INS and hyperinsulinism: Participants were assessed with a fasting insulin and glucose along with three tests of cognitive function (DWR, DSS, and WF) at baseline and 6 years later. Hyperinsulinemia results from fasting insulin and HOMA-IR were associated with significantly lower baseline DWR, DSS, and WF scores and a greater decline over 6 years in DWR and WF.