Cerebral microbleeds are associated with deficits in cognitive processing speed and executive functions in middle-aged adults with type 1 diabetes

Iiris Kyläheiko; Aleksi Tarkkonen; Linda Kuusela; Juha Martola; Teemu I Paajanen; Jussi Virkkala; Per-Henrik Groop; Lena M Thorn; Turgut Tatlisumak; Jukka Putaala; Daniel Gordin; Hanna Jokinen; FinnDiane Study Group

doi:10.1016/j.diabres.2025.113080

Cerebral microbleeds are associated with deficits in cognitive processing speed and executive functions in middle-aged adults with type 1 diabetes

Diabetes Res Clin Pract. 2026 Feb:232:113080. doi: 10.1016/j.diabres.2025.113080. Epub 2026 Jan 2.

Authors

Affiliations

¹ Department of Psychology, Faculty of Medicine, University of Helsinki, PO Box 21 (Haartmaninkatu 3) 00014 Helsinki, Finland; Department of Neurology, Kymenlaakso Central Hospital, Kotkantie 41, 48210 Kotka, Finland; Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2U, Tukholmankatu 8, 00290 Helsinki, Finland; Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, University of Helsinki, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland. Electronic address: iiris.kylaheiko@helsinki.fi.
² Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2U, Tukholmankatu 8, 00290 Helsinki, Finland; Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, University of Helsinki, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland; HUS Medical Imaging Center, Department of Radiology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029 HUS, Finland. Electronic address: aleksi.tarkkonen@hus.fi.
³ HUS Medical Imaging Center, Department of Radiology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029 HUS, Finland. Electronic address: linda.kuusela@hus.fi.
⁴ HUS Medical Imaging Center, Department of Radiology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029 HUS, Finland. Electronic address: juha.martola@hus.fi.
⁵ Work Ability and Working Careers Unit, Finnish Institute of Occupational Health, Topeliuksenkatu 41 b, 00250 Helsinki, Finland. Electronic address: teemu.paajanen@ttl.fi.
⁶ Department of Clinical Neurophysiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029 HUS, Finland. Electronic address: jussi.virkkala@hus.fi.
⁷ Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, University of Helsinki, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland; Department of Nephrology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029 HUS, Finland; Department of Diabetes, Central Clinical School, Monash University, Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia. Electronic address: per-henrik.groop@helsinki.fi.
⁸ Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland; Research Program for Clinical and Molecular Metabolism, University of Helsinki, Biomedicum Helsinki, Haartmaninkatu 8, 00290 Helsinki, Finland; Department of General Practice and Primary Health Care, Helsinki University Hospital and University of Helsinki, Tukholmankatu 8 B, 00029 HUS, Finland. Electronic address: lena.thorn@helsinki.fi.
⁹ Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Blå stråket 7, plan 3, Sahlgrenska 41345 Gothenburg, Sweden; Department of Neurology, Sahlgrenska University Hospital, Blå stråket 5, 41345 Gothenburg, Sweden. Electronic address: turgut.tatlisumak@gmail.com.
¹⁰ Department of Neurology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029 HUS, Finland. Electronic address: jukka.putaala@hus.fi.
¹¹ Minerva Foundation Institute for Medical Research, Biomedicum Helsinki 2U, Tukholmankatu 8, 00290 Helsinki, Finland; Department of Nephrology, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00029 HUS, Finland; Joslin Diabetes Center, Harvard Medical School, 1 Joslin Place, Boston, MA 02215, USA. Electronic address: daniel.gordin@helsinki.fi.
¹² Department of Psychology, Faculty of Medicine, University of Helsinki, PO Box 21 (Haartmaninkatu 3) 00014 Helsinki, Finland; Division of Neuropsychology, HUS Neurocenter, Helsinki University Hospital and University of Helsinki, PO Box 302 (Paciuksenkatu 21), 00029 HUS, Finland. Electronic address: hanna.jokinen@helsinki.fi.

PMID: 41485646
DOI: 10.1016/j.diabres.2025.113080

Abstract

Aims: Adults with type 1 diabetes (T1D) have an increased risk of cerebral small vessel disease (cSVD)-related brain changes already in midlife, yet their significance for cognitive functions remains poorly understood. We investigated associations between cerebral microbleeds (CMBs), white matter hyperintensities (WMHs), and cognition in individuals with T1D and without any neurological symptoms.

Methods: Participants (n=167; age 46.4±7.7 years) underwent cross-sectional clinical and biochemical evaluations, brain magnetic resonance imaging, and neuropsychological assessment. CMB number and topography (lobar, deep/infratentorial, or mixed location) and WMHs, quantified volumetrically, were evaluated.

Results: Compared to absence of CMBs, higher burden of CMBs (≥3) was associated independently of age with poorer processing speed (standardized β from 0.18 to 0.23, p<0.05) and executive functions (standardized β from 0.18 to -0.25, p<0.05), but not with episodic memory. Mild WMHs had no independent relationships with cognition. Compared to other topographies, mixed CMB location was more often negatively related to cognition (standardized β from 0.20 to 0.32, p<0.05).

Conclusions: CMBs were related to a subtle, yet systematic impairment in cognition, whereas mild WMHs were not. The results provide insight into the development of early cSVD-related cognitive changes already in midlife and suggest an increased risk of cognitive decline in T1D.

Keywords: Cerebral microbleeds; Cerebrovascular disease; Cognition; MRI; Type 1 Diabetes.

MeSH terms

Adult
Cerebral Hemorrhage* / complications
Cerebral Hemorrhage* / physiopathology
Cerebral Hemorrhage* / psychology
Cerebral Small Vessel Diseases
Cognition* / physiology
Cross-Sectional Studies
Diabetes Mellitus, Type 1* / complications
Diabetes Mellitus, Type 1* / physiopathology
Diabetes Mellitus, Type 1* / psychology
Executive Function* / physiology
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neuropsychological Tests
Processing Speed
White Matter / pathology