INVESTIGATORS

OBJECTIVEdMacrovascular disease may contribute to increased risk of accelerated cognitive decline in patients with type 2 diabetes. We aimed to determine associations of measures of macro-vascular disease with cognitive change in a cognitively healthy older population with type 2 diabetes. RESEARCHDESIGNANDMETHODSdEight hundred thirty-onemen andwomen (aged 60–75 years) attended two waves of the prospective Edinburgh Type 2 Diabetes Study (ET2DS). At baseline, clinical and subclinical macrovascular disease was measured, including cardiovascular event history, carotid intima-media thickness (cIMT), ankle brachial index (ABI), and serum N-terminal probrain natriuretic peptide (NT-proBNP). Seven neuropsychological tests were administered at base-line and after 4 years; scores were combined to a standardized general ability factor (g). Adjustment of follow-up g for baseline g assessed 4-year cognitive change. Adjustment for vocabulary (estimated premorbid ability) was used to estimate lifetime cognitive change. RESULTSdMeasures of cognitive decline were significantly associated with stroke, NT-proBNP, ABI, and cIMT, but not with nonstroke vascular events. The association of stroke with increased estimated lifetime cognitive decline (standardized b,20.12) and of subclinical mark-ers with actual 4-year decline (standardizedb,20.12, 0.12, and20.15 for NT-proBNP, ABI, and cIMT, respectively) reached the Bonferroni-adjusted level of statistical significance (P, 0.006). Results altered only slightly on adjustment for vascular risk factors. CONCLUSIONSdStroke and subclinical markers of cardiac stress and generalized atherosclero-sis are associatedwith cognitive decline in older patientswith type2diabetes. Further investigation into the potential use of subclinical vascular disease markers in predicting cognitive decline is warranted