QuoteStratified analyses indicated that the heightened risk of cognitive decline associated with high artificial sweetener consumption was particularly pronounced in adults younger than 60 years. In contrast, older adults did not demonstrate significant associations between sweetener tertiles and cognitive trajectories. Furthermore, diabetes status served as an important effect modifier. Among individuals with diabetes, high intake of total sweeteners, as well as individual agents such as aspartame, acesulfame k, and saccharin, was strongly associated with accelerated memory and global cognitive impairment.