Understanding the pathways through which diabetes accelerates cognitive decline is essential for prevention. First, impaired glucose metabolism and insulin resistance starve neurons of adequate energy, compromising their capacity for normal function and plasticity. Second, chronic hyperglycaemia triggers sustained neuroinflammation and damages the cerebrovascular system, disrupting the blood-brain barrier and reducing cerebral perfusion—consequences that elevate vascular dementia risk and may accelerate Alzheimer pathology. Third, metabolic dysfunction promotes amyloid-β accumulation, a hallmark of Alzheimer disease. These interconnected mechanisms suggest that aggressive glycaemic management during midlife represents a critical window for neuroprotection. Clinicians should counsel patients that tight glucose control and emerging neuroprotective medications offer evidence-based strategies to preserve cognitive health into late life.
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