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Therefore, we investigated the association of prediabetes, diabetes and HbA1c with change in global and domain\u2010specific cognitive scores in cognitively unimpaired (CU) adults, as well as the potential effect modification by sex or age.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This longitudinal study included 4236 CU persons aged \u2265\u200950\u2009years from the population\u2010based Mayo Clinic Study of Aging. We ran linear mixed\u2010effect models with baseline prediabetes, diabetes and HbA1c predicting longitudinal global and domain\u2010specific (i.e., memory, language, attention\/executive function, and visuospatial skills) cognitive z\u2010scores and raw scores. Models were adjusted for age, sex, education, medical comorbidity, repeated cognitive testing, and ApoE\u025b4. We additionally ran models with sex and age interactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to normoglycemic individuals, individuals with prediabetes and diabetes showed poorer performance on cognitive tests, i.e., TMT\u2010B, category fluency, and block design subtest over time. Additionally, the presence of prediabetes, diabetes, longer diabetes duration and higher HbA1c were associated with faster global and domain\u2010specific cognitive decline over a median follow\u2010up of 6.4\u2009years (range 1\u201319). Three\u2010way interactions showed that the effect of diabetes on decline in global cognition, attention and visuospatial domains was more pronounced in women than in men. Age did not modify the effect of diabetes or higher HbA1c on cognition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results suggest that prediabetes and diabetes significantly shorten the timeframe before a potentially clinically noticeable change in global and domain\u2010specific cognition is reached. Thus, lifestyle modification to reverse prediabetes and prevent diabetes could potentially reduce the rate of cognitive decline in aging populations. The findings differed by sex (i.e., the effect of diabetes on decline in global cognition, attention and visuospatial domains was more pronounced in women than men).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70231","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T16:33:36Z","timestamp":1764952416000},"page":"345-354","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A Longitudinal Investigation of Prediabetes, Diabetes,\n                    <scp>HbA1c<\/scp>\n                    and Cognitive Trajectories Among Cognitively Unimpaired Individuals"],"prefix":"10.1111","volume":"74","author":[{"given":"Anna","family":"Pink","sequence":"first","affiliation":[{"name":"Department of Geriatrics Paracelsus Medical University  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4011-9842","authenticated-orcid":false,"given":"Janina","family":"Krell\u2010Roesch","sequence":"additional","affiliation":[{"name":"Institute of Sports and Sports Science Karlsruhe Institute of Technology  Karlsruhe Germany"},{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy A.","family":"Syrjanen","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8328-136X","authenticated-orcid":false,"given":"Maria","family":"Vassilaki","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie A.","family":"Fields","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernhard","family":"Iglseder","sequence":"additional","affiliation":[{"name":"Department of Geriatrics Paracelsus Medical University  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elmar","family":"Aigner","sequence":"additional","affiliation":[{"name":"First Department of Medicine Paracelsus Medical University  Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Walter K.","family":"Kremers","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"Clifford R.","family":"Jack","sequence":"additional","affiliation":[{"name":"Department of Radiology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan B.","family":"Racette","sequence":"additional","affiliation":[{"name":"College of Health Solutions Arizona State University  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald C.","family":"Petersen","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences Mayo Clinic  Rochester Minnesota USA"},{"name":"Department of Neurology Mayo Clinic  Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1187-7230","authenticated-orcid":false,"given":"Yonas E.","family":"Geda","sequence":"additional","affiliation":[{"name":"Department of Neurology Barrow Neurological Institute  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/alz.13016"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2105\/ajph.88.9.1337"},{"key":"e_1_2_10_4_1","volume-title":"Diabetes in America","author":"Cowie C. 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