Understanding the inter-relationships of type 2 diabetes and hypertension with brain and cognitive health: A UK Biobank study

Aim: To understand the impact of diabetes and co-morbid hypertension on cognitive and brain health. Materials and Methods: We used data from the UK Biobank cohort consisting of similar to 500 000 individuals aged 40 to 69 years. Our outcomes included brain structural magnetic resonance imaging variables and cognitive function tests in a maximum of 38 918 individuals. We firstly tested associations with all outcomes between those with diabetes (n = 2043) and without (n = 36 875) and, secondly, compared those with co-morbid diabetes/hypertension (n = 1283) with those with only diabetes (n = 760), hypertension (n = 9649) and neither disease (n = 27 226). Our analytical approach comprised linear regression models, with adjustment for a range of demographic and health factors. Standardized betas are reported. Results: Those with diabetes had worse brain and cognitive health for the majority of neuroimaging and cognitive measures, with the exception of g fractional anisotropy (white matter integrity), amygdala, pairs matching and tower rearranging. Compared with individuals with co-morbid diabetes and hypertension, those with only hypertension had better brain health overall, with the largest difference observed in the pallidum (beta = .189, 95% CI = 0.241; 0.137), while those with only diabetes differed in total grey volume (beta = .150, 95% CI = 0.122; 0.179). Individuals with only diabetes had better verbal and numeric reasoning (beta = .129, 95% CI = 0.077; 0.261), whereas those with only hypertension performed better on the symbol-digit substitution task (beta = .117, 95% CI = 0.048; 0.186). Conclusions: Individuals with co-morbid diabetes and hypertension have worse brain and cognitive health compared with those with only one of these diseases. These findings potentially suggest that prevention of both diabetes and hypertension may delay changes in brain structure, as well as cognitive decline and dementia diagnosis.