Higher Odds Of Cognitive Impairment Research Articles

Facial aging, cognitive impairment, and dementia risk

BackgroundFacial aging, cognitive impairment, and dementia are all age-related conditions. However, the temporal relation between facial age and future risk of dementia was not systematically examined.ObjectivesTo investigate the relationship between facial age (both subjective/perceived and objective) and cognitive impairment and/or dementia risk.MethodsThe study included 195,329 participants (age ≥ 60 y) from the UK Biobank (UKB) with self-perceived facial age and 612 participants from the Nutrition and Health of Aging Population in China Project (NHAPC) study (age ≥ 56 y) with objective assessment of facial age. Cox proportional hazards model was used to prospectively examine the hazard ratios (HRs) and their 95% confidence intervals (CIs) of self-perceived facial age and dementia risk in the UKB, adjusting for age, sex, education, APOE ε4 allele, and other potential confounders. Linear and logistic regressions were performed to examine the cross-sectional association between facial age (perceived and objective) and cognitive impairment in the UKB and NHAPC, with potential confounders adjusted.ResultsDuring a median follow-up of 12.3 years, 5659 dementia cases were identified in the UKB. The fully-adjusted HRs comparing high vs. low perceived facial age were 1.61 (95% CI, 1.33 ~ 1.96) for dementia (P-trend ≤ 0.001). Subjective facial age and cognitive impairment was also observed in the UKB. In the NHAPC, facial age, as assessed by three objective wrinkle parameters, was associated with higher odds of cognitive impairment (P-trend < 0.05). Specifically, the fully-adjusted OR for cognitive impairment comparing the highest versus the lowest quartiles of crow’s feet wrinkles number was 2.48 (95% CI, 1.06 ~ 5.78).ConclusionsHigh facial age was associated with cognitive impairment, dementia and its subtypes after adjusting for conventional risk factors for dementia. Facial aging may be an indicator of cognitive decline and dementia risk in older adults, which can aid in the early diagnosis and management of age-related conditions.

Interplay of education and DNA methylation age on cognitive impairment: insights from the Health and Retirement Study.

Few studies have assessed the association of educational attainment on dementia and cognitive impairment through DNA methylation age acceleration, while accommodating exposure-mediator interaction effects. We evaluated the mediation role of six epigenetic clocks with dementia, cognitive impairment non-dementia, and normal cognition, while accommodating exposure-mediator interaction effects. To understand the joint association of low education (≤12 years) and DNA methylation age acceleration (yes/no) in relation to cognitive impairment, we used weighted logistic regression, adjusting for chronological age, sex, race/ethnicity, and cell type composition. We performed four-way mediation and interaction decomposition analysis. Analyses were conducted on 2016 venous blood study participants from the Health and Retirement Study (N=3724). Both GrimAge acceleration (OR=1.6 95%CI 1.3-2.1) and low educational attainment (OR=2.4 95%CI 1.9-3.0) were associated with higher odds of cognitive impairment in a mutually adjusted logistic model. We found additive interaction associations between low education and GrimAge acceleration on dementia. We observed that 6-8% of the association of education on dementia was mediated through GrimAge acceleration. While mediation effects were small, the portion of the association of education on dementia due to additive interaction with GrimAge acceleration was between 23.6 and 29.2%. These results support the interplay of social disadvantage and biological aging processes on impaired cognition.

Associations between sleep duration, depression status, and cognitive function among Chinese elderly: A community-based study

BackgroundThe associations of sleep duration and depressive status on cognitive function among the elderly remain controversial. This study aimed to investigate the associative effects and mediating mechanisms between sleep duration and depressive status on cognitive function in elderly adults. MethodsParticipants were recruited from cross-sectional and cohort surveys of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). We identified thresholds for sleep duration and depression and used logistic regression to explore their independent and joint effects on cognitive impairment. Further, we analyze the mediating effects of depressive status on the association between sleep duration and cognitive function. ResultsOf 13840 elderly (median age: 84 years, female: 54.6 %), 2835 (20.5 %) had cognitive impairment. Compared with those who slept 6–8 h, the ORs (95%CIs) for those who slept < 6 h and > 8 h were 0.98 (0.85, 1.12) and 1.48 (1.32, 1.66). Compared with non-depressed, the OR (95%CI) for the depressed participants was 1.74 (1.53, 1.98). Compared with those with sleep 6–8 h and none-depression, those with sleep > 8 h and depression had the highest odds of cognitive impairment (OR = 2.40, 95%CI: 1.88–3.07). Additionally, Compared with those who slept 6–8 h, the associations between depression-mediated short and long sleep and cognitive impairment were 51.1 % and 6.5 %, respectively. LimitationsCross-sectional studies require caution in the interpretation of causal associations. ConclusionsLong sleep and depression were independently and jointly associated with higher odds of cognitive impairment among the Chinese elderly, and short sleep increased the risk of cognitive impairment by promoting the prevalence of depression.

