Abstract
A third of dementia cases could be attributable to modifiable risk-factors. Midlife high-density lipoprotein cholesterol (HDL-C) is a measure which could help identify individuals at reduced risk of developing age-related cognitive decline. The Japan Public Health Centre-based prospective (JPHC) Study is a large population-based cohort which started in 1990. This study included 1299 participants from Saku area in Nagano prefecture. Participants had HDL-C measured in 1995–1996, and underwent a mental health screening in 2014–2015. Of these, 1114 participants were included in MCI analyses, and 781 participants were included in dementia analyses. Logistic regression models were used to determine odds ratios (OR) and 95% confidence intervals (CI) for the association between HDL-C quartiles and MCI and dementia, respectively. For dementia analysis, quartiles 2–4 were collapsed due to low number of cases. Missing data was addressed through multiple imputations. There were 386 cases of MCI and 53 cases of dementia. Compared to the lowest HDL-C quartile, the highest HDL-C quartile was significantly inversely associated with MCI (OR = 0.47, 95% CI, 0.28–0.79) in the multivariable analysis. High HDL-C (quartiles 2–4) was inversely associated with dementia compared to low HDL-C (quartile 1) (OR = 0.37, 95% CI, 0.16–0.88). This study has found that high midlife HDL-C levels are inversely associated with both late-life MCI and dementia in a Japanese population.
Highlights
It is estimated that one third of dementia disease cases could be attributable to modifiable risk factors.[1]
High levels of high-density lipoprotein cholesterol (HDL-C) are inversely associated with both MCI5 and dementia,[4,6] albeit with some discrepant findings reporting no association between HDL-C and either cognitive function,[7,8,9,10] mild cognitive impairment (MCI),[11,12] or dementia.[13,14,15,16,17,18]
Mild cognitive impairment Compared to individuals included in complete case analysis, those with missing data for at least one of the variables included in the final models for MCI analyses were younger, more likely to be men, have higher education, more likely to be smokers, have higher mean TG levels and lower mean HDL-C levels
Summary
It is estimated that one third of dementia disease cases could be attributable to modifiable risk factors.[1] A key to intervention and prevention is the early identification of measures associated with both dementia and mild cognitive impairment (MCI), a “state intermediate between normal cognition and dementia”.2. One such measure is serum high-density lipoprotein cholesterol (HDL-C), a potentially stronger predictor of age-related cognitive decline[3] and Alzheimer’s disease (AD) in the elderly[4] than other lipid measures.
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