STRUCTURAL BRAIN CHANGES ON MRI AND THEIR ASSOCIATION WITH THE SEVERITY OF COGNITIVE DYSFUNCTION IN TYPE 2 DIABETES MELLITUS

Aim: To investigate and characterize MRI-detectable structural brain changes associated with cognitive im­pairment in patients with type 2 diabetes mellitus (T2DM). Methods: This study included 61 patients with T2DM, stratified into three groups based on Mini-Mental State Examination (MMSE) score: severe cognitive impairment (Group I, n=20), mild-to-moderate cognitive impairment (Group II, n=26), and no cognitive impairment (Group III, n=15). All participants underwent brain MRI, with assessment of cortical atrophy, ventricular and subarachnoid space changes, and lacunar infarcts. Statistical analysis was per­formed using Jamovi software. Results: Mean MMSE scores were 21.3±3.1, 25.4±2.3, and 28.1±1.8 in Groups I, II, and III, respectively. Severe cortical atrophy was present in 85% of Group I patients versus none in Group III (χ²=44.3, p<0.001, ε²=0.739), with the strongest associations observed for temporal (ε²=0.781) and parietal (ε²=0.741) lobes. Ventricular deformation and pronounced subarachnoid space expansion were significantly more frequent in Group I (p<0.001). The mean number of lacunar infarcts decreased progressively across groups (6.10±2.05, 1.85±0.73, and 0.60±0.51, respectively; p<0.001), most frequently localized to the internal capsule and basal ganglia. Conclusion: MRI-detectable structural brain changes — cortical atrophy, ventricular system alterations, and lacunar infarct burden — are strongly associated with the severity of cognitive impairment in patients with T2DM, supporting the use of brain MRI as an objective tool for assessing and potentially identifying at-risk patients.