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It promotes aortic stiffness which predicts Alzheimer's disease and related dementias (ADRD) development.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We studied longitudinal relationship between ECW\/TBW ratio and neurocognitive decrements in type 2 diabetes (T2D) and mediating role of aortic stiffness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In a prospective Asian cohort, we measured ECW\/TBW ratio using bioimpedance analysis (BIA) and pulse wave velocity (PWV) using applanation method. The Repeatable Battery for Assessment of Neuropsychological Status (RBANS) was used to assess neurocognitive performance. Linear mixed model was applied to examine if ECW\/TBW was associated with neurocognitive performance<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study comprised 1412 patients at baseline. Over maximum of 9.4 years\u2019 follow-up, 823 patients had repeated neurocognitive assessment. We observed associations between higher ECW\/TBW ratio (continuous variable) and edema group with lower total RBANS score. The adjusted coefficients were \u22121.43 (95%CI \u22122.31, \u22120.56) and \u22125.88 (95%CI \u22129.00, \u22122.75) respectively. There were similar observations for delayed memory, visuospatial\/constructional and attention. Based on cross-lagged panel model, there was larger standardized effect size from baseline ECW\/TBW ratio to follow-up total RBANS score (\u03b2\u2009=\u20090.053, p\u2009=\u20090.026) compared to that from baseline total RBANS score to follow-up ECW\/TBW ratio (\u03b2\u2009=\u2009\u22120.020, p\u2009=\u20090.461). PWV mediated 13.3% of the relationship.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results demonstrated a relationship between volume overload and cognitive decrements, with potential mediation from aortic stiffness. There was temporal precedence of ECW\/TBW over neurocognitive performance. BIA-determined ECW\/TBW ratio is a promising biomarker of neurocognitive decrements in T2D.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/25424823261421570","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T13:30:27Z","timestamp":1774877427000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Insights into the role of extracellular-to-total body water ratio on neurocognitive decrements over time in Asians with type 2 diabetes"],"prefix":"10.1177","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1716-0871","authenticated-orcid":false,"given":"Serena","family":"Low","sequence":"first","affiliation":[{"name":"Khoo Teck Puat Hospital"},{"name":"Khoo Teck Puat Hospital"},{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 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