Data derived from populations suggest that several comorbidities of diabetes including chronic kidney disease (CKD) increase the risk for cognitive impairment, structural brain changes associated with dementia as measured with magnetic resonance imaging (MRI), and dementia. The relationship between cerebrovascular disease and cognition, especially in diabetic kidney disease remains understudied and poorly understood in American Indians (AIs). More than 3.7 million AI/ANs, Blacks, Latinos, and Asians suffer from Alzheimer’s disease (AD), and experience earlier onset of cognitive impairment and AD than Whites experience. The few studies of AD in AI/ANs are limited by small, single-community samples. Dementia due to cerebrovascular disease is often referred to as “vascular dementia" or vascular cognitive impairment and dementia (VCID). Despite the high prevalence of VCID, the biological basis of this disease and its relationship with structural brain changes measured with MRI has been far less studied than Alzheimer’s disease. A striking feature of VCID is that risk to date has been difficult to predict based on medical diagnosis alone. The relationships between MRI measures (white matter hyperintensity volume, diffusion measures, such as fractional anisotropy and mean diffusivity, arterial cerebral blood flow, total brain volume, total white matter volume, total gray matter volume and hippocampal volume), neuropsychological testing, and neurological evaluation including balance testing will be evaluated to identify correlates of cerebrovascular disease and cognitive ability. Resting state functional MRI will be used to analyze the connectome in order to separate AD from VCID. We are prosing following aims for the supplement-funding request: Aim 1) Describe and analyze the co-prevalence of diabetic CKD and AD (cerebrovascular disease, cognitive impairment, and related dementia) among the AI population using the National IHS Epidemiology Data Mart. Hypothesis: The odds of AD will be higher among AI patients with diabetic CKD compared to AI patients without CKD adjusting for other covariates. Aim 2) Establish AI-specific normative values of MRI atrophy in brain regions selectively affected by AD and evaluate AD-related regional atrophy in combination with cognitive and behavioral changes to calculate prevalence of probable AD in Zuni Indians with diabetic CKD. Aim 3) Estimate associations of MRI markers of probable AD with measures of cognitive and physical function, independent of the effects of vascular brain injury in Zuni Indians with diabetic CKD.