Increased Odds of Cognitive Impairment in Adults with Depressive Symptoms and Antidepressant Use.

The relationship between antidepressant use and class with cognition in depression is unclear. This study aimed to evaluate the association of cognition with depressive symptoms and antidepressant use (class, duration, number). Data from the National Health and Nutrition Examination Survey were examined for cognitive function through various tests and memory issues through the Medical Conditions questionnaire. Depressive symptoms were assessed using the Patient Health Questionnaire-9. A total of 2867 participants were included. Participants with depressive symptoms had significantly higher odds of cognitive impairment (CI) on the animal fluency test (aOR=1.89, 95% CI=1.30, 2.73, P=0.002) and Digit Symbol Substitution test (aOR=2.58, 95% CI=1.34, 4.9, P=0.007), as well as subjective memory issues (aOR=7.25, 95% CI=4.26, 12.32, P<0.001) than those without depression. There were no statistically significant associations between any of the CI categories and depressive symptoms treated with an antidepressant and antidepressant use duration. Participants who were using more than one antidepressant had significantly higher odds of subjective memory issues than those who were using one antidepressant. Specifically, users of atypical antidepressants, selective serotonin reuptake inhibitors, or tricyclic antidepressants (TCAs) had significantly higher odds of subjective memory issues in comparison to no antidepressants, with TCAs showing the largest odds (aOR=4.21, 95% CI=1.19, 14.86, P=0.028). This study highlights the relationship between depressive symptoms, antidepressant use, and CI. Future studies should further evaluate the mechanism underlying this phenomenon.

DNA Methylation Age Acceleration Mediates the Relationship between Systemic Inflammation and Cognitive Impairment.

Chronic inflammation and DNA methylation are potential mechanisms in dementia etiology. The linkage between inflammation and DNA methylation age acceleration in shaping dementia risk is understudied. We explored the association of inflammatory cytokines with cognitive impairment and whether DNA methylation age acceleration mediates this relationship. In a subset of the 2016 wave of the Health and Retirement Study (n=3,346, age>50), we employed logistic regression to estimate the associations between each inflammatory cytokine (interleukin-6 (IL-6), C-reactive protein (CRP), and insulin-like growth factor-1 (IGF-1)), and both Langa-Weir classified cognitive impairment non-dementia and dementia, respectively. We calculated DNA methylation age acceleration residuals by regressing GrimAge on chronologic age. We tested if DNA methylation age acceleration mediated the relationship between systemic inflammation and cognitive impairment, adjusting for sociodemographic, behavioral factors, chronic conditions, and cell type proportions. The prevalence of cognitive impairment was 16%. In the fully-adjusted model, participants with a doubling of IL-6 levels had 1.12 (95% CI: 1.02-1.22) times higher odds of cognitive impairment. Similar associations were found for CRP and IGF-1. Participants with a doubling of IL-6 levels had 0.77 (95% CI: 0.64, 0.90) years of GrimAge acceleration. In mediation analyses with each cytokine as predictor separately, 17.7% (95% CI: 7.0%, 50.9%) of the effect of IL-6 on cognitive impairment was mediated through DNA methylation age acceleration. Comparable mediated estimates were found for CRP and IGF-1. Systemic inflammation is associated with cognitive impairment, with suggestive evidence that this relationship is partially mediated through DNA methylation age acceleration.

Association of physical activity and vitamin D deficiency with cognitive impairment in older adults: a population based cross-sectional analysis.

