Even though well known in type 2 diabetes, the existence of brain changes in type 1 diabetes (T1D) and both their neuroanatomical and clinical features are less well characterized. To fill the void in the current understanding of this disease, we sought to determine the possible neural correlate in long-duration T1D at several levels, including macrostructural, microstructural cerebral damage, and blood flow alterations. In this cross-sectional study, we compared a cohort of 61 patients with T1D with an average disease duration of 21 years with 54 well-matched control subjects without diabetes in a multimodal MRI protocol providing macrostructural metrics (cortical thickness and structural volumes), microstructural measures (T1-weighted/T2-weighted [T1w/T2w] ratio as a marker of myelin content, inflammation, and edema), and cerebral blood flow. Patients with T1D had higher T1w/T2w ratios in the right parahippocampal gyrus, the executive part of both putamina, both thalami, and the cerebellum. These alterations were reflected in lower putaminal and thalamic volume bilaterally. No cerebral blood flow differences between groups were found in any of these structures, suggesting nonvascular etiologies of these changes. Our findings implicate a marked nonvascular disruption in T1D of several essential neural nodes engaged in both cognitive and motor processing.

1st Department of Neurology Faculty of Medicine Masaryk University and University Hospital of St Anne Brno Czech Republic

Center for Magnetic Resonance Research University of Minnesota Minneapolis MN

Department of Medicine Surgery and Dentistry Scuola Medica Salernitana University of Salerno Salerno Italy

Department of Medicine University of Minnesota Minneapolis MN

Department of Neurology Charles University 1st Faculty of Medicine and General University Hospital Prague Czech Republic

Diagnostic Imaging Center Kuopio University Hospital Kuopio Finland

Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN

High Field MR Centre Department of Biomedical Imaging and Image guided Therapy Medical University of Vienna Vienna Austria

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Different FreeSurfer versions might generate different statistical outcomes in case-control comparison studies

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