Vol 24, No 1 (2021)
Research paper
Published online: 2021-01-29

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Age, BMI and diabetes as independent predictors of brain hypoperfusion

Zita Képes1, Ferenc Nagy2, Ádám Budai2, Sándor Barna2, Regina Esze3, Sándor Somodi3, Miklós Káplár3, Ildikó Garai12, József Varga1
Pubmed: 33576479
Nucl. Med. Rev 2021;24(1):11-15.


Background: Cerebral blood flow abnormalities are supposed to be potential risk factors for developing cognitive dysfunction
in the general population. Aging, obesity and type 2 diabetes mellitus are associated with perfusion abnormalities leading to
cognitive impairment, neurodegeneration and future development of dementia. In our study, we aimed at identifying independent
factors that contribute to the appearance of regional brain perfusion changes besides those that are already known.
Material and methods: Forty-three type 2 diabetic and twenty-six obese patients were enrolled. After the intravenous administration
of 740 MBq 99mTc-hexamethylpropylene amine oxime (HMPAO), all subjects underwent brain perfusion SPECT imaging
applying AnyScan S Flex dual-head gamma camera (Mediso, Hungary). Using Philips Achieva 3T scanner brain resting-state
functional MRI was also performed. The SPECT and MRI images were co-registered and transformed to the MNI152 atlas
space so that data of the following standard volumes of interest (VOIs) could be obtained: frontal lobe, parietal lobe, temporal
lobe, occipital lobe, limbic region, cingulate, insula, basal ganglia, cerebrum, limbic system and brain stem. Using the SPSS
25 statistical software package, general linear regression analysis, Student’s t-test, and Mann-Whitney U-test were applied for
statistical analyses.
Results: Multivariate linear analysis identified that BMI and age are significantly (p < 0.0001) associated with perfusion, and
patient group was slightly above threshold (p = 0.0524). We also found that the presence of diabetes was an independent
significant predictor of normalized regional brain perfusion only in the insula (p < 0.001). Other independent predictors of
normalized regional brain perfusion were: age in the insula (p < 0.001) and in the limbic region (p < 0.01), and BMI in the
brain stem (p < 0.01).
Conclusions: Age and BMI proved to be general, and diabetes regional predictor of brain hypoperfusion. BMI appeared to
be a novel factor affecting brain perfusion. In one specific region, the insula, we detected a difference between the obese and
the diabetic group. These findings may be significant in the understanding of the development of cognitive impairment in
metabolic diseases.

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