The global aging situation is becoming increasingly critical and cognitive impairment in the elderly has become a public health burden of concern. Physical activity (PA) and vitamin D may play a key role in improving cognitive impairment. However, little studies have examined the interaction between these two. The purpose of this study was to assess the association of PA and vitamin D with cognitive impairment in older adults, as well as the interactions of PA and vitamin D. This study was conducted by multi-stage random sampling of elderly people ≥60 years old, and a total sample of 2,492 (1,207 male and 1,285 female, mean age of 69.41 ± 6.75 years) with complete data was included in the analysis. PA was assessed by the Global Physical Activity Questionnaire, and < 600 MET-min/week was used as the division criteria. Serum vitamin D was measured by high-performance liquid chromatography tandem mass spectrometry, and 25-hydroxyvitamin D2/D3 concentration < 20 ng/mL was used as a vitamin D deficiency criterion. Cognitive function was assessed by three subtests: the Consortium to Establish a Registry for Alzheimer's disease word learning test (CERAD-WL) for immediate and delayed learning, the Animal Fluency Test (AFT) for verbal fluency; and the Digit Symbol Substitution Test (DSST) for information processing speed and switching attention. All three subtests were scored at less than the lowest quartile of the score as a criterion for cognitive impairment. Statistical analysis was performed using SPSS for chi-square test, rank sum test, interaction analysis, subgroup analysis, and regression analysis. Lower level of PA is associated with higher odds of cognitive impairment (CERAD W-L: OR = 1.596, 95% CI: 1.338-1.905, p < 0.001; AFT: OR = 1.833, 95% CI: 1.534-2.190, p < 0.001; DSST: OR = 1.936, 95% CI: 1.609-2.329, p < 0.001). Vitamin D deficiency has significant effects in AFT (OR = 1.322, 95% CI: 1.103-1.584, p = 0.003) and DSST (OR = 1.619, 95% CI: 1.345-1.948, p < 0.001). After adjusted for covariates, PA and vitamin D have multiplicative interaction on AFT (OR = 0.662, 95% CI: 0.448-0.977, p = 0.038) and DSST (OR = 0.775, 95% CI: 0.363-0.868, p = 0.009). The interaction between PA and vitamin D was not significant in the CERAD W-L (OR = 0.757, 95% CI: 0.508-1.128, p = 0.172). The results showed that lower level of PA and vitamin D deficiency were associated with higher odds of cognitive impairment in the elderly population and that there was a multiplicative interaction between PA and vitamin D on cognitive function, with a significant effect of vitamin D on cognitive impairment in high PA conditions.

Polyvascular atherosclerosis and renal dysfunction increase the odds of cognitive impairment in vascular disease: findings of the LipidCardio study

IntroductionGrowing evidence suggests a causal role for atherosclerotic vascular disease in cognitive impairment and dementia. Atherosclerosis may present as monovascular disease (monoVD) or as widespread polyvascular atherosclerotic disease (polyVD). Evidence on the relationship between monoVD or polyVD and cognitive impairment is limited.MethodsWe conducted a cross-sectional analysis of baseline data from the LipidCardio Study. The main outcome measure was the presence of cognitive impairment, defined as a Mini-Mental State Examination (MMSE) score < 26.ResultsThe mean age was 71.5 years, 30.3% were female, 17.3% had no evidence of large-vessel atherosclerosis, 71.1% had monoVD, and 11.7% had polyVD, defined as the presence of atherosclerosis in ≥ 2 vascular territories (coronary, cerebral, aortic, or lower extremity). A total of 21.6% had cognitive impairment according to the prespecified cutoff (MMSE < 26). Overall, the odds of cognitive impairment increased for each additional vascular territory affected by atherosclerosis [adjusted odds ratio 1.76, 95% confidence interval (CI) 1.21–2.57, p = 0.003]. Furthermore, there was evidence for an interaction between vascular disease and chronic kidney disease (CKD). The odds of cognitive impairment were not greater in the monoVD subgroup compared to those without any atherosclerosis, if CKD was absent (OR 0.98, 95% CI 0.48–2.10; p = 0.095), while the odds ratio (OR) of cognitive impairment with polyVD compared to no atherosclerosis was 2.71 (95% CI 1.10–6.92; p = 0.031). In contrast, in patients with CKD, both monoVD and polyVD were associated with significantly higher odds of cognitive impairment than no atherosclerosis.ConclusionsPolyVD is associated with increased odds of cognitive impairment. MonoVD is associated with cognitive impairment only in the presence of CKD.

