Association Between Knee Extension Strength and Cognitive Function in Older Adults With Type 2 Diabetes: a cross sectional study. Running Title

Background: Cognitive impairment is a frequent and clinically important complication in older adults with type 2 diabetes. Reduced muscle strength is common in this population and may be associated with cognitive function; however, evidence from routine clinical settings remains limited. Methods: This cross-sectional study included 42 older adults with type 2 diabetes. Knee extension strength normalized to body weight was assessed using a handheld dynamometer. Cognitive function was evaluated using a standardized cognitive assessment. Multivariable linear regression analyses were performed to examine the association between knee extension strength and cognitive function after adjusting for relevant demographic and clinical confounders. Results: Knee extension strength was significantly associated with cognitive function. In multivariable regression analysis, knee extension strength remained independently associated with cognitive performance after adjustment for potential confounders. The inclusion of knee extension strength substantially improved the explanatory power of the regression model. Conclusions: Lower knee extension strength was independently associated with poorer cognitive function in older adults with type 2 diabetes. Assessment of lower extremity muscle strength may provide clinically relevant information when evaluating cognitive health in this population.