Role of endothelium-independent vasodilation in the relationship between visceral adiposity and reduced cognitive performance in older adults with type 2 diabetes.

Objective In this cross-sectional analysis, we sought to assess the relationship of adiposity and forearm microvascular reactivity with cognitive dysfunction among older Asians with type 2 diabetes (T2D). Methods Subjects with T2D aged >= 55 years were analyzed (N = 907). Cognitive performance was assessed using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Mini-Mental State Exam (MMSE). Visceral fat area (VFA) was estimated by tetrapolar multi-frequency bioimpedance. Forearm microvascular endothelium-dependent vasodilation (EDV) and endothelium-independent vasodilation (EIV) were assessed by laser Doppler imaging with iontophoresis. Results RBANS total score was correlated with VFA, EDV, and EIV (all P < .05). However, VFA was correlated with EIV, but not with EDV. Multivariable linear regression showed significant association between VFA and RBANS total score (B = -0.02, 95% CI= -0.03 to -0.01) or memory (immediate and delayed) index scores. These associations were attenuated after adjustment for EIV. Mediation analysis showed that EIV partially mediated the relationship between visceral adiposity and RBANS scores (all Sobel tests P < .05). EIV also mediated the relationship between VFA and MMSE score. Conclusions Impaired endothelium-independent vascular smooth muscle reactivity may exert a mediatory effect on the association between increased visceral adiposity and decreased cognitive performance in older adults with T2D.