Abstract
Changes in estradiol during aging are associated with increased dementia risk. It remains unclear how estradiol supports cognitive health and whether risk factors, such as midlife obesity, are exacerbated by estrogen loss. To assess whether visceral adipose tissue (VAT) moderates the association between age and brain network structure and to investigate whether estradiol moderates the association between VAT and brain network structure. Cross-sectional study of data from 974 cognitively healthy adults in Germany who participated in the Health Study of the Leipzig Research Centre for Civilization Diseases, a previously described population-based cohort study. Two moderation analyses were performed, including VAT as the moderator variable between age and brain network structure and estradiol as the moderator variable between VAT and brain network structure. The study was conducted from August 1, 2011, to November 23, 2014. Analyses were conducted from August 2017 to September 2018. Serum estradiol levels from fasting blood and visceral adipose tissue volume from T1-weighted magnetic resonance imaging (MRI). Brain network covariance (individual loading on structural network derived from T1-weighted MRI) and memory performance (composite score from the Consortium to Establish a Registry for Alzheimer Disease [CERAD] verbal episodic memory test on learning [score range, 0-30], recall [score range, 0-10], and recognition [score range, 0-20]). Final analyses included data from 473 women (mean [SD] age, 50.10 [15.63] years) and 501 men (mean [SD] age, 51.24 [15.67] years). Visceral adipose tissue was associated with an exacerbation of the negative association of aging with network covariance for women (interaction term β = -0.02; 95% bias-corrected bootstrap CI, -0.03 to -0.01; P = .001) and men (interaction term β = -0.02; 95% bias-corrected bootstrap CI, -0.03 to -0.01; P < .001). Estradiol level was associated with a reduction in the negative association of VAT with network covariance in women (interaction term β = 0.63; 95% bias-corrected bootstrap CI, 0.14-1.12; P = .01), with no significant association in men. In the female midlife subgroup (age range, 35-55 years, when menopause transition occurs), low estradiol levels were associated with lower memory network covariance (Cohen d = 0.61; t80 = 2.76; P = .007) and worse memory performance (Cohen d = 0.63; t76 = 2.76; P = .007). This study reports a novel association between VAT, estradiol, and structural brain networks as a potential mechanism underlying cognitive decline in women. These findings appear to highlight the need for sex-specific strategies, including VAT and hormonal screening during midlife, to support healthy cognitive aging.
Highlights
Neuroimaging evidence suggests an association between age-related brain atrophy, cognitive decline, and obesity.[1]
Visceral adipose tissue was associated with an exacerbation of the negative association of aging with network covariance for women and men
Estradiol level was associated with a reduction in the negative association of Visceral adipose tissue (VAT) with network covariance in women, with no significant association in men
Summary
Neuroimaging evidence suggests an association between age-related brain atrophy, cognitive decline, and obesity.[1] Emerging data linking obesity to increased cognitive impairment in old age are concerning given that approximately 39% of the world’s adult population are overweight and 13% are obese.[2] Visceral adipose tissue (VAT) is a known risk factor for vascular and metabolic diseases,[3,4,5] but the results of some studies[6,7] suggest that elevated VAT may impair cognitive function. Expanded VAT is further linked to brain atrophy, such as decreased hippocampal volume, cortical thickness, and total brain volume.[6,8] researchers are starting to view visceral obesity in midlife as a risk factor for dementia and depression in later life[9,10] independent of type 2 diabetes and cardiovascular comorbidities, with the findings of other studies[11,12] suggesting an even stronger association in women
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