Cross-Sectional Study Examining the Association Between Metabolic Syndrome and Cognitive Function Among the Oldest Old

Metabolic syndrome and cognitive deficits in the Greek cohort of Epirus Health Study

BACKGROUND

Metabolic syndrome is considered an important risk factor for cognitive decline and dementia. However, the evidence in middle-aged individuals is still conflicting. The aim of the study was to explore the association between metabolic syndrome and its individual components with cognitive function and to investigate possible interaction between sex, age and genetic predisposition for metabolic syndrome and Alzheimer's disease in a middle-aged Greek cohort.

METHODS

A total of 2,077 healthy adults (mean age: 46.7 years) were included in the primary cross-sectional analysis and 305 of them in secondary prospective analyses. Metabolic syndrome was defined by the revised National Cholesterol Education-Adult Treatment Panel III and the International Diabetes Federation criteria. Cognitive function was measured primarily with the Trail Making, Verbal fluency and Logical Memory test, and in secondary prospective analyses with online versions of Posner cueing task, an emotional recognition task, Corsi block-tapping task and Stroop task.

RESULTS

Multivariable linear regressions showed an association of metabolic syndrome with lower performance in attention (β=1.62 seconds, 95% CI=0.20, 3.04) and memory (β=-0.62 words, 95% CI=-1.19, -0.05) that could be driven by associations with elevated fasting glucose and abdominal obesity. Similar associations were observed in the secondary prospective analyses.

CONCLUSION

In summary, metabolic syndrome was associated with cognitive deficits in domains related with the cognitive profile of vascular cognitive impairment.

Metabolic Syndrome: A Strange Companion of Atrial Fibrillation; A Blessing in Disguise from the Neuropsychiatric Point of View

Background: The concept of metabolic syndrome (MetSy) brings together components that individually represent a risk factor for cardiovascular diseases, which over time can prove to be more harmful if a combined effect of these is exhibited. Method: A single-centre retrospective study in an academic medical unit was conducted. We analysed the link between the MetSy and the occurrence of neuropsychic complications among atrial fibrillation (AF) patients. We sifted through the files of the patients admitted during 2015-2016 to the Municipal Emergency University Hospital Timisoara, Romania, with the diagnosis of AF. We divided these AF patients into two groups: the first group comprised patients with atrial fibrillation and MetSy (267 patients), while the second group comprised AF patients without MetSy (843 patients). We analysed the occurrence of neuropsychic changes (stroke, Parkinson's disease, dementia, cognitive impairment, and silent lacunar infarction) among the two groups. Results: Cognitive impairment (p-value = 0.0081) and dementia (p-value < 0.0001) were less frequent in patients with AF and MetSy than in those with AF without MetSy. Regarding the presence of stroke and Parkinson's disease (PD), we could not demonstrate the existence of any statistically significant difference between the two groups. Using logistic regression (enter test), we found that MetSy might have a protective effect (OR = 0.4040, 95% CI [0.2132; 0.7654], p-value = 0.0054) for the occurrence of dementia in those patients. Furthermore, obesity was the only factor with a possible protective effect from all the constituents of the MetSy when analysed together (with a significance level of p-value = 0.0004 for the logistic regression). The protective effect of MetSy against stroke occurrence was supplementarily proven by a longer period of survival without stroke from the AF diagnosis (3.521 years, p = 0.0304) compared to patients with AF without MetSy (3.286 years to first stroke occurrence). Conclusions: Metabolic syndrome might offer protection against the occurrence of dementia among patients with AF, but no effect was noted when compared with the presence of stroke. Further studies on larger cohorts can help us reach a conclusion regarding the positive effects of the metabolic syndrome.

