***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To examine the relationship of diabetes mellitus to depression , cognition , and structural brain anatomical variables in a 60 - 64-year-old community-dwelling sample . The authors hypothesized that subjects with Type 2 diabetes are more likely to be depressed , have more brain atrophy , and poorer cognitive function compared with nondiabetic comparison subjects . METHODS A r and om sample of 478 subjects aged 60 - 64 years from a larger community sample were interviewed and underwent physical examinations , assessment of depression , st and ard cognitive assessment s , brain magnetic resonance imaging ( MRI ) scans , and fasting blood tests .  Subjects were considered diabetic if they were on treatment for diabetes or recorded a fasting blood glucose level of greater than 10 mmol/L. The MRI scans were analyzed for brain atrophy , gray matter ( GM ) , white matter ( WM ) , cerebrospinal fluid ( CSF ) , hippocampal , and white matter hyperintensity ( WMH ) volumes . RESULTS MRI data were available for 39 subjects with diabetes and 428 subjects without diabetes . Descriptive analyses showed that subjects with diabetes were more likely to have poor physical health , a higher body mass index , and higher scores of depression and anxiety compared with comparison subjects without diabetes . In multiple regression analyses , diabetes was associated with greater total brain atrophy and larger CSF volume , but did not differ in the WM , GM , and WMH volumes .  Diabetes patients performed less well on a task of fine motor dexterity . CONCLUSIONS Diabetes is related to increased brain atrophy and poor motor function in 60 - 64 year olds , independent of depression , vascular risk factors , and small vessel disease of the brain AIM To assess whether an intensive multifactorial treatment can reduce cognitive decrements and cognitive decline in screen-detected type 2 diabetes . METHODS The multinational ADDITION- study , a cluster-r and omized parallel group trial in patients with screen-detected type 2 diabetes , compared the effectiveness of intensive multifactorial treatment ( IT ; lifestyle advice and strict regulation of metabolic parameters ) with routine care ( RC ) on cardiovascular outcome . In The Netherl and s r and omization was stratified according to practice organization . Allocation was concealed from patients . The present study assessed the effect of IT on cognition through two  neuropsychological assessment s ( NPA ) on two occasions . The assessment s took place three and six years after the start of the intervention . Non-diabetic controls served as reference group . The first NPA was performed in 183 patients ( IT : 97 ; RC : 86 ) and 69 controls . The second NPA was performed in 135 patients ( IT : 71 ; RC : 64 ) and 55 controls . Primary outcome was a composite score , including the domains memory , information-processing speed and attention and executive function . Comparisons between the treatment groups were performed with multi-level analyses . RESULTS The first NPA showed no differences between the treatment groups ( mean difference composite z-score : 0.00 ; 95%-CI -0.16 to 0.16 ; IT vs RC ) . Over the next three years cognitive decline in the diabetic groups was within the range of the reference group and did not differ between the treatment arms ( difference decline between diabetic groups -0.12 ; -0.24 to 0.01 ; IT vs RC ) . CONCLUSIONS Six years of IT in screen-detected type 2 diabetes had no benefit on cognitive functioning over RC BACKGROUND Few prospect i ve studies have assessed diabetes mellitus as a risk factor for incident  Alzheimer disease ( AD ) and decline in cognitive function . OBJECTIVE To evaluate the association of diabetes mellitus with risk of AD and change in different cognitive systems . DESIGN Longitudinal cohort study . PARTICIPANTS For up to 9 years , 824 older ( those > 55 years ) Catholic nuns , priests , and brothers underwent detailed annual clinical evaluations .  MAIN OUTCOME MEASURES Clinical ly diagnosed AD and change in global and specific measures of cognitive function . RESULTS Diabetes mellitus was present in 127 ( 15.4 % ) of the participants . During a mean of 5.5 years of observation , 151 persons developed AD . In a proportional hazards model adjusted for age , sex , and educational level , those with diabetes mellitus had a 65 % increase in the risk of developing AD compared with those without diabetes mellitus ( hazard ratio , 1.65 ; 95 % confidence interval , 1.10 - 2.47 ) . In r and om effects models , diabetes mellitus was associated with lower levels of global cognition , episodic memory , semantic memory , working memory , and visuospatial ability at baseline . Diabetes mellitus was associated with a 44 % greater rate of decline in perceptual speed ( P = .02 ) , but not in other cognitive systems . CONCLUSIONS Diabetes mellitus may be associated with an increased risk of developing AD and may affect cognitive systems differentially BACKGROUND The long-term effect of type 2 diabetes on cognitive function is uncertain . OBJECTIVE To determine whether older women with diabetes have an increased risk of cognitive impairment and