Association between cardiovascular risk factors and cognitive impairment in adults aged 60 years or older from Chile: a cross-sectional study

BackgroundFew studies in Latin America have examined the association between cardiovascular risk factors and cognitive impairment (CI) in a nationally representative sample. Therefore, this study aimed to estimate the prevalence of CI in a nationally representative sample of adults aged 60 years or older from Chile and to investigate the association between cardiovascular risk factors and CI.MethodsData from the cross-sectional 2016–2017 National Health Survey of Chile, which included 2031 adults (63.7% women) was used. Body mass index, metabolic syndrome (blood pressure, triglycerides, fasting glucose or treatment for diabetics, waist circumference, and HDL cholesterol), risk of cardiovascular disease (history and measured variables, using the Framingham risk score), tobacco use, and physical activity were measured. CI was assessed using the Mini-Mental Status Examination (MMSE).ResultsOverall, the prevalence of CI was 12.2% at the national level. Significant differences in CI were observed by age, education level, risk of cardiovascular disease, and smoking. High risk of cardiovascular disease was associated with higher odds of CI (OR: 2.04; 95%CI: 1.20–3.45) compared to low risk. Smoking was significantly associated with a lower likelihood of CI (OR: 0.56; 95%CI: 0.36–0.87) compared to never smoking. Body mass index, metabolic syndrome, and physical activity were not associated with CI.ConclusionsThis study provided additional support for previous findings on the relationship between cognitive decline and an elevated risk of cardiovascular disease. Worse CI was associated with the group with the highest risk of cardiovascular disease, and the presence of lifestyle factors, such as obesity and physical inactivity, exacerbate this relationship, but not being a current smoker.

Prevalence of subjective memory complaints at age 90+ and their cross‐sectional association with cognition: The 90+ Study

AbstractBackgroundSubjective memory complaints (SMC) present in 8‐33% of older adults younger than 90, and associated with worse cognition in cross‐sectional studies. However, the prevalence of SMC and its cross‐sectional association with objectively measured cognition at age 90+ are unknown. The aims are to: (1) determine the prevalence of SMC and (2) examine the cross‐sectional association of SMC with cognitive diagnosis and cognitive test scores in individuals aged 90 and older.MethodWe analyzed data from 1,112 participants of The 90+ Study , a longitudinal study of aging and cognition in people age 90 and older. SMC was assessed at baseline using an item from the Geriatric Depression Scale (GDS): “Do you think you have more problems with memory than most?” Cognitive diagnosis was determined from a neurological exam without knowledge GDS scores and catergorized as normal, cognitive impairment no dementia (CIND), and dementia. Cognitive tests measured verbal memory, verbal fluency, and executive function. We assessed the association between SMC and cognitive diagnosis using multinomial logistic regression and estimated the odds ratios of having CIND or dementia in those with SMC vs. No SMC. We used linear regression models stratified by congitive diagnosis to analyze the relationship between SMC and test scores. All analyses were adjusted for age, sex, education, and total GDS.ResultMean age was 93 years, 68% were women, 46% had college education or higher, and 16% had SMC. Participants reporting SMC had 1.69 times higher odds of a CIND diagnosis and 4.07 times higher odds of a dementia diagnosis compared to No SMC (Figure). SMC was associated with worse performance on memory and animal fluency in normal, and on memory only in CIND. SMC was not associated with performance on cognitive tests in participants with dementia (Table 2).ConclusionIn this cohort of adults aged 90+, SMC prevalence was comparable to reports in older adults &lt;90. Cross‐sectionally, SMC was associated with higher odds of cognitive impairment, and with poorer performance on memory in participants without dementia, potentially reflecting insight into their cognition. Our findings suggest that SMC is a useful indicator of memory impairment after age 90.

