Neuropathological Insights Into the Link Between Type 2 Diabetes and Dementia

Jeremy J. Pruzin, Peter T. Nelson, Erin L. Abner, Zoe Arvanitakis

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

1 Scopus citations


Type 2 diabetes (T2D) is recognized as being associated with pathological changes in the aged human brain, but the precise nature, extent, and underlying mechanisms involved in these changes are incompletely understood. Research groups have reported an increased risk for cognitive impairment and all-cause dementia, and vascular dementia in particular, but also clinical Alzheimer's disease (AD) among persons with T2D compared with those without it. In line with the clinical data and the fact that the most common cause of dementia is mixed pathology, two leading hypotheses that may explain how T2D contributes to dementia relate to cerebrovascular disease (CVD) and AD neuropathological changes (ADNC). Published data have shed light on these two hypotheses. On the one hand, clinicopathological studies have consistently demonstrated that T2D is associated with brain infarcts, especially small subcortical cerebral infarcts, which supports a role for CVD in relating T2D to dementia. On the other hand, the scientific literature to date does not clearly support a link between T2D and ADNC, which argues against a role for AD. This dissociation underscores emerging themes: the imprecision of clinical diagnoses, the impact of CVD on aging, and the importance of considering treatable conditions such as T2D in patients with cognitive impairment. Furthermore, other T2D-associated changes in the brain, even unrelated to AD or CVD, are possible mechanisms, and further research is needed.

Original languageEnglish
Title of host publicationType 2 Diabetes and Dementia
Number of pages30
ISBN (Electronic)9780128094549
StatePublished - Jan 1 2018

Bibliographical note

Publisher Copyright:
© 2018 Elsevier Inc. All rights reserved.


  • Alzheimer disease neuropathologic changes
  • Amyloid plaques
  • Atherosclerosis
  • Cerebral amyloid angiopathy
  • Infarct
  • Neurofibrillary tangles
  • Pathology

ASJC Scopus subject areas

  • General Medicine
  • General Neuroscience


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