2 R01 DK064832-11, NIDDK Hershey (PI) 8/1/16 — 4/30/21
Early Predictors of Brain Health and Development in Youth with T1DM
Type 1 diabetes mellitus (T1DM) is typically diagnosed in childhood and over time can lead to complications affecting the retina, heart, kidneys, peripheral nerves, and more recently appreciated, the brain. Studies consistently find that early age of onset and, to a more variable extent, poor glycemic control over years are associated with reduced cognitive performance and altered brain structure in children with T1DM. As yet, our understanding of why early age of onset would pose more risks for the brain is limited, making interventions difficult to develop. Given that the initial clinical presentation of T1DM in children is the earliest and often the most severe glycemic state they experience over their lifetime, it is possible that age of onset and severity of initial clinical presentation interact to modify risks for brain health and development. This hypothesis has clear clinical implications and the potential to resolve conflicting literature, yet has not been explicitly tested. Thus, the goal of this study is to determine how clinical features at the time of T1DM diagnosis, such as hyperglycemia, diabetic ketoacidosis (DKA) and degree of beta cell failure, interact with age of onset to shape the development of the brain and its responses to subsequent glycemic control.
1 R21 NS098020-01, NINDS Hershey/Culver (co-PIs) 9/1/16 — 8/31/18
Using Diffuse Optical Tomography to Understand Deep Brain Stimulations Impact on Cortical Networks
We have developed a novel high-density diffuse optical tomography (HD-DOT) system that can measure functional connectivity and cortical blood flow responses to tasks. This technique can now be applied to patient populations that cannot be imaged with fMRI. A prime example of this new opportunity is individuals with implanted deep brain stimulators (DBS). The impact of DBS responsible for clinical benefit and potential side-effects is still not fully understood and could be useful clinically. We have previously shown the feasibility of using HD-DOT in a small number of patients with subthalamic nucleus (STN) DBS. The work proposed here will establish the utility and sensitivity of HD-DOT to answer important clinical and theoretical questions in two different DBS populations.