A. Big Picture: We are in the midst of two important converging demographic shifts in this country. One is the "graying" of America and the exponential expansion of the elderly population and the other is the rapid growth of obesity and diabetes in this country, due to changes in our lifestyle. There is good evidence that diabetes increases ones risk for developing dementia but we do not know much about the mechanisms for this and if those with more mild forms of diabetes or abnormal glucose control are also at increased risk for cognitive impairment. We will undertake a series of scientific aims that will greatly improve our understanding of how diabetes may affect the aging brain.

B. Benefits to public and research field: If we establish these links between diabetes and cognitive aging, it will offer possible ways to prevent cognitive impairment. For example, elderly diabetes may need to be screened and treated for cognitive deficits and those at risk for diabetes could be monitored more closely for cognitive symptoms.

C. Approach: We will accomplish these aims as part of an ongoing study of aging involving nearly 3,000 elders in which participants have had repeated measures of cognitive function gathered over 11 years of follow-up. In addition, state of the art assays of glucose regulation have been collected. Thus, we will, in a very cost-effective manner, be able to investigate the important relationships between diabetes, diabetes control, glucose regulation in non-diabetics and cognitive function in older adults. Furthermore, we will explore how these metabolic parameters are associated with structural brain changes in a subset of participants.

D. Why innovative and unique: This work is innovative in that we are linking several important blood markers of diabetes and glucose regulation with cognition and brain MRI changes. In addition, we will explore several ways in which diabetes may cause detrimental changes in the brain.

E. Interest in field: I am particularly interested in trying to prevent cognitive impairment in older adults. Diabetes has emerged as a fascinating and common disease that has a big effect on cognition but we still do not understand some of the ways these conditions are linked. I hope that by conducting this research, we will improve our understanding of cognitive impairment and importantly, suggest ways to prevent or mitigate against cognitive impairment.