{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:04:49Z","timestamp":1789452289925,"version":"build-2803163510"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes mellitus (T2DM) is a well-established risk factor for dementia, and COVID-19 has been associated with persistent neurological and cognitive sequelae. However, whether this association extends beyond the early post-infection period among older adults with T2DM\u2014a population with compounded vascular and metabolic vulnerability\u2014remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the TriNetX Global Collaborative Network, we conducted a retrospective cohort study of patients aged \u226565\u202fyears with T2DM, comparing those with documented COVID-19 to a matched unexposed cohort (1:1 propensity score matching). A 1-year landmark design was applied, with follow-up extending to 6\u202fyears after the index date. The primary outcome was incident overall dementia, which is a composite of vascular dementia, Alzheimer\u2019s disease, and unspecified\/other dementia. The secondary outcomes included individual dementia subtypes, mild cognitive impairment, all-cause mortality, and cerebral infarction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching, 449,745 patients were included in each group with well-balanced covariates (all standardized mean differences &amp;lt;0.1). Documented COVID-19 was associated with a significantly increased risk of overall dementia [hazard ratio (HR 1.51), 95% confidence interval (CI) 1.47\u20131.55,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001]. The secondary outcomes were similarly elevated, such as vascular dementia (HR 1.61), Alzheimer\u2019s disease (HR 1.41), mild cognitive impairment (HR 1.66), all-cause mortality (HR 1.56), and cerebral infarction (HR 1.33; all\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The hazard ratio for overall dementia increased progressively across sequential landmark periods (1.51 at 1\u202fyear, 1.66 at 2\u202fyears, and 2.09 at 3\u202fyears), and the findings remained robust across sensitivity analyses, addressing survival, healthcare utilization, and exposure misclassification. The findings were consistent in separately constructed and propensity score-matched additional cohorts restricted to adults aged 50\u201365\u202fyears and to patients indexed during the Omicron-predominant period.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this large propensity score-matched cohort study, documented COVID-19 was associated with an increased long-term risk of incident dementia among older adults with T2DM, with the association persisting and strengthening beyond the early post-infection period. These findings support sustained attention to cognitive health in this metabolically susceptible population following COVID-19; however prospective studies incorporating standardized cognitive and biomarker assessments are needed to clarify underlying causes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnagi.2026.1927383","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:35:30Z","timestamp":1789450530000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term risk of incident dementia following documented COVID-19 among older adults with type 2 diabetes: a propensity score-matched cohort study"],"prefix":"10.3389","volume":"18","author":[{"given":"I-Wen","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Hospital, Liouying","place":["Tainan City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Chen","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, E-Da Hospital, I-Shou University","place":["Kaohsiung City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun-Ning","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan City, Taiwan"]},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University","place":["Kaohsiung City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuo-Chuan","family":"Hung","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Chi Mei Medical Center","place":["Tainan City, Taiwan"]},{"name":"School of Medicine, College of Medicine, National Sun Yat-sen University","place":["Kaohsiung City, Taiwan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"77","DOI":"10.31083\/j.jin2103077","article-title":"Neurological sequelae of COVID-19","volume":"21","author":"Ahmad","year":"2022","journal-title":"J. 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