Brains of people with diabetes have to work harder

Professor Velandai Srikanth is a clinician-
researcher based at Frankston Hospital in 
the south of Melbourne

by Anne Crawford

It was exactly the sort of investigation – and findings – that excites Professor Velandai Srikanth: Twenty-two sets of twins, all aged about sixty, controlled for factors including age, sex, genes and early shared environment. One twin in each pair had type 2 diabetes.

Comprehensive measures of brain structure and function were obtained. The twins in the study, funded by the Diabetes Australia Research Trust, showed no difference in brain volumes and ultimately performed the same in standard tests of cognitive function. But when it came to testing memory during a functional MRI, it became evident that the diabetic twin’s brain was much working harder, needing to recruit more areas to do the task.

“Something may be happening in the brains of people with type 2 diabetes that is forcing them to recruit more areas of the brain to do a task, compared with their non-diabetic co-twin,” Professor Srikanth said. “The question now is what might be happening to reduce the efficiency of the brain in type 2 diabetes, even at middle age.”  

A follow-up study, funded by the NHMRC, is underway, investigating the reasons for the finding.

Exploring what happens to the brains of people with type 2 diabetes and poor metabolic health as they age is Professor Srikanth’s main focus in terms of his personal research.  

Diabetes in particular has interested him in this context since 2007 when he received the first of several grants to research the area. Since then, Professor Srikanth, in collaboration with others in Melbourne, Hobart and Queensland, has led the field in Australia and influenced it internationally.

“Type 2 Diabetes increases the risk of dementia by approximately two-fold,” he said.

“There may be interventions that can be used to delay cognitive decline in people with this disease, and even if we can delay it by a year or two we can have a large reduction in the burden of dementia in the population.”

Professor Srikanth’s research group recently conducted a pilot clinical trial to test whether physical exercise can help preserve cognitive function over time in people with type 2 diabetes. He is in the process of securing more funding to conduct a larger study on this.

The recently appointed Professor of Medicine in the Central Clinical School is also working to boost the research capability of others at Peninsula Health, where he is based. 

“A major focus for me is to try to enhance the ability of clinical researchers here, to try to promote the research culture, and establish Peninsula Health as a centre of clinical research excellence. There are currently very good areas of research happening in certain disciplines within Peninsula Health that could be developed more over time.”

Professor Srikanth‘s research group is involved in a number of other projects that range from the clinical, to technological, and to enhancing health services.

A practising geriatrician, he knows that people with dementia living at home alone are often unable to access the support they need, partly because of their reduced cognitive function. He wants a new type of service introduced to help.

“We want to see if we can set up a mechanism by which these people can be assisted by specially trained support workers embedded in health services to navigate that process and thereby stay at home longer,” he said.

Professor Srikanth is also involved in stroke research, pursuing an interest in the field that started during his medical training in the early nineties and which developed further with a PhD on the link between stroke and dementia. He is collaborating with Monash Medical Centre colleagues in acute stroke on a technological solution to get affected patients to the right hospital as expediently as possible.  

He is active in developing new ways to monitor and treat stroke risk, working with the Monash Institute of Medical Engineering (MIME) to develop wearable devices to measure blood pressure. High blood pressure or hypertension is a major risk factor for stroke and heart attack.

Professor Srikanth also collaborates on large-scale international projects to investigate vascular risk in developing countries such as Vietnam and India. He is an investigator on a large project as part of the Global Alliance for Chronic Disease looking at the risk factors and management of hypertension in disadvantaged settings in developing countries. The researchers, led by Monash University’s Professor Amanda Thrift, were surprised to find that hypertension was even affecting people who lived under the poverty line and was becoming prevalent particularly in relatively affluent men.

“It is a matter of trying to find out what local factors influence the risk of getting high blood pressure and which on-the-ground interventions can be put in place to stop that from happening,” he said.

 “Yes, I am busy!” he said of his working life. “But it is all interesting and keeps me occupied productively.”

Wood AG, Chen J, Moran C, Phan T, Beare R, Cooper K, Litras S, Srikanth V.  Brain Activation duringMemory Encoding in Type 2 Diabetes Mellitus: A Discordant Twin Pair Study. J Diabetes Res. 2016;2016:3978428. doi: 10.1155/2016/3978428. Epub 2016 May 29.
Srikanth's web page: www.med.monash.edu.au/medicine/alfred/research/srikanth-group.html