title: Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions.
abstract: Type 2 diabetes is associated with dementia, and also with more slight cognitive decrements. In this Review we discuss trajectories from normal cognition to dementia in people with type 2 diabetes, and explore opportunities for treatment. Slight diabetes-associated cognitive decrements and dementia affect different age groups and show a different evolution. These cognitive entities should therefore not be regarded as a continuum, although their effects might be additive. Vascular damage is a key underlying process in both entities. Glucose-mediated processes and other metabolic disturbances might also have a role. No treatment has been established, but management of vascular risk factors and optimisation of glycaemic control could have therapeutic benefit. We identify possible opportunities for intervention to improve cognitive outcomes in people with type 2 diabetes, and suggest how treatment can be tailored to individual risk profiles and comorbidities.
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands. Electronic address: g.j.biessels@umcutrecht.nl.
authors.forename: Geert Jan
authors.initials: GJ
authors.lastname: Biessels
authors.affiliation: Metabolic Unit, Western General Hospital, Edinburgh, UK.
authors.forename: Mark W J
authors.initials: MW
authors.lastname: Strachan
authors.affiliation: Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Frank L J
authors.initials: FL
authors.lastname: Visseren
authors.affiliation: Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: Kaiser Permanente Division of Research, Oakland, CA, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Whitmer
mesh_terms: D003704:Dementia / Q000150:complications* / Q000473:pathology / Q000517:prevention & control; D003863:Depression / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000473:pathology; D018450:Disease Progression; D006801:Humans; D012307:Risk Factors; D012959:Socioeconomic Factors