Association between Micronutrient-Related Dietary Pattern and Cognitive Function among Persons 55 Years and Older in China: A Longitudinal Study

Appropriate dietary patterns for preserving cognitive function in China remains unknown. This study explored the association between dietary pattern and cognitive function in the Chinese population. A total of 6308 adults aged 55 and above who participated in the China Health and Nutrition Survey at least two waves from 1997 to 2018 were selected. The dietary pattern was determined using the reduced rank regression method with responses regarding vitamin C, vitamin E, zinc, iron, copper, and selenium intakes. We used a three-level random coefficient model to evaluate the association. A "vegetable-pork" dietary pattern characterized by high intakes of Legume products, vegetables, fruits, nuts, pork, fish, and plant oil was identified. Compared to the first quartile (Q1) of dietary scores, the regression coefficients (p value) for the global cognitive score across Q2, Q3, and Q4 were 0.27 (p = 0.030), 0.45 (p < 0.001), and 0.50 (p < 0.001), respectively. The adjusted odds ratios (ORs) and the 95% confidence intervals (CIs) for poor cognition across Q2, Q3, and Q4 were 0.82 (0.73 to 0.93), 0.79 (0.69 to 0.91), and 0.74 (0.63 to 0.86), respectively. The relationship appeared to be stronger among people who were 65 years and older, women, people from the south, and smokers. Higher adherence to the "vegetable-pork" diet is associated with better cognitive function among Chinese elders.

The Joint Effect of Body Mass Index and Serum Lipid Levels on Incident Dementia among Community-Dwelling Older Adults

OBJECTIVES

This study aimed to explore the joint effect of body mass index (BMI) and serum lipids levels on incident dementia.

METHODS

We prospectively followed up with 1,627 dementia-free community residents aged ≥60 for 5.7 years on average. At baseline, weight, and height were measured, and total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were detected in serum. Demographic characteristics were collected through questionnaires. Dementia was based on consensus diagnosis of neurologists and neuropsychologists using DSM-IV criteria. Additive Cox proportional model was used to assess the exposure-response relationship between BMI and serum lipid levels and dementia risk. Interactions and further classifications of BMI and serum lipid levels were further presented by bivariate surface models and decision-tree models.

RESULTS

The joint effects of TC with BMI, TG with BMI, and LDL-C with BMI on the risk of incident dementia shared a similar pattern, different from their independent exposure-response curves. The joint effect of HDL-C with BMI showed an S-surface but without statistical significance. Participants with TC<5.4 mmol/L and BMI<21 kg/m2 (Hazard Ratio(HR) 1.93, 95% Confidence Interval (CI) 1.05-3.53), TC<5.4 mmol/L and BMI≥21 kg/m2 (HR 1.73, 95% CI 1.09-2.72), and TC≥5.4 mmol/L and BMI<21 kg/m2 (HR 4.02, 95% CI 2.10-7.71) were identified to have the increased risk of incident dementia compared to those with TC≥5.4 mmol/L and BMI≥21 kg/m2. Participants with TG<1.7 mmol/L and BMI<21 kg/m2 had an increased risk of incident dementia compared to those with TG≥1.7 mmol/L and BMI≥21 kg/m2 (HR 1.98, 95%CI 1.17-3.3). Participants with LDL-C≥3.3 mmol/L and BMI<21 kg/m2 were identified to have an increased risk of incident dementia compared to those with LDL-C≥3.3 mmol/L and BMI≥21 kg/m2 (HR 3.33, 95%CI 1.64-6.78).

CONCLUSIONS

Our study showed that low BMI combined with low or high levels of serum lipids may increase the risk of dementia among older adults. This finding suggests the potential impacts of these two metabolic indexes on the risk of dementia.

The Association Between the Duration, Treatment, Control of Hypertension and Lifestyle Risk Factors in Middle-Aged and Elderly Patients with Mild Cognitive Impairment: A Case-Control Study

BACKGROUND

Epidemiological studies suggest that the incidence of hypertension in China is causally related to cognitive impairment. However, there is a dearth of information available regarding important factors for the association, including disease duration, therapeutic options, and risk factors associated with mild cognitive impairment (MCI) in patients with hypertension.

METHODS

We selected a diverse cohort of 572 patients with hypertension and assessed cognitive function using MoCA. Potential risk factors were investigated by a structured questionnaire. Risk factors associated with the hypertension-induced MCI occurring conversion of were analyzed using multifactorial regression analysis.

