The correlation between microstructural changes in the hypothalamus and mild cognitive impairment and short-chain fatty acids in the gut in T2DM patients
Objective:To assess microstructural changes in the posterior thalamus of type 2 diabetes mellitus(T2DM)patients using diffusion kurtosis imaging(DKI)and investigate the correlation between DKI parameter changes,cognitive function scores,and alterations in short-chain fatty acids in the gut.Materials and Methods:DKI data were collected from both sides of the thalamus in 57 T2DM patients[comprising 29 T2DM-mild cognitive impairment(MCI)cases and 28 T2DM-nonMCI and 30 healthy controls(HC group)].Various DKI parameters including fractional anisotropy(FA),mean kurtosis(MK),radial kurtosis(RK),and fractional anisotropy of kurtosis(FAK)were measured.Additionally,short-chain fatty acid levels in the gut were assessed.Correlation analyses were performed between the average DKI parameter values in different brain regions among the three groups,cognitive function scores,and short-chain fatty acids.Results:The T2DM-MCI group exhibited significantly lower left thalamic MK values compared to both the T2DM-nonMCI and HC groups(P<0.05).In comparison to HC,the T2DM-MCI group showed a general decrease in left thalamic RK,right thalamic FA,and KFA values(P<0.05).Pairwise comparisons revealed statistically significant differences in left thalamic RK values between HC and T2DM-nonMCI groups(P<0.05),as well as in right thalamic FA and KFA values between T2DM-nonMCI and T2DM-MCI groups(P<0.05).Furthermore,in T2DM patients,there was a positive correlation between right thalamic FA and FAK values and MoCA scores(r=0.328,P=0.015;r=0.435,P=0.001).Left thalamic RK values were positively correlated with butyric acid(r=0.431,P=0.001).Left thalamic MK values exhibited positive correlations with MoCA scores and butyric acid(r=0.294,P=0.030;r=0.287,P=0.033).Right thalamic FAK values showed a negative correlation with TMT-A scores(r=-0.318,P=0.018).Conclusions:Microstructural changes in the thalamus of T2DM patients may be an important physiological mechanism underlying cognitive impairment,and gut butyric acid levels may partially influence the microstructural integrity of the left thalamus.