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Examining the causal mediating role of brain pathology on the relationship between diabetes and cognitive impairment: the Cardiovascular Health Study

Author

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  • Ryan M. Andrews
  • Ilya Shpitser
  • Oscar Lopez
  • William T. Longstreth
  • Paulo H. M. Chaves
  • Lewis Kuller
  • Michelle C. Carlson

Abstract

The paper examines whether diabetes mellitus leads to incident mild cognitive impairment and dementia through brain hypoperfusion and white matter disease. We performed inverse odds ratio weighted causal mediation analyses to decompose the effect of diabetes on cognitive impairment into direct and indirect effects, and we found that approximately a third of the total effect of diabetes is mediated through vascular‐related brain pathology. Our findings lend support for a common aetiological hypothesis regarding incident cognitive impairment, which is that diabetes increases the risk of clinical cognitive impairment in part by impacting the vasculature of the brain.

Suggested Citation

  • Ryan M. Andrews & Ilya Shpitser & Oscar Lopez & William T. Longstreth & Paulo H. M. Chaves & Lewis Kuller & Michelle C. Carlson, 2020. "Examining the causal mediating role of brain pathology on the relationship between diabetes and cognitive impairment: the Cardiovascular Health Study," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 183(4), pages 1705-1726, October.
    • Handle: RePEc:bla:jorssa:v:183:y:2020:i:4:p:1705-1726
    DOI: 10.1111/rssa.12570
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    References listed on IDEAS

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