RESULTS

MCI was observed in 256 of 572 individuals, which increased with age (OR=1.15, 95% CI 1.10-1.20), but was decreased with high education status (OR=0.47, 95% CI 0.32-0.71). Risk factors independently associated with MCI were diabetes (OR=2.40, 95% CI 1.53-3.76), hyperlipidemia (OR=1.49, 95%=1.01-2.16), high salt diet (OR=2.27, 95% CI 1.34-3.84), and physical activity:>2h/week (OR=0.65, 95%0.44-0.94). However, controlling blood pressure to "normal" target values helped decrease the incidence of MCI (OR=0.44, 95% CI 0.30-0.65): this was not age dependent.

CONCLUSION

Our results suggest that it is necessary to promote the education of the middle-aged and elderly Chinese population to correctly and effectively use anti-hypertensives to control hypertension to a normal range to prevent cognitive.

Race/ethnicity and gender modify the association between diet and cognition in U.S. older adults: National Health and Nutrition Examination Survey 2011-2014

INTRODUCTION

It is unclear whether the association between Mediterranean-type Diet (MeDi) and cognition is similar across different racial/ethnic groups or between women and men.

METHODS

The current study included 2435 participants (≥60 years of age) of the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Linear regression models were applied to examine the association between diet and cognition, adjusted for multiple demographic variables. Interaction between MeDi and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, other), and between MeDi and gender, were examined, followed by stratified analyses.

RESULTS

One score increase in MeDi was associated with 0.039 (95%confidence interval [CI] = 0.016-0.062) higher global cognitive z-score. Significant associations between MeDi and global cognition and between MeDi and immediate recall were found in the non-Hispanic Whites only (P-interaction = 0.057 and 0.059, respectively). MeDi was associated with increased score of animal fluency score in men but not in women (P-interaction = 0.082).

DISCUSSION

The positive association between MeDi and cognition might be dependent on race/ethnicity and gender.

Metabolic Syndrome and Cognitive Trajectories in the Framingham Offspring Study

Metabolic syndrome (MetS) has been linked to increased risk of developing cognitive impairment and dementia including Alzheimer's disease. It remains unclear whether and at what stage in the adult lifespan MetS and its components begin to alter the trajectory of cognitive performance. In the present study, 2,892 Framingham Offspring participants completed health assessments every four years since 1971 and underwent repeat neuropsychological testing from 1999 to 2014. We estimated the associations of levels and changes in cognitive trajectories with hazard of MetS using a joint growth/survival model. All models were adjusted for baseline age, sex, education, and smoking status. Findings showed that both mid-life and late-life MetS were associated with lower level of cognitive functioning but not cognitive trajectories. Associations were strongest among those who were nondemented and apolipoprotein (APOE) ɛ4 noncarriers. In addition, individuals with the most rapid cognitive decline were more likely to have MetS. The pattern of results showed that associations between MetS and cognition varied, depending upon whether the sample was stratified by genetic and cognitive status and whether we considered cognitive performance as a continuous variable or examined categorical groupings. Given that mid-life MetS was associated with poorer cognition at age 55, cognitive changes may occur early during the MetS process. Our findings suggest that those with MetS are at greater risk of dementia given their lower level of cognitive functioning and also suggest that MetS may be a risk factor for decline in the absence of known risk factors including the APOEɛ4 allele.

Sex differences in the relationship between dietary pattern adherence and cognitive function among older adults: findings from the NuAge study

BACKGROUND

Consumption of a prudent dietary pattern rich in healthy nutrients is associated with enhanced cognitive performance in older adulthood, while a Western dietary pattern low in healthy nutrients is associated with poor age-related cognitive function. Sex differences exist in dietary intake among older adults; however, there is a paucity of research examining the relationship between sex-specific dietary patterns and cognitive function in later life.

METHODS

The current study aimed to investigate sex differences in the relationship between sex-specific dietary pattern adherence and global cognitive function at baseline and over a 3-year follow-up in 1268 community-dwelling older adults (M_age = 74 years, n = 664 women, n = 612 men) from the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge). A 78-item Food Frequency Questionnaire was used to estimate dietary intake over the previous year. Sex-specific dietary pattern scores were derived using principal component analysis. Global cognition was assessed using the Modified Mini-Mental State Examination (3MS).

RESULTS

Adjusted linear mixed effects models indicated that a healthy, prudent dietary pattern was not associated with baseline cognitive performance in men or women. No relationship was found between Western dietary pattern adherence and baseline cognitive function in women. Among men, adherence to an unhealthy, Western dietary pattern was associated with poorer baseline cognitive function (β = - 0.652, p = 0.02, 95% CI [- 1.22, - 0.65]). No association was found between prudent or Western dietary patterns and cognitive change over time in men or women.

CONCLUSIONS

These findings highlight the importance of conducting sex-based analyses in aging research and suggest that the relationship between dietary pattern adherence and cognitive function in late life may be sex-dependent.

Metabolic Syndrome and Cognitive Function: Cross-Sectional Study on Community-Dwelling Non-Demented Older Adults in Japan

AIM

This is a cross-sectional study of relation between metabolic syndrome and cognitive function in community-dwelling non-demented older adults in Japan. We examine the effect of metabolic syndrome and its components on global cognitive function. We also aim to clarify differences of specific cognitive domains between the subjects with and without metabolic syndrome.

METHODS

We studied 2150 subjects aged between 60 and 90 years whose scores on mini mental state examination (MMSE) were over 23 points. We analyzed difference in MMSE scores between the subjects with and without metabolic syndrome. Logistic regression analysis was performed with MMSE score as the dependent variable and metabolic syndrome components as the independent variable adjusted with age. We also examined differences in attention, logical memory, and verbal and category fluency between the subjects with and without metabolic syndrome.

RESULTS

MMSE scores were not significantly different between subjects with and without metabolic syndrome. In logistic regression analysis, the score of MMSE was significantly negatively associated with triglycerides in males and significantly negatively associated with abdominal circumference in females. Subjects with metabolic syndrome showed significantly lower performance of attention tasks compared to subjects without metabolic syndrome.

CONCLUSIONS

Our results suggest that in community-dwelling non-demented Japanese older adults, attention but not global cognitive function may be impaired by metabolic syndrome. Inverted association between some components of metabolic syndrome and global cognitive function indicate necessity of further studies on the relation between undernutrition and cognitive function.

A systematic review of existing peripheral biomarkers of cognitive aging: Is there enough evidence for biomarker proxies in behavioral modification interventions?: An initiative in association with the nutrition, exercise and lifestyle team of the Canadian Consortium on Neurodegeneration in Aging

Peripheral biomarkers have shown significant value in predicting brain health and may serve as a useful proxy measurement in the assessment of evidence-based lifestyle behavior modification programs, including physical activity and nutrition programs, that aim to maintain cognitive function in late life. The aim of this systematic review was to elucidate which peripheral biomarkers are robustly associated with cognitive function among relatively healthy non-demented older adults. Following the standards for systematic reviews (PICO, PRIMSA), and employing MEDLINE and Scopus search engines, 222 articles were included in the review. Based on the review of biomarker proxies of cognitive health, it is recommended that a comprehensive biomarker panel, or biomarker signature, be developed as a clinical end point for behavior modification trials aimed at enhancing cognitive function in late life. The biomarker signature should take a multisystemic approach, including lipid, immune/inflammatory, and metabolic biomarkers in the biological signature index of cognitive health.

Prediction of mortality in Chinese very old people through the frailty index based on routine laboratory data

The increased risk of death in older adults can be successfully identified through frailty index (FI), based on comprehensive geriatric assessment data and self-reported data from the accumulated deficit, although the method depending on routine laboratory data (FI-LAB) remains uncertain. In the current study, the capacity of FI-LAB in evaluating the risk of mortality in a very old Chinese community cohort was analyzed. The 90-year- and above old individuals from a Dujiangyan community in Sichuan Province, China, who had completed a health assessment at baseline (in 2005) and whose laboratory data were analyzed (n = 736) from cumulative data from the Project of Longevity and Aging. The FI-LAB data was constructed from routine laboratory data and calculated as the ratio of abnormal factors in 22 variables (including red blood cells, white blood cells, and alanine transaminase) that can be assessed through blood tests. The multivariable Cox regression was used to evaluate the effect of frailty on death. In the four-year follow-up, 53.5% of the 736 participants (age = 93.6 ± 3.4 years; 67.5% women), were reported dead. The FI-LAB mean baseline value was 0.21 (standard deviation = 0.10; range = 0 to 0.55). Frailty (after adjusting for gender, age, and other confounders) could be directly correlated with increased death risk, with a hazard ratio of 1.31 (95% confidence interval (CI): 1.07–1.61) in comparison with those without frailty among the individuals. Frailty as defined by FI-LAB, established only on routine laboratory data, indicates a significant death risk in the very old people.

Triglycerides Paradox Among the Oldest Old: "The Lower the Better?"

OBJECTIVES

Currently, most treatment guidelines suggest lowering hypertriglyceridemia of any severity, even in elderly individuals. However associations of serum triglycerides (TGs) with adverse health and mortality risk decrease with age, it remains unclear among the oldest old (aged 80 years and older). The study was to investigate the relationship of serum TG concentrations with cognitive function, activities of daily living (ADLs), frailty, and mortality among the oldest old in a prospective cohort study.

DESIGN

Longitudinal prospective cohort study.

SETTING

Community-based setting in longevity areas in China.

PARTICIPANTS

A total of 930 (mean age = 94.0 years) Chinese oldest old.

MEASUREMENTS

The TG concentrations were measured at baseline survey in 2009. Cognitive function, ADLs, frailty, and mortality were determined over 5 years of follow-up. Cox proportional hazards models and competing risk models were performed to explore the association, adjusting for potential confounders.

RESULTS

Each 1-mmol/L increase in TGs was associated with a nearly 20% lower risk of cognitive decline, ADL decline, and frailty aggravation during the 5 years of follow-up. Consistently, higher TGs (each 1 mmol/L) was associated with lower 5-year all-cause mortality after fully adjustment (hazard ratio [HR] = 0.79; 95% confidence interval [CI] = 0.69-0.89). Nonelevated TG concentrations (less than 2.26 mmol/L) were associated with higher mortality risk (HR = 1.72; 95% CI = 1.22-2.44), relative to TGs of 2.26 mmol/L or more. We observed similar results regarding TG concentrations and mortality in 1-year lag analysis and when excluding participants with identified chronic disease.

CONCLUSION

In the oldest old, a higher concentration of TGs was associated with a lower risk of cognitive decline, ADL decline, frailty aggravation, and mortality. This paradox suggests the clinical importance of revisiting the concept of "the lower the better" for the oldest old. J Am Geriatr Soc 67:741-748, 2019.

Frailty and Cognitive Impairment in Predicting Mortality Among Oldest-Old People

Backgrounds: Frailty and cognitive impairment are critical geriatric syndromes. In previous studies, both conditions have been identified in old-age adults as increased risk factors for mortality. However, the combined effect of these two syndromes in predicting mortality among people with advanced age is not well understood. Thus, we used Chinese community cohort to determine the impact of the combined syndromes on the oldest-old people. Methods: Our present study is part of an ongoing project on Longevity and Aging in Dujiangyan, which is a community study on a 90+ year cohort in Sichuan Province in China. Participants were elderly people who completed baseline health assessment in 2005 followed by a collection of mortality data in 2009. Frailty and cognitive function were assessed with 34-item Rockwood Frailty Index and the Mini-Mental Status Examination, respectively, and the combined effect(s) of these two parameters on death was examined using the Cox proportional hazard regression model. Results: This study consisted of a total of 705 participants (age = 93.6 ± 3.3 years; 67.4% females), of which 53.8% died during a four-year follow-up period. The prevalence of frailty, cognitive impairment, and the overlap of these two syndromes was 63.7, 74.2, and 50.3%, respectively. Our data showed that the subjects with combined frailty and cognitive impairment were associated with increased risk of death (age, gender, education level, and other potential confounders adjusted); the hazard ratio was 2.13 (95% confidence interval 1.39, 3.24), compared with the control group. However, neither frailty alone nor cognitive impairment alone increased the risk of death in these individuals. Conclusion: The combined frailty and cognitive impairment, other than the independently measured syndromes (frailty or cognitive impairment alone), was a significant risk factor for death among the oldest-old Chinese people.

Biomarkers for Early Diagnosis of Alzheimer's Disease in the Oldest Old: Yes or No?

In recent years, many efforts have been spent to identify sensitive biomarkers able to improve the accuracy of Alzheimer's disease (AD) diagnosis. Two different workgroups (NIA-AA and IWG) included cerebrospinal fluid (CSF) and neuroimaging findings in their sets of criteria in order to improve diagnostic accuracy as well as early diagnosis. The number of subjects with cognitive impairment increases with aging but the oldest old (≥85 years of age), the fastest growing age group, is still the most unknown from a biological point of view. For this reason, the aim of our narrative mini-review is to evaluate the pertinence of the new criteria for AD diagnosis in the oldest old. Moreover, since different subgroups of oldest old have been described in scientific literature (escapers, delayers, survivors), we want to outline the clinical profile of the oldest old who could really benefit from the use of biomarkers for early diagnosis. Reviewing the literature on biomarkers included in the diagnostic criteria, we did not find a high degree of evidence for their use in the oldest old, although CSF biomarkers seem to be still the most useful for excluding AD diagnosis in the "fit" subgroup of oldest old subjects, due to the high negative predictive value maintained in this age group.

Investigation of the prevalence of Cognitive Impairment and its risk factors within the elderly population in Shanghai, China

To investigate the prevalence of cognitive impairment and its risk factors among Chinese elders aged over 80 years, a community-based, cross-sectional study was conducted from May to June 2016 in Shanghai, China. Cognitive function was measured by using Mini-Mental Status Examination. Multiple logistic regression assessed associations between risk factors and cognitive impairment. Of 480 participants, 30% were diagnosed with cognitive impairment. Women [adjusted odds ratio (AOR): 1.71, 95% confidence interval (CI): 1.03-2.83], solitary life (AOR: 3.15, 1.89-5.26), monthly income less than 2000 Chinese yuan (AOR: 3.47, 1.18-10.23) were significantly associated with increased risk of cognitive impairment, compared with men, non-solitary life, and monthly income greater than 4000 Chinese yuan, respectively. Overweight (AOR: 0.59, 0.36-0.97), being physically active at least 60 minutes per day (AOR: 0.59, 0.35-0.95), antihypertensive drugs users (AOR: 0.45, 0.28-0.72), and lipid lowering drugs users (AOR: 0.21, 0.06-0.76) significantly lowered the risk of cognitive impairment, compared with normal weight, inadequate outdoor activity, and non-medication users, respectively. Accordingly, this study found that women, solitary life, lower income was associated with increased risk of cognitive impairment, while overweight, being physically active, and antihypertensive and lipid lowering drugs usage might lower the risk.

Impact of Worsened Metabolic Syndrome on the Risk of Dementia: A Nationwide Cohort Study

BACKGROUND

The relationship of alteration of metabolic syndrome (MetS) with dementia remains unclear. The purpose of study was to evaluate the association between dynamic change in MetS status around a 5-year period and dementia.

METHODS AND RESULTS

The cohort study was conducted from the Taiwanese Survey on Prevalence of Hypertension, Hyperglycemia, and Hyperlipidemia in 2002, with follow-up in 2007. The sample was subsequently linked to the National Health Insurance Research Database. Participants were divided into 3 groups: persistent MetS (MetS both in 2002 and 2007); nonpersistent MetS (MetS either in 2002 or 2007); and non-MetS (MetS neither in 2002 nor 2007). Furthermore, the individuals with nonpersistent MetS were categorized as improved MetS (MetS in 2002 but not in 2007) and worsened MetS (MetS not in 2002 but in 2007). Each participant was tracked until the end of 2011 to identify the development of dementia. In total, 3458 participants aged 40 to 80 years were included. Up to 10 years and 31 741 person-years of follow-up, 76 patients developed dementia. Only a relationship was found between the nonpersistent MetS and dementia (adjusted hazard ratio=1.93; 95% confidence interval =1.17-3.19; P=0.010). Moreover, a significantly higher dementia risk was observed in patients with worsened MetS (adjusted hazard ratio=2.22; 95% confidence interval=1.32-3.72; P=0.003), but not those with persistent (P=0.752) or improved (P=0.829) MetS. Similar results were detected in participants aged ≥65 years.

CONCLUSIONS

Patients with worsened MetS had an increased dementia risk during the 10-year follow-up period in a population-based sample.

Prevalence and clinical profile of metabolic syndrome in longevity: study from Guangxi Zhuang Autonomous Region, China

BACKGROUND

Metabolic syndrome (MetS) was a risk factor for cardiovascular diseases, yet the prevalence of MetS among nonagenarians and centenarians was rarely reported. Here we investigated the prevalence of MetS and its components among nonagenarians and centenarians in our Zhuang population from Bama, Guangxi Zhuang Autonomous Region, China.

METHOD

In Bama area, there registered 881 individuals who lived more than 90 years old in 269,800 local residents and our study involved 307 long-lived participants and 486 local younger (35-68 years) persons, as controls. MetS was defined according to the revised National Cholesterol Education Program's Adult Treatment Panel III (NCEP ATPIII) criteria.

RESULTS

The overall prevalence estimates of MetS among longevity group were 28.0% based on NCEP ATPIII criteria. The most common metabolic component was elevated blood pressure (61.1%), followed by raised fasting glucose (39.1%) and low high-density lipoprotein cholesterol (low HDL-C) (28.0%). The prevalence of MetS and abdominal obesity in women (33.6% and 22.1% respectively) was higher than that of men (19.8% and 3.7% respectively) (P_range < .001-0.019). Compared with controls, long-lived individuals were more likely to have two or more metabolic abnormalities (P_range < 0.001), and less likely to have zero or one metabolic abnormality (P_range < 0.001-0.020).

CONCLUSION

This study showed substantiality the prevalence and clinical profile of MetS in longevity population in Guangxi Zhuang Autonomous Region, China.

Metabolic Syndrome and Cognitive Performance Among Chinese ≥50 Years: A Cross-Sectional Study with 3988 Participants

BACKGROUND

To date, the relationship between metabolic syndrome (MetS) and cognitive performance has not been well defined. This study aimed to explore the relationship between MetS and cognitive performance among Chinese elderly population.

METHODS

A cross-sectional study was performed, with data collected in seven clinical centers from five provinces of Northern China. All recruited participants were ≥50 years of age and complained with cognitive impairment or were reported with cognitive impairment by his/her caregiver(s). MetS was diagnosed according to the criteria issued by Chinese Medical Association Diabetes Association. Cognitive function was scored by Montreal Cognitive Assessment (MoCA).

RESULTS

Three thousand nine hundred eighty-eight participants (in an average of 66.4 ± 8.8 years of age, male 53.1%) were included in the analysis. Six hundred seventy-three (16.9%) participants were diagnosed with MetS, and 3013 (75.6%) participants had mild cognitive impairment (MCI) (MoCA score <26). There was no statistically significant difference in the MoCA scores between participants with MetS (21.0 ± 5.4) and without MetS (21.3 ± 5.3). In the logistic regression, after adjusting factors of age, education, marital status, smoking, and physical activity, diabetes and dyslipidemia were associated with MCI, whereas hypertension and overweight or obesity were not. Participants with diabetes had a higher risk of MCI (OR = 1.24, 95% CI: 1.03-1.50). Participants with dyslipidemia had a lower risk of MCI (OR = 0.81, 95% CI: 0.68-0.97).

