Diabetes, brain infarcts, cognition and small vessels in the Canadian alliance for healthy hearts and minds study

Background:  Diabetes is a risk factor for cerebrovascular disease and cognitive impairment. The anatomical basis for this is uncertain.

Methods: The Canadian Alliance for Healthy Hearts and Minds (CAHHM) collected brain and carotid magnetic resonance imaging (MRI) and two cognitive tests (DSST and MoCA) in a cross-sectional sample of men and women. Brain MRIs identified brain infarcts (BI), lacunar BI, high white matter hyperintensity (WMH), vascular brain injury (VBI - BI or high WMH) and small vessel VBI (lacunar BI or high WMH). Carotid MRIs estimated carotid wall volume, a measure of subclinical atherosclerosis. Cognitive scores were standardized to each site’s mean score, and cognitive impairment was identified by one or both test scores ≤ 1 standard deviation below the site’s mean score on that test.    

Results: The 7733 participants included 495 (6.4%) with diabetes, of whom 388 were taking diabetes drugs. After age and sex adjustment, diabetes was independently associate...