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Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI
den Heijer T, Vermeer SE, van Dijk EJ, Prins ND, Koudstaal PJ, Hofman A, Breteler MM.. Diabetologia, 2003-11-01
Topic: Brain proteins, microglia and lab models
Aim/hypothesis Type 2 diabetes increases the risk not only of vascular dementia but also of Alzheimer's disease. The question remains whether diabetes increases the risk of Alzheimer's disease by diabetic vasculopathy or whether diabetes influences directly the development of Alzheimer neuropathology. In vivo, hippocampal and amygdalar atrophy on brain MRI are good, early markers of the degree of Alzheimer neuropathology. We investigated the association between diabetes mellitus, insulin resistance and the degree of hippocampal and amygdalar atrophy on magnetic resonance imaging (MRI) accounting for vascular pathology. Methods Data was obtained in a population-based study of elderly subjects without dementia between 60 to 90 years of age. The presence of diabetes mellitus and, in non-diabetic subjects, insulin resistance was assessed for 506 participants in whom hippocampal and amygdalar volumes on MRI were measured. We assessed the degree of vascular morbidity by rating carotid atherosclerosis, and brain white matter lesions and infarcts on MRI. Results Subjects with diabetes mellitus had more hippocampal and amygdalar atrophy on MRI compared to subjects without diabetes mellitus. Furthermore, increasing insulin resistance was associated with more amygdalar atrophy on MRI. The associations were not due to vascular morbidity being more pronounced in persons with diabetes mellitus. Conclusions/interpretation Type 2 diabetes is associated with hippocampal and amygdalar atrophy, regardless of vascular pathology. This could suggest that Type 2 diabetes directly influences the development of Alzheimer neuropathology.
Key findings
- Results Subjects with diabetes mellitus had more hippocampal and amygdalar atrophy on MRI compared to subjects without diabetes mellitus.
- Furthermore, increasing insulin resistance was associated with more amygdalar atrophy on MRI.
- Conclusions/interpretation Type 2 diabetes is associated with hippocampal and amygdalar atrophy, regardless of vascular pathology.
- This could suggest that Type 2 diabetes directly influences the development of Alzheimer neuropathology.
Why it matters
In 506 adults aged 60–90 without dementia, people with type 2 diabetes had more shrinkage of the hippocampus and amygdala on MRI. This was not explained by worse carotid atherosclerosis, white matter lesions or brain infarcts. Among people without diabetes, higher insulin resistance went with more amygdala shrinkage. The authors say this "could suggest" diabetes directly affects Alzheimer-type brain changes, but the study measured MRI atrophy, not Alzheimer pathology or dementia, and it shows an association, not cause and effect.
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Study details
- Participants506
- Evidence strengthLow
How this study scored 54/100
Published in a peer-reviewed journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Diabetologia) |
| Journal's citation record | 3 / 4 | Diabetologia: journal h-index 337 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2003 — older than 20 years, still counted |
| Sample size | 2 / 4 | 506 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 516 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 20.6 citations a year over 25 year(s) since 2003 |
| Impact for its field and year | 3 / 6 | Cited 7.2× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 3 / 6 | Cited by 23 other studies in this library |
| Still being cited | 2 / 4 | Cited 37 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Monique M.B. Breteler: h-index 162 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Erasmus MC: institution h-index 1,321 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | PubMed indexes it as a multicentre study |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 14595538) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 54 / 100 | — |
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Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 7 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
den Heijer, T., Vermeer, S. E., van Dijk, E. J., Prins, N. D., Koudstaal, P. J., Hofman, A., et al. (2003). Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI. Diabetologia. https://doi.org/10.1007/s00125-003-1235-0
Vancouver
den Heijer T, Vermeer SE, van Dijk EJ, Prins ND, Koudstaal PJ, Hofman A, et al. Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI. Diabetologia. 2003. doi:10.1007/s00125-003-1235-0. PMID: 14595538.
BibTeX
@article{denheijer2003-14595538,
author = {den Heijer, T. and Vermeer, S. E. and van Dijk, E. J. and Prins, N. D. and Koudstaal, P. J. and Hofman, A. and Breteler, M. M.},
title = {{Type 2 diabetes and atrophy of medial temporal lobe structures on brain MRI}},
journal = {Diabetologia},
year = {2003},
doi = {10.1007/s00125-003-1235-0},
pmid = {14595538},
url = {https://doi.org/10.1007/s00125-003-1235-0}
}
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