CARDIOMETABOLIC DISORDERS ACCELERATE COGNITIVE DECLINE AND TOTAL BRAIN VOLUME LOSS: A POPULATION-BASED LONGITUDINAL STUDY

Abstract

Cardiometabolic disorders (CMDs), including hypertension, heart disease, and prediabetes/diabetes have been individually associated with cognitive deficits, but their additive effect on cognitive decline remains unclear. We quantified the magnitude of their association with cognitive decline and structural brain changes and assessed the extent to which the links were additive. From the population-based Swedish National study on Aging and Care–Kungsholmen, 2987 dementia-free participants aged ≥60 years were identified at baseline, and followed for 6 years. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) at baseline and follow-ups. CMDs were ascertained based on clinical examination, inpatient registry, and information on medication use. A subsample (n=460) underwent magnetic resonance imaging (MRI) at baseline and follow-ups. Data were analysed using mixed-effects models with adjustment for potential confounders. Of all participants, 1257 (42.1%) had one, 978 had two (32.7%), and 294 (9.8%) had three CMDs at baseline. CMDs were related to faster MMSE decline compared to no CMDs, and the multi-adjusted β coefficients (95% CIs) were -0.076 (-0.153 to 0.000, p=0.05) for one, -0.188 (-0.289 to -0.088, p<0.01) for two, and -0.509 (-0.718 to -0.301, p<0.01) for three CMDs. MRI data showed that one (β= -1.369, 95% CI: -0.275 to 0.128, p=0.052), two (β= -1.936, 95% CI: -3.571 to -0.300, p<0.05) and three (β= -4.835, 95% CI: -8.747 to -0.922, p=0.01) CMDs were associated with changes of total brain volume. There was evidence of an additive dose-dependent effects of CMDs on MMSE decline (β= -0.094 per disorder, p<0.01) and total brain volume loss (β= -1.096 per disorder, p<0.01). CMDs accelerate cognitive decline and total brain volume loss, and an increasing number of the conditions appears additive in this regard.