Stroke/complications/diagnostic imaging/epidemiology/*psychology
MH  - White Matter/diagnostic imaging/pathology
OTO - NOTNLM
OT  - cognitive dysfunction
OT  - dementia
OT  - diabetes mellitus
OT  - ischemic attack, transient
OT  - stroke
EDAT- 2017/08/13 06:00
MHDA- 2017/09/28 06:00
CRDT- 2017/08/13 06:00
PHST- 2017/04/13 00:00 [received]
PHST- 2017/06/26 00:00 [revised]
PHST- 2017/06/28 00:00 [accepted]
PHST- 2017/08/13 06:00 [pubmed]
PHST- 2017/09/28 06:00 [medline]
PHST- 2017/08/13 06:00 [entrez]
AID - STROKEAHA.117.017709 [pii]
AID - 10.1161/STROKEAHA.117.017709 [doi]
PST - ppublish
SO  - Stroke. 2017 Sep;48(9):2368-2374. doi: 10.1161/STROKEAHA.117.017709. Epub 2017 
      Aug 11.