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Relationships of DTI findings with neurocognitive dysfunction in children with Type 1 diabetes mellitus
Huseyin Toprak1, Huseyin Yetis1, Alpay Alkan1
11 Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.
Insights
Children with Type 1 diabetes show significant brain changes on diffusion tensor imaging (DTI). These diffusion tensor imaging (DTI) alterations in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values correlate with neurocognitive deficits.
Area of Science:
- Neuroimaging
- Pediatric Endocrinology
- Neurology
Background:
- Type 1 diabetes mellitus (DM) is a chronic condition affecting children.
- Early detection of brain changes in pediatric Type 1 DM is crucial.
- Diffusion Tensor Imaging (DTI) offers insights into white matter integrity.
Purpose of the Study:
- To identify diffusion tensor imaging (DTI) brain changes in children with Type 1 DM.
- To correlate fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values with neurocognitive function.
- To explore DTI as an early indicator of brain injury in pediatric diabetes.
Main Methods:
- Included 35 children with Type 1 DM and 21 healthy controls.
- Assessed neurocognitive functions in the Type 1 DM group.
- Calculated FA and ADC values in 20 brain regions for all subjects.
- Investigated associations between DTI metrics and neurocognitive test results.
Main Results:
- Widespread significant differences in FA and ADC values were observed in children with Type 1 DM compared to controls.
- Specific correlations found between ADC values (caudate nucleus, corpus callosum, parietal white matter) and neurocognitive tests (verbal, executive function, spatial orientation).
- FA values in the inferior longitudinal fasciculus, mid-brain, internal capsule, and thalamus correlated with cognitive performance and IQ.
Conclusions:
- Type 1 diabetes is associated with significant widespread brain DTI changes (FA and ADC values).
- These DTI alterations may represent early signs of myelin or axonal damage.
- DTI can detect neurocognitive dysfunction in pediatric Type 1 DM, aiding early preventive strategies.
Objective:
To determine whether there were diffusion tensor imaging (DTI) changes in the brain among children with Type 1 diabetes mellitus (DM) and investigate the correlation between the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values and neurocognitive functions.
Methods:
35 children with Type 1 DM and 21 age-matched healthy control subjects were included. Neurocognitive functions of subjects with Type 1 DM were evaluated. In both groups, FA and ADC values were calculated in 20 different locations. The association between neurocognitive function tests and FA and ADC values was investigated.
Results:
Subjects with diabetes had significant changes in FA and ADC values in widespread brain regions compared with the healthy control group. ADC values in the caudate nucleus were negatively associated with verbal point. Increased ADC values in the genu of the corpus callosum were positively associated with Stroop test. There was a negative correlation between the ADC values of the parietal white matter and the judgment of line orientation test. FA values of the inferior longitudinal fasciculus were positively correlated with performance point. However, a negative correlation was noted between FA values of mid-brain and intelligence quotient level as well as another negative correlation between FA values of the posterior crus of the internal capsule and thalamus with verbal point.
Conclusion:
Subjects with diabetes demonstrated significant changes in FA and ADC values in widespread brain regions, and such changes could be early features of injury to myelinated fibres or axonal degeneration. Our findings suggest that brain damage may have begun at the cellular level in the initial stage of Type 1 diabetes and neurocognitive impairments may be inevitable.
Advances In Knowledge:
DTI can demonstrate ADC and FA changes which are well correlated with neurocognitive dysfunction in the brains of children with Type 1 DM. This may help us in guiding preventive measures in early period of the disease before deterioration of neurocognitive functions.
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