Abstract
Type 2 diabetes is common in older people and is associated with higher risk of both vascular dementia and Alzheimer's disease. This review examines the evidence for increased risk of dementia and mild cognitive impairment in patients with diabetes and the role of potential confounders. The relationship of diabetes and impaired fasting glucose with brain structure is also reviewed, focusing on longitudinal studies in older people. The pathophysiology underlying cognitive change in type 2 diabetes is examined with reference to vascular disease, hypoglycaemia, inflammation and insulin levels. Implications for clinical care in older people with diabetes are discussed, with a recommendation for cognitive evaluation as a routine part of end-organ, diabetes complication review.