Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression

Thomas T. van Sloten, Sanaz Sedaghat, Mercedes R. Carnethon, Lenore J. Launer, Coen D.A. Stehouwer

Research output: Contribution to journalReview articlepeer-review

21 Scopus citations


Adults with type 2 diabetes are at an increased risk of developing certain brain or mental disorders, including stroke, dementia, and depression. Although these disorders are not usually considered classic microvascular complications of diabetes, evidence is growing that microvascular dysfunction is one of the key underlying mechanisms. Microvascular dysfunction is a widespread phenomenon in people with diabetes, including effects on the brain. Cerebral microvascular dysfunction is also apparent in adults with prediabetes, suggesting that cerebral microvascular disease processes start before the onset of diabetes. The microvasculature is involved in the regulation of many cerebral processes that when impaired predispose to lacunar and haemorrhagic stroke, cognitive dysfunction, and depression. Main drivers of diabetes-related cerebral microvascular dysfunction are hyperglycaemia, obesity and insulin resistance, and hypertension. Increasing amounts of data from observational studies suggest that diabetes-related microvascular dysfunction is associated with a higher risk of stroke, cognitive dysfunction, and depression. Cerebral outcomes in diabetes might be improved following treatments targeting the pathways through which diabetes damages the microcirculation. These treatments might include drugs that reduce dicarbonyl compounds, augment cerebral insulin signalling, or improve blood–brain barrier permeability and cerebral vasoreactivity.

Original languageEnglish (US)
Pages (from-to)325-336
Number of pages12
JournalThe Lancet Diabetes and Endocrinology
Issue number4
StatePublished - Apr 2020
Externally publishedYes

Bibliographical note

Funding Information:
TTvS is supported by a VENI research grant (916.19.074) from the Netherlands Organization for Scientific Research and the Netherlands Organization for Health Research and Development, a Dutch Heart Foundation research grant ( 2018T025 ), and a travel grant from L'institut Servier. LJL is supported by the Intramural Research Program (National Institute on Aging, US National Institutes of Health).

Publisher Copyright:
© 2020 Elsevier Ltd

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Intramural
  • Research Support, Non-U.S. Gov't
  • Review


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