Abstract
BackgroundEvidence on cognitive function in older South Africans is limited, with few population-based studies. We aimed to estimate baseline associations between cognitive function and cardiometabolic disease risk factors in rural South Africa.MethodsWe use baseline data from “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa” (HAALSI), a population-based study of adults aged 40 and above in rural South Africa in 2015. Cognitive function was measured using measures of time orientation, immediate and delayed recall, and numeracy adapted from the Health and Retirement Study cognitive battery (overall total cognitive score range 0–26). We used multiple linear regression to estimate associations between cardiometabolic risk factors (including BMI, hypertension, dyslipidemia, diabetes, history of stroke, alcohol frequency, and smoking status) and the overall cognitive function score, adjusted for potential confounders.ResultsIn multivariable-adjusted analyses (n = 3018; male = 1520; female = 1498; median age 59 (interquartile range 50–67)), cardiometabolic risk factors associated with lower cognitive function scores included: diabetes (b = − 1.11 [95% confidence interval: − 2.01, − 0.20] for controlled diabetes vs. no diabetes); underweight BMI (b = − 0.87 [CI: − 1.48, − 0.26] vs. normal BMI); and current and past smoking history compared to never smokers. Factors associated with higher cognitive function scores included: obese BMI (b = 0.74 [CI: 0.39, 1.10] vs. normal BMI); and controlled hypertension (b = 0.53 [CI: 0.11, 0.96] vs. normotensive).ConclusionsWe provide an important baseline from rural South Africa on the associations between cardiometabolic disease risk factors and cognitive function in an older, rural South African population using standardized clinical measurements and cut-offs and widely used cognitive assessments. Future studies are needed to clarify temporal associations as well as patterns between the onset and duration of cardiometabolic conditions and cognitive function. As the South African population ages, effective management of cardiometabolic risk factors may be key to lasting cognitive health.
Highlights
Evidence on cognitive function in older South Africans is limited, with few population-based studies
We aim to describe the baseline associations between cardiometabolic disease risk factors and cognitive function from a population-based study of older adults in rural South Africa
Health and Aging in Africa (HAALSI) is a population-based study nested in the Agincourt Health and socio-Demographic Surveillance System (AHDSS) in rural Mpumalanga province in north eastern South Africa, adjacent to Mozambique [44]
Summary
Evidence on cognitive function in older South Africans is limited, with few population-based studies. Increasing evidence shows links between cardiometabolic disease risk factors, such as hypertension and diabetes, and subsequent cognitive decline among older adults [8,9,10,11,12,13,14]. Diabetes and obesity have been associated with lower cognitive function through insulin resistance, inflammation, oxidative stress, and effects on vascular function [15,16,17]. Both NCD risk factors and cognitive disorders are major contributors to the global burden of disability [18]. There are limited studies in many LMICs, in sub-Saharan Africa, on cognition and its relationship with NCD risk factors [19, 20]
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