cognitive decline . DESIGN Prospect i ve cohort study . SETTING Four research centers in the United States ( Baltimore , Md ; Portl and , Ore ; Minneapolis , Minn ; and the Monongahela Valley , Pennsylvania ) . PARTICIPANTS Community-dwelling white women 65 years and older ( n = 9679 ) . MEASUREMENTS Physician-diagnosed diabetes and other aspects of health history were assessed by interview . Three tests of cognitive function , the Digit Symbol test , the Trails B test , and a modified version of the Mini-Mental State Examination ( m-MMSE )  , were administered at baseline and 3 to 6 years later . Change in cognitive function was defined by the change in the score for each test . Major cognitive decline was defined as the worst 10th percentile change in the score for each test . RESULTS Women with diabetes ( n = 682 [ 7.0 % ] ) had lower baseline scores than those without diabetes on all 3 tests of cognitive function ( Digit Symbol and Trials B tests , P<.01 ; m-MMSE , P = .03 ) and experienced an accelerated cognitive decline as measured by the Digit Symbol test ( P<.01 ) and m-MMSE ( P = .03 ) . Diabetes was also associated with increased odds of major cognitive decline as determined by scores on the Digit Symbol ( odds ratio = 1.63 ; 95 % confidence interval , 1.20 - 2.23 ) and Trails B ( odds ratio , 1.74 ; 95 % confidence interval , 1.27 - 2.39 ) tests when controlled for age , education , depression , stroke , visual impairment , heart disease , hypertension , physical activity , estrogen use , and smoking . Women who had diabetes for more than 15 years had a 57 % to 114 % greater risk of major cognitive decline than women without diabetes . CONCLUSION Diabetes is associated with lower levels of cognitive function and greater cognitive decline among older women Objective : To determine the influence of type 2 diabetes mellitus on the risk of dementia and AD . Background : Both dementia and diabetes are frequent disorders in elderly people . Methods : Prospect i ve population -based cohort study among 6,370 elderly subjects . At baseline study participants were examined for presence of diabetes mellitus . Nondemented participants were followed up , on average , for 2.1 years . Incident dementia was diagnosed using a three-step screening and comprehensive diagnostic workup . To complete the follow-up , medical files were studied of persons who could not be reexamined . We estimated relative risks with proportional hazard regression , adjusting for age , sex , and possible confounders . Results : During the follow-up , 126 patients became demented , of whom 89 had AD . Diabetes mellitus almost doubled the risk of dementia ( relative risk [ RR ] 1.9 [ 1.3 to 2.8 ] ) and AD ( RR 1.9 [ 1.2 to 3.1 ] ) . Patients treated with insulin were at highest risk of dementia ( RR 4.3 [ 1.7 to 10.5 ] ) . Conclusion : The diabetes attributable risk for dementia of 8.8 % suggests that diabetes may have contributed to the clinical syndrome in a substantial proportion of all dementia patients OBJECTIVES To relate diabetes mellitus ( DM ) status and duration to late-life cognitive impairment and decline in men and women . DESIGN Prospect i ve cohort . SETTING Community . PARTICIPANTS Five thous and nine hundred seven men in the Physicians ' Health Study II and 6,326 women in the Women 's Health Study ( mean age 74.1 and 71.9 , respectively , at baseline cognitive assessment ) ; 553 men and 405 women had DM . MEASUREMENTS Primary outcomes were general cognition ( the Telephone Interview for Cognitive Status ( TICS ) and a global score averaging five tests ) and verbal memory . All participants had second assessment s approximately 2 years later ; women had third assessment s an average of 4 years later . RESULTS In adjusted linear regression models , participants with DM had significantly lower baseline scores for all outcomes , and longer duration of DM was associated with lower scores ( P-trends < .001 ) . Men with DM had significantly greater 2-year cognitive decline than men without DM , and longer duration of DM was associated with worse decline ( P-trends < or = .01 ) . In repeated- measures analyses of response profiles , women with DM had significantly greater 4-year cognitive decline in all outcomes than women without DM . In women , as in men , there was generally greater cognitive decline with longer duration of DM ( e.g. , the adjusted mean difference in decline on the TICS associated with duration of > or = 5 years was -0.74 ( 95 % confidence interval = -1.05 to -0.43 ) points ( P-trend < .001 ) . There were no significant sex-DM interactions . CONCLUSION Type 2 DM and longer duration of DM are similarly related to cognitive impairment and decline in men and women 
    Output:
    
We found no difference in the sub-domains of verbal short-term memory and working memory .
The meta- analysis revealed a detrimental effect of T2DM on cognitive sub-domains , namely , episodic memory and cognitive flexibility .
There was a trend for the logical memory , phonemic fluency and processing speed to be affected .
The analysis indicates that T2DM is a detrimental factor on certain cognitive sub-domains , rendering the person vulnerable to subsequent dementia .