The role of sleep disturbances in the association between housing conditions and subjective cognitive impairment

AbstractBackgroundAdverse housing conditions such as crowding, air pollution, or insufficient heat are associated with cognitive impairment. However, the mechanism linking adverse housing conditions and cognitive impairment is not fully understood. Adverse housing can affect sleep – an essential physiologic activity for cognitive function, yet this pathway is understudied. We tested associations between housing condition, sleep disturbances, and cognitive impairment.MethodsThis study utilized data from the Health and Retirement Study, a longitudinal panel study among adults (2020). Participants (n = 2,639) completed questionnaires on housing, sleep disturbances, and cognition. Housing was measured by self‐reported ratings of their homes physical condition (1‐excellent to 5‐poor). Sleep disturbances were self‐reported as trouble falling asleep, trouble waking up during the night, and trouble with waking up too early and not being able fall asleep again, and each item was scored from 0 (rarely/never) to 2 (most of the time). Cognitive impairment was defined as a participant rating of fair or poor regarding their memory at the present time. Logistic regression models were fit to test associations between housing and sleep and cognitive impairment after adjustment for age, sex, and race.ResultsThe sample had a mean age of 66.2+10.6 years, and 60% were female, 21.4% Black, 64.6% White, and 11.4% other racial group. The prevalence of cognitive impairment and sleep disturbance was 28.7% and 42.8%, respectively. Individuals living in adverse housing conditions had 32% and 48% higher odds of sleep disturbances [Adjusted Odds Ratio (aOR) = 1.32, 95% confidence interval (1.21, 1.43)] and cognitive impairment [aOR = 1.48 (1.36, 1.62)], respectively. Sleep disturbances were associated with higher odds of cognitive impairment, OR = 2.04 (1.71, 2.44). After adjustment for sleep disturbances, the association between housing condition and cognitive impairment was slightly attenuated, aOR = 1.40 (1.28, 1.54).ConclusionsLiving in adverse housing conditions were associated with greater sleep disturbances and subjective cognitive impairment. Results suggest that sleep may explain a small portion of the association between housing conditions and cognitive impairment, but a formal test of mediation is needed. Housing and sleep may be points of intervention for reducing cognitive impairment.

Life-course socioeconomic status and its impact on functional health of Portuguese older adults

Abstract Background Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive, and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socioeconomic status (SES) and different dimensions of functional health in older adults. Methods Data on 821 Portuguese adults aged 50 and over in 2013-2015 were analyzed. Life-course SES was computed using participants’ paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm+nm), upward (m+nm), downward (nm+m), stable low (m+m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health. Results Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β=−9.75; 95%CI: -14.34;-5.15; SF-36 mental health: β=−7.33; 95%CI: -11.55;-3.11; handgrip strength: β=−1.60; 95%CI: -2.86;-0.35; walking time, highest tertile: OR = 5.28; 95%CI: 3.07;9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95%CI: 0.96;3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95%CI: 1.78;11.95). Conclusions A disadvantaged life-course SES impacts older adults’ physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health. Key messages • Overall, stable high SES leads to better functional health, but for mental health functioning, handgrip strength and walking speed, it is possible to overcome the initial social disadvantage. • These results reinforce that even though health disparities may start early in life, they are mutable and capable of changing through the improvement of socioeconomic conditions.

Associations among body mass index, handgrip strength, and cognitive impairment in older men and women in India

BackgroundThis study examined the associations among body mass index (BMI), handgrip strength (HGS) and cognitive impairment among older adults in India. We also assessed whether these associations vary by gender. MethodsWe used data from baseline wave of the Longitudinal Aging Study in India (2017–18) with a sample of 31,464 adults age 60 and above. Cognitive impairment was assessed using different domains of cognition, including memory, orientation, arithmetic functioning, and visuospatial and constructional ability. We used multivariable logistic regression and interaction analyses to test the research hypotheses. ResultsOlder women had 2.25 times the odds of cognitive impairment than older men [AOR: 2.25; CI: 2.01–2.53]. The odds of cognitive impairment were 1.36 times among underweight older adults [AOR: 1.36; CI: 1.23–1.50], 0.72 times among overweight [AOR: 0.72; CI: 0.62–0.83], and 0.66 times among obese older adults [AOR: 0.66; CI: 0.51–0.84] compared to peers with normal BMI. Underweight women had 3.14 times the odds of being cognitively impaired [AOR: 3.14; CI: 2.67–3.68] compared to older men with normal BMI. Further, older men who were underweight and had a weak HGS had higher odds of cognitive impairment than older men with a normal BMI and strong HGS. Conversely, older women who were overweight or obese and had strong HGS reported lower odds of cognitive impairment than older women with normal BMI and strong HGS. ConclusionsThat the association between BMI and cognitive impairment differs between men and women and by HGS gives health care providers and practitioners additional information needed to identify groups of older adults most susceptible to cognitive impairment. In particular, gender specific policies and an assessment of HGS may be useful when crafting interventions to minimize the negative consequences of varying body types on later life cognitive function.

Association between oral health and cognitive function among Chinese older adults: the Taizhou imaging study

BackgroundWe aimed to investigate the association between oral health and cognitive function in a sample of older adults from a Chinese rural community.MethodsThe cross-sectional cognitive function of 677 individuals were assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA). A comprehensive profile of the oral health status was evaluated by questionnaire and clinical examination.ResultsMultiple covariates-adjusted regression models demonstrated decayed teeth (DT) and decayed/missing/filled teeth (DMFT) were negatively associated with MoCA score (all p < 0.05). Calculus index (CI) and clinical attachment loss (CAL) were significantly associated with the lower MoCA, short-term memory and executive function score, respectively (all p < 0.05). Additionally, participants with missing teeth unrestored tend to get lower MMSE and MoCA scores (p < 0.05). The results also showed that increased DT and CI were modestly associated with higher odds of cognitive impairment (p < 0.05).ConclusionsThere is an association between oral health and global cognition. Poor periodontal status was strongly associated with worse global cognition performance, especially in the short-term memory and executive domain for the aging population.

Life-course socio-economic status and its impact on functional health of Portuguese older adults.

Functional health is arguably one of the most important health indicators for older adults, because it assesses physical, cognitive and social functions in combination. However, life-course circumstances may impact this multidimensional construct. The aim of the present study was to assess the relationship between life-course socio-economic status (SES) and different dimensions of functional health in older adults. Data on 821 Portuguese adults aged 50 years and over in 2013-2015 were analysed. Life-course SES was computed using participants' paternal occupation (non-manual (nm); manual (m)) and own occupation (nm; m), resulting in four patterns: stable high (nm + nm), upward (m + nm), downward (nm + m) and stable low (m + m). Functional health included physical and mental functioning, cognitive function, handgrip strength, and walking speed. Linear (beta coefficients) and logistic regressions (odds ratios) were used to estimate the association between life-course SES and functional health.Overall, those who accumulated social disadvantage during life-course presented worse functional health than those with stable high SES (stable low - SF-36 physical functioning: β = -9.75; 95% CI: -14.34; -5.15; SF-36 mental health: β = -7.33; 95% CI: -11.55; -3.11; handgrip strength: β = -1.60; 95% CI: -2.86; -0.35; walking time, highest tertile: OR = 5.28; 95% CI: 3.07; 9.09). Those with an upward SES were not statistically different from those in the stable high SES for most of the health outcomes; however, those with an upward SES trajectory tended to have higher odds of cognitive impairment (OR = 1.75; 95% CI: 0.96; 3.19). A downward SES trajectory increased the odds of slower walking speed (OR = 4.62; 95% CI: 1.78; 11.95). A disadvantaged life-course SES impacts older adults' physical and mental functioning. For some outcomes, this was attenuated by a favourable adulthood SES but those with a stable low SES consistently presented worse functional health.

Sex comparisons in the association of prediabetes and type 2 diabetes with cognitive function, depression, and quality of life: The Maastricht study.

There are sex differences in the excess risk of diabetes-associated cardiovascular disease. However, it is not clear whether these sex differences exist with regard to other complications like mental health aspects. Therefore, we investigated sex differences in the association of prediabetes and type 2 diabetes (T2D) with cognitive function, depression, and quality of life (QoL). In a population-based cross-sectional cohort study (n = 7639; age 40-75 years, 50% women, 25% T2D), we estimated sex-specific associations, and differences therein, of prediabetes and T2D (reference: normal glucose metabolism) with measures of cognitive function, depression, and physical and mental QoL. Sex differences were analysed using multiple regression models with interaction terms. In general, T2D, but not prediabetes, was associated with higher odds of cognitive impairment, major depressive disorder, and poorer QoL. The odds ratio (OR) of cognitive impairment associated with T2D was 1.29 (95% CI: 0.96-1.72) for women and 1.39 (1.10-1.75) for men. The OR of major depressive disorder associated with T2D was 1.19 (0.69-2.04) for women and 1.68 (1.02-2.75) for men. The mean difference of the physical QoL score (ranging from 0 to 100, with 100 indicating the best possible QoL) associated with T2D was -2.09 (-2.92 to -1.25) for women and -1.81 (-2.48 to -1.13) for men. The mean difference of the mental QoL score associated with T2D was -0.90 (-1.79 to -0.02) for women and -0.52 (-1.23 to 0.20) for men. There was no clear pattern of sex differences in the associations of either prediabetes or T2D with measures of cognitive function, depression, or QoL. In general, T2D was associated with worse cognitive function, depression, and poorer QoL. The strength of these associations was similar among women and men.

Association between low vitamin D levels and cognitive impairment in Chilean older adults: findings of the National Health Survey 2016-2017

Recent studies have shown that low vitamin D levels constitute a potential risk factor for the development of cognitive impairment. The present study aimed to investigate the association between vitamin D levels and the suspicion of cognitive impairment in Chilean older adults. We performed a cross-sectional study, including 1,287 participants ≥ 65 years (56.8% were women, age range 65 to 97 years) from the Chilean National Health Survey. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE). Participants were classified into three groups according to their vitamin D levels (> 29 ng/ml sufficient, 12-29 ng/ml deficit, and < 12 ng/ml severe deficit). The association between vitamin D levels and cognitive impairment was explored using logistic regression analysis, adjusted for confounding factors. The prevalence of vitamin D deficit and vitamin D severe deficit was 37.7% and 21.0%, respectively. Compared to older adults with sufficient levels of vitamin D, those with severe deficits had a 94% (OR: 1.94 [95% IC: 1.27; 1.66], p = 0.002) higher odds of cognitive impairment (unadjusted model). Adjusting according to sociodemographic factors, lifestyle, adiposity, sunlight exposure, and multimorbidity slightly attenuated the association to 61% (OR: 1.61 [95%IC: 1.03; 2.19], p = 0.046), but remain significant. A severe deficit of vitamin D was associated with higher odds of cognitive impairment in Chilean older adults independent of major confounding factors. Future studies are needed to provide causal evidence between vitamin D and the suspicion of cognitive impairment.

Body Mass Index and Cognition: Associations Across Mid- to Late Life and Gender Differences.

Higher mid-life body mass index (BMI) is associated with lower late-life cognition. Associations between later-life BMI and cognition are less consistent; evidence suggests reverse causation may play a role. We aimed to characterize associations between BMI and cognition across a wide age range during mid- to late life (55-85years) and examine whether associations vary by gender. We used data from the Health and Retirement Study (HRS) (N=39,153) to examine the association between BMI and 3 cognitive outcomes: cognitive level, cognitive decline, and cognitive impairment. We used a series of linear regression, mixed effects regression, and logistic regression models, adjusting for potential confounders. Higher BMI before age 65 (midlife) was associated with lower cognitive performance, faster rates of cognitive decline, and higher odds of cognitive impairment in late life. Averaging across analyses assessing associations between BMI measured before age 60 and late-life cognition, a 5-unit higher level of BMI was associated with a 0.26 point lower cognitive score. Beyond age 65, associations flipped, and higher BMI was associated with better late-life cognitive outcomes. Associations in both directions were stronger in women. Excluding those with BMI loss attenuated findings among women in older ages, supporting the reverse causation hypothesis. In this sample, age 65 represented a critical turning point between mid- and late life for the association between BMI and cognition, which has important implications for recruitment strategies for studies focused on risk factors for late-life cognitive outcomes. Evidence of gender differences raises the need to further investigate plausible mechanisms.

PSYCHOSOCIAL WORKING CONDITIONS IN MID-LIFE AND COGNITIVE AND PHYSICAL IMPAIRMENT IN OLDER AGE

Abstract Background Psychosocial working conditions have been associated with cognitive and physical impairment among older adults. However, less is known on whether psychosocial working conditions are associated with a combination of cognitive and physical impairments. The aim of this study was to investigate the associations between midlife psychosocial working conditions and physical and cognitive impairment among older adults, and to assess whether there are sex differences in these associations. Methods The data were derived from two Swedish nationally representative surveys (n=839) with a follow-up time of 20-24 years. Multinomial and binary logistic regressions were used to assess the associations between work stressors according to the job demand-control model, and a combination of cognitive and physical impairment. Results Low control jobs were significantly associated with higher odds of both cognitive and physical impairment as well as a combination of cognitive and physical impairment. Passive jobs (low control, low demand) were associated with higher odds of cognitive impairment, and cognitive and physical impairment in combination. Active jobs (high control, high demand) were associated with lower odds of cognitive impairment. Sex-stratified analyses showed stronger associations among men than among women. Among men passive jobs were significantly associated with both cognitive and physical impairment. Low strain jobs were significantly associated with less physical impairment. Conclusions These results highlight the importance of midlife psychosocial working conditions for late-life physical and cognitive impairment, and especially among men. Jobs characterised by higher control, lower strain and active jobs may promote resilience and cognitive reserve among older populations.

MENTAL-SOMATIC MULTIMORBIDITY IN GROUP-BASED TRAJECTORIES OF COGNITIVE FUNCTION FOR MIDDLE-AGED AND OLDER ADULTS

Abstract Somatic and mental multimorbidity contributes to cognitive decline. The study aims to identify distinct trajectories of cognitive performance among middle-aged and older adults, and to examine the contribution of specific somatic and mental multimorbidity combinations on subsequent risk of cognitive impairment. We used group-based trajectory modeling to identify trajectories of cognitive impairment risk among participants in the Health &amp; Retirement Study during years 1998-2016 (N=20,372). We included time-invariant sociodemographic factors (sex, race/ethnicity, education) to quantify their association with trajectory class membership, and time-varying multimorbidity combinations to examine their relative impact on observed trajectories. Four somatic-mental multimorbidity combinations were analyzed: somatic multimorbidity (two or more of the following: heart disease, lung disease, hypertension, arthritis, diabetes, cancer), stroke-multimorbidity (any somatic including stroke); depressive-multimorbidity (any somatic including high depressive symptoms); and stroke and depressive multimorbidity (including both stroke and high depressive symptoms). We identified three trajectory classes of cognitive impairment: low baseline risk with gradual increase (55.1%); low baseline risk with rapid increase (32.8%); and high baseline risk with gradual increase (12.1%). In the group with low baseline risk with rapid increase, stroke-multimorbidity (OR: 2.40, 95%CI: 2.11, 2.74) and depressive-multimorbidity (OR: 1.65, 95%CI: 1.50,1.81) each had higher odds of cognitive impairment relative to somatic multimorbidity. Similarly, stroke and depressive multimorbidity (OR: 3.46, 95%CI: 2.85, 4.21) was associated with higher odds of cognitive impairment compared with somatic multimorbidity. This study highlights the importance of risk modification for somatic and mental multimorbidity combinations from mid-life to inform interventions to sustain cognitive performance.

Anxiety and cognitive functioning in the Maastricht study: A cross-sectional population study

BackgroundHigher anxiety levels in older adults are associated with worse executive functioning and an increased risk for dementia. In this study individual anxiety disorders and clinically relevant generalized anxiety symptoms are studied in relation to multiple cognitive domains. MethodThis cross-sectional study includes 7344 community-dwelling participants of The Maastricht Study aged 40–75 years and oversampling of type 2 diabetes. Panic disorder with and without agoraphobia, agoraphobia and lifetime panic disorder were measured with the Mini International Neuropsychiatric Interview. Generalized anxiety symptoms were measured with the Generalized Anxiety Disorder 7-item scale (GAD-7). Multiple cognitive domains (executive functioning, memory and processing speed) and cognitive impairment were assessed. Multivariable linear and logistic regression analyses were used with adjustment for potential confounders. Interaction analyses were performed to test the moderation of age, sex and type 2 diabetes (due to oversampling). ResultsAgoraphobia was associated with worse scores on all cognitive domains (range B = −0.12 to −0.10; range 95%CI = −0.20 to −0.04) and with higher odds of cognitive impairment (OR = 1.51, 95%CI = 1.18–1.93). High scores on the GAD-7 were associated with worse scores on processing speed (B = −0.11, 95%CI = −0.20 to −0.03) and higher odds of cognitive impairment (OR = 1.42, 95%CI = 1.02–1.97). Panic disorder was significantly associated with worse scores on memory tasks (B = −0.25, 95%CI = −0.48 to −0.02). Associations were stronger in the younger participants and for agoraphobia and GAD-7 scores also in those with type 2 diabetes. ConclusionMultiple anxiety disorders and generalized anxiety symptoms were associated with worse cognitive functioning on several cognitive domains.