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BACKGROUND: Alzheimer's disease (AD), type 2 diabetes mellitus (characterised by insulin resistance) and depression are significant challenges facing public health. Research has demonstrated common comorbidities among these three conditions, typically focusing on two of them at a time. OBJECTIVE: The goal of this study, however, was to assess the inter-relationships between the three conditions, focusing on mid-life (defined as age 40-59) risk before the emergence of dementia caused by AD. METHODS: In the current study, we used cross-sectional data from 665 participants from the cohort study, PREVENT. FINDINGS: Using structural equation modelling, we showed that (1) insulin resistance predicts executive dysfunction in older but not younger adults in mid-life, that (2) insulin resistance predicts self-reported depression in both older and younger middle-aged adults and that (3) depression predicts deficits in visuospatial memory in older but not younger adults in mid-life. CONCLUSIONS: Together, we demonstrate the inter-relations between three common non-communicable diseases in middle-aged adults. CLINICAL IMPLICATIONS: We emphasise the need for combined interventions and the use of resources to help adults in mid-life to modify risk factors for cognitive impairment, such as depression and diabetes.

Original publication




Journal article


BMJ Ment Health

Publication Date





delirium & cognitive disorders, depression & mood disorders, psychiatry, Middle Aged, Humans, Adult, Aged, Diabetes Mellitus, Type 2, Insulin Resistance, Depression, Cohort Studies, Cross-Sectional Studies, Cognition, Alzheimer Disease