Diabetes Plus Hypertension Worsen Brain Structure, Function

Key Takeaways

  • People with diabetes have overall worse brain and cognitive health based on brain imaging and results from various cognitive tests.

  • People with both diabetes and hypertension have worse overall brain and cognitive health compared with people who have just one of these disorders.

Why This Matters

  • The study’s findings suggest that prevention of both diabetes and hypertension may delay structural brain changes, cognitive decline, and dementia.

  • Clinicians need to put greater emphasis on trying to understand when detectable differences in brain structure occur as this may improve their ability to track progression of dementia in people with diabetes.

Study Design

  • Cross-sectional study of 38,918 participants in the UK Biobank enrolled in 2006-2010 and who subsequently underwent a brain MRI scan as part of their UK Biobank participation, including 2043 people with diabetes.

  • Participants also completed seven different measures of cognitive function. 

  • The analysis excluded people who reported any neurodegenerative or related diseases.

Key Results

  • People with diabetes had significantly worse brain appearance on MRI, after adjustment for possible confounders including cardiovascular disease.

  • Total brain volume and total grey matter volume in people with diabetes were each reduced by about 10%-20% compared to those without diabetes.

  • People with diabetes had significantly worse performance on five of the seven cognitive-function tests, after full adjustment.

  • In people with both diabetes and hypertension, total grey matter volume was significantly reduced compared to those with diabetes only. Their total brain volume was also reduced compared to those with diabetes only, but the difference just missed significance.

  • People with both diabetes and hypertension had worse performance on the reaction time and symbol digit substitution tests that were part of the cognitive-function tests.


  • The UK Biobank had a low recruitment response rate, which may have caused selection bias.

  • The UK Biobank relies on self-reported data for certain medical diagnoses, which could lead to misclassification.

  • The study relied on observational data, which precludes causal conclusions.


  • The study received no commercial funding.

  • None of the authors had commercial disclosures.

This is a summary of a preprint research study written by authors from the University of Oxford and University College London on MedRxiv provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on MedRxiv.org.

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