Kanaya et al examined the 4-year change in cognitive performance among older adults according to glucose tolerance status (normal [NGT, n = 632], impaired [IGT, n = 249], or diabetic [DM, n = 118]). Three cognitive tests were measured 4 years apart in 999 white men and women aged 42 to 89 years, enrolled in the Rancho Bernardo Study. Participants were classified with sex-specific linear regression models adjusted for age, education, depression score, apolipoprotein E ϵ4 allele, and current estrogen use. At baseline, mean cognitive function scores did not differ between glucose tolerance groups. Women with diabetes had a 4-fold increased risk of a major cognitive decline on the test of Verbal Fluency after 4 years compared with nondiabetic women (Figure 1). Glycohemoglobin attenuated this effect, but lipids, blood pressure, and microvascular or macrovascular disease did not. Performance on the Mini-Mental State Examination and Trail-Making Test B did not differ by baseline glucose status.