Brain and Cognition Signature Fingerprinting Vascular Health in Diabetic Individuals: An International Multi-Cohort Study

•What is the primary question addressed by this study?Is cognitive signature related to diabetic complications and mortality?•What is the main finding of this study?Cognitive signatures from magnetic resonance imaging and tests are significantly associated with increased risks of mortality and vascular complications in both middle- and older-aged people with diabetes.A faster decline in retinal microcirculation was found in diabetic patients with poorer cognitive function, reflecting the corresponding worse systemic circulation.•What is the meaning of the finding?Questionnaire or brain-imaging-based cognition serves as a potential indicator of mortality and systemic vascular complications in the diabetic population.