Association between patterns of multiple chronic conditions and cognitive impairment in community‐dwelling older adults in Taiwan

Abstract

AbstractBackgroundPrevious studies mainly explored the effect of single chronic disease on cognition. However, limited focuses have been put on the co‐existence of diseases, symptoms, and functional impairments and how their combinations affect older adults. This study aimed to identify sex‐specific patterns of multiple chronic conditions (MCC) and to relate them with cognitive impairment in a six‐year cohort study.MethodWe included 516 non‐demented older adults at baseline (2011‐2013) from the ongoing Taiwan Initiative for Geriatric Epidemiological Research, with three biennially follow‐ups. The global and domain‐specific (memory, attention, executive function, and language) cognition were assessed using the Taiwanese version of Montreal Cognitive Assessment and a battery of neuropsychological tests. Exploratory factor analysis was utilized to identify patterns of 33 self‐reported chronic conditions. For each pattern, the factor score of each participant was calculated by summing up the product of the status of a specific condition and its corresponding factor loadings. The generalized linear mixed model was utilized to examine the association between MCC patterns and cognitive performance adjusted for age, years of education, apolipoprotein E ε4 status, cigarette smoking, alcohol consumption, and years of follow‐up.ResultThree MCC patterns were identified for each sex, which included (1) Mental‐Exhaustion, (2) Cancer‐Thyroid, and (3) Frailty‐Cardiometabolic patterns in females; and (1) Mental‐Skeletal, (2) Cardiometabolic‐Renal, and (3) Thyroid‐Prostate patterns in males. Among females, higher factor scores of the Mental‐Exhaustion and Frailty‐Cardiometabolic patterns were significantly associated with poor performance of global cognition (β: ‐0.16), logical memory (β:‐0.11 to ‐0.07) and executive function (β:‐0.32). Among males, higher factor scores of the Mental‐Skeletal and Thyroid‐Prostate patterns were significantly associated with poor performance of memory (β:‐0.11) and attention (β:‐0.13). In contrast, a protective effect was observed between Cancer‐Thyroid pattern and memory (β:0.12 to 0.13) or attention (β:0.16), as well as between Cardiometabolic‐Renal pattern and verbal fluency (β:0.15).ConclusionMCC patterns identified in this Asian population were different from those observed in western countries, and these patterns were associated with poor global or domain‐specific cognition. Further research was required to validate our findings and to clarify the underlying mechanism between MCC and cognitive impairment.