Diabetes is one of the major risk factors for dementia. However, the molecular mechanism underlying the risk of diabetes for dementia is largely unknown. Recent studies revealed that epigenetic modifications may play a role in the pathogenesis of diabetes. We hypothesized that diabetes may cause epigenetic changes in the brain that may adversely affect synaptic function. We found significant elevation in the expression of histone deacetylases (HDACs) class IIa in the brains of diabetic subjects compared with control subjects, and these changes coincide with altered expression of synaptic proteins. In a mouse model of diet-induced type 2 diabetes (T2D), we found that, similar to humans, T2D mice also showed increased expression of HDAC IIa in the brain, and these alterations were associated with increased susceptibility to oligomeric Ab-induced synaptic impairments in the hippocampal formation and eventually led to synaptic dysfunction. Pharmacological inhibition of HDAC IIa restored synaptic plasticity. Our study demonstrates that diabetes may induce epigenetic modifications affecting neuropathological mechanisms in the brain leading to increased susceptibility to insults associated with neurodegenerative or vascular impairments. Our study provides, for the first time, an epigenetic explanation for the increased risk of diabetic patients developing dementia. Diabetes 2014;63:645-654 | DOI: 10.233763:645-654 | DOI: 10. /db13-1063 The prevalence of dementia increases with age. It is estimated that .36 million people worldwide are currently living with this devastating disease, and the prevalence is expected to increase to 66 million by 2030 and 115 million by 2050 (1). Dementia can be caused by a number of progressive diseases such as Alzheimer disease (AD) and vascular dementia. Mounting evidence suggests that cognitive impairments associated with dementia may be traced back to neuropathological conditions initiated several decades before clinical onset. Therefore, clinical development of novel interventions for dementia is now based on mechanisms associated with primary or secondary prevention.Diabetes increases the risk of both AD dementia and vascular dementia (2-9). Based on the National Diabetes Health Fact Sheet,~8.3% of Americans have diabetes and, as with dementia, the prevalence of diabetes increases with age; currently, 26.9% of people $65 years old have diabetes (10). Despite national and international campaign efforts to counter type 2 diabetes (T2D), its prevalence is still rising. T2D and hyperglycemia are associated with cognitive dysfunction and an increased risk for dementia, including AD-type dementia. Three longitudinal studies conducted by Yaffe et al. (11), Komulainen et al. (12), and Dik et al. (13) independently showed that T2D is related to a higher risk of cognitive decline. A meta-analysis performed by Profenno, Porsteinsson, and Faraone (14) reviewed thirteen longitudinal epidemiological studies that examined the association between diabetes and dementia and found Emerging evidence h...