Association of obesity, diabetes and hypertension with cognitive impairment in older age

Insa Feinkohl, Gunnar Lachmann, Wolf-Rüdiger Brockhaus, Friedrich Borchers, Sophie K Piper, Thomas H Ottens, Hendrik M Nathoe, Anne-Mette Sauer, Jan M Dieleman, Finn M Radtke, Diederik van Dijk, Tobias Pischon, Claudia Spies, Insa Feinkohl, Gunnar Lachmann, Wolf-Rüdiger Brockhaus, Friedrich Borchers, Sophie K Piper, Thomas H Ottens, Hendrik M Nathoe, Anne-Mette Sauer, Jan M Dieleman, Finn M Radtke, Diederik van Dijk, Tobias Pischon, Claudia Spies

Abstract

Background: Age-related cognitive impairment is rising in prevalence but is not yet fully characterized in terms of its epidemiology. Here, we aimed to elucidate the role of obesity, diabetes and hypertension as candidate risk factors.

Methods: Original baseline data from 3 studies (OCTOPUS, DECS, SuDoCo) were obtained for secondary analysis of cross-sectional associations of diabetes, hypertension, blood pressure, obesity (body mass index [BMI] ≥30 kg/m2) and BMI with presence of cognitive impairment in log-binomial regression analyses. Cognitive impairment was defined as scoring more than 2 standard deviations below controls on at least one of 5-11 cognitive tests. Underweight participants (BMI<18.5 kg/m2) were excluded. Results were pooled across studies in fixed-effects inverse variance models.

Results: Analyses totaled 1545 participants with a mean age of 61 years (OCTOPUS) to 70 years (SuDoCo). Cognitive impairment was found in 29.0% of participants in DECS, 8.2% in SuDoCo and 45.6% in OCTOPUS. In pooled analyses, after adjustment for age, sex, diabetes and hypertension, obesity was associated with a 1.29-fold increased prevalence of cognitive impairment (risk ratio [RR] 1.29; 95% CI 0.98, 1.72). Each 1 kg/m2 increment in BMI was associated with 3% increased prevalence (RR 1.03; 95% CI 1.00, 1.06). None of the remaining risk factors were associated with impairment.

Conclusion: Our results show that older people who are obese have higher prevalence of cognitive impairment compared with normal weight and overweight individuals, and independently of co-morbid hypertension or diabetes. Prospective studies are needed to investigate the temporal relationship of the association.

Keywords: aging; body mass index; cognitive epidemiology; cognitive impairment; diabetes; hypertension; obesity.

Conflict of interest statement

Disclosure Insa Feinkohl and Gunnar Lachmann were supported by funding from the European Union, Seventh Framework Programme [FP7/2007–2013], under grant agreement no. HEALTH-F2-2014-602461 BioCog (Biomarker Development for Postoperative Cognitive Impairment in the Elderly): www.biocog.eu. Gunnar Lachmann was supported by the Clinician Scientist Program granted by the Berlin Institute of Health (BIH). We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité – Universitätsmedizin Berlin. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Pooled association of obesity with cognitive impairment (model 2). Abbreviations: CI, confidence interval; DECS, Dexamethasone for Cardiac Surgery; SE, standard error; SuDoCo, Surgery Depth of Anaesthesia Cognitive Outcome.
Figure 2
Figure 2
Pooled association of BMI with cognitive impairment (model 2). Abbreviations: BMI, body mass index; CI, confidence interval; DECS, Dexamethasone for Cardiac Surgery; SE, standard error; SuDoCo, Surgery Depth of Anaesthesia Cognitive Outcome.

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