Objective To investigate the association of cognitive impairment with language and visuospatial abnormalities in young and middle-aged patients with diabetes mellitus type 2 （T2DM）.Methods A total of 124 young and middle-aged patients with T2DM who attended Cangzhou People's Hospital from October 2020 to October 2021 were enrolled as subjects， and according to the presence or absence of cognitive impairment， they were divided into observation group and control group （n=62 each）. The 62 patients with diabetes and cognitive impairment were enrolled as the observation group， with a Montreal Cognitive Assessment （MoCA） score of <26 points， and the 62 patients with diabetes alone were enrolled as the control group， with an MoCA score of ≥26 points. The two groups were compared in terms of executive function ［verbal fluency test， Stroop color word test （CWT）， and trail making test （TMT）］， visuospatial ability， and language ability （reading ability， writing ability， listening comprehension ability， and retelling ability）. The Pearson correlation coefficient was used to analyze the correlation of MoCA score with fasting plasma glucose （FPG） and 2-hour postprandial blood glucose （2hPBG）； the hierarchical regression model was used to analyze the association of executive function and language ability with cognitive function， and the logistic regression model was used to analyze the association between visuospatial ability and cognitive function.Results Compared with the control group， the observation group had significantly lower right numbers of verbal fluency test and CWT and significantly longer CWT time， TMT-A time， and TMT-B time （P<0.05）. The observation group had significantly lower scores of visuospatial ability and language ability than the control group （P <0.05）. The Pearson correlation analysis showed that MoCA score was correlated with FPG and 2hPBG （r=-0.366 and -0.338 respectively， both P<0.001）. The hierarchical regression analysis showed that verbal fluency test， CWT right number， reading ability， and writing ability had a significant positive impact on MoCA score （P<0.001）， while TMT-A time and TMT-B time had a significant negative impact on MoCA score （P<0.001）. The logistic regression analysis showed that visuospatial ability score was an independent risk factor for cognitive function in patients with T2DM （P<0.05）.Conclusions Dynamic observation of language ability and visuospatial ability can provide a basis for identifying cognitive impairment in young and middle-aged patients with T2DM. ［Journal of International Neurology and Neurosurgery, 2023, 50(3): 41-46］