INTRODUCTION: The relationship of diabetes to specific neuropathologic causes of dementia is incompletely understood.

METHODS: We used logistic regression to evaluate the association between diabetes and infarcts, Braak neurofibrillary tangle stage, and neuritic plaque score in 2365 autopsied persons. In a subset of >1300 persons with available cognitive data, we examined the association between diabetes and cognition using Poisson regression.

RESULTS: Diabetes increased odds of brain infarcts (odds ratio [OR] = 1.57, P < .0001), specifically lacunes (OR = 1.71, P < .0001), but not Alzheimer's disease neuropathology. Diabetes plus infarcts was associated with lower cognitive scores at end of life than infarcts or diabetes alone, and diabetes plus high level of Alzheimer's neuropathologic changes was associated with lower mini-mental state examination scores than the pathology alone.

DISCUSSION: This study supports the conclusions that diabetes increases the risk of cerebrovascular but not Alzheimer's disease pathology, and at least some of diabetes' relationship to cognitive impairment may be modified by neuropathology.

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Published in Alzheimer's & Dementia, v. 12, issue 8, p. 882–889.

© 2016 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

This manuscript version is made available under the CC‐BY‐NC‐ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/

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SMART is supported by NIA grant R01-AG038651. Cohort studies were supported by NIA grants P30-AG10161 and R01-AG15819 (ROS), R01-AG17917 (Rush MAP), P30-AG028383 (BRAiNS), P50- AG005681 (Wash U MAP), P30-AG008017 (OBAS, KEAP, AADAPt). HAAS Funding: NHLBI contract N01- HC-05102, NIA contract N01-AG-4-2149, NIA grants U01-AG019349 and U01-AG017155, Kuakini Medical Center, Hawaii Community Foundation grant 2004-0463, and the Office for Research and Development, Department of Veterans Affairs. Other support includes NINDS grant R01-NS084965.