In recent years is has become clear that type 2 diabetes affects the central nervous system. These long-term complications manifest as structural changes on brain imaging, cognitive decrements and a 1.5-2 fold increased risk for the development of dementia, in particular in the elderly. The pathogenesis of diabetes-induced brain damage is not completely understood. Both vascular and metabolic disturbances may play an important role in the impact of diabetes on the brain. The course of development of cerebral changes in diabetes is also uncertain and may already have an onset in the preclinical stages of diabetes, like the metabolic syndrome. In this thesis, brain MR imaging, MR angiography and MR spectroscopy were performed to study structural brain changes as well as functional alterations of the cerebral vasculature and cerebral metabolism in patients with type 2 diabetes or metabolic syndrome. The relation of MR findings with clinical features and cognitive functioning was also addressed. With the results of these studies, we are able to identify patients with type 2 diabetes who have an increased risk for cognitive decline. This may direct the development of effective preventive strategies and help to decide at what stage these interventions should be initiated
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