**4. Pilot study: magnetic resonance spectrometry as a method of estimation of brain metabolism in type 1 diabetes mellitus**

The proton magnetic resonance multilocular spectroscopy of the brain was carried out on a MAGNETOM Symphony 1.5 T (Siemens) device with the relaxation time TE = 135, and the voxel volume was 1.5 cm3; the main spectra of choline (Cho), creatine/phosphocreatine (Cr, Cr2), and N-acetylaspartate (NAA) were analyzed [22]. With the help of the regional approach, the data of metabolites Cho (choline), creatine), Cr2 (phosphocreatine), NAA (N-acetylaspartate), localized in the hippocampal region on the left and right.

The study revealed that the average age of patients with type 1 diabetes mellitus was 26 ± 4.8 years, and the control group was 30 ± 6.4 years. When comparing patients with type 1 diabetes mellitus (30 people) and control group (18 people) in metabolites Cho (choline), Cr (creatine), Cr2 (phosphocreatine), NAA and (N-acetylaspartate), distributed by the method of linear grouping and regional approach, no statistically significant differences were found.

When comparing the values obtained for the Cho metabolite, a statistically significant difference in the Cho12 index was found: in patients with type 1 diabetes mellitus, 0.82 (0.75–0.84), compared with a higher value in the control group, 0.87 (0.81–2.02).

When comparing the tables for the Cr metabolite, statistically significant differences in the indices were found: Cr5, Cr10, Cr25, Cr26, Cr28, Cr31, and Cr36.

In the study of the metabolite NAA, no significant differences in voxels were found. The study revealed changes in the ratio of metabolites Cho, Cr, Cr2, and NAA.

Thus, the main differences in patients with type 1 diabetes mellitus and in the control group were found by the metabolites Cr and Cr2. At the same time, these parameters are energy metabolism markers in their function and promote glycolysis [23, 24]. In addition, it was reported that in the voxel assessment there are significant differences in Cr and Cr2 in the

**Figure 7.** Examples of models with the smallest squares indicating a negative relationship between a multi-scale SH, the volumes of regions of the brain, as well as cognitive functions: (A) the ratio between GVC2 and volume of GM in the left island cortex, (B) the ratio between GVC1 and GM volume in the right spindle-shaped gyrus, (C) the ratio between GVC2 and GM volume in the left cingulate gyrus, and (D) the ratio between GVC2 and total cognitive performance (composite T)

**Parameters The main group The control group Significance** MEAN 9.17 (8.36–10.00) 7.25 (6.77–7.87) U = 29, p = 0.001 SD 4.54 (3.86–5.79) 2.95 (2.61–3.47) U = 26, p = 0.001 CONGA 6.66(5.77–7.81) 4.32 (4.15–4.51) t = −4.9, p = 0.001 LI 22.35 (20.76–92.99) 27.17(22.84–55.68) U = 98.5, p = 0.776 Gindex 56.41 (52.00–79.69) 45.50 (36.85–50.76) U = 43, p = 0.007 LBGI 11.16 (8.24–17.26) 6.77 (4.44–7.53) U = 53.5, p = 0.023 HBGI 13.19 (11.01–21.25) 8.00 (6.91–10.45) U = 43, p = 0.006 MAGE 4.86 ± 0.23 2.44 ± 0.13 U = 34, p = 0.002 Mvalue 28.38 (20.46–26.90) 14.43 (11.92–17.04) U = 124.5, p = 0.001 MAG 59.60 (53.54–88.43) 34.60 (30.83–42.17) t = −8.5, p = 0.001

(SD, triangles; control, circles).

Note: Mann-Whitney U test, Student's t-test.

28 Cognitive Disorders

**Table 8.** Characteristics of VG indicators by groups.

hippocampus region. This is due to the presence of a concentration gradient of these metabolites between the anterior and posterior parts of the hippocampus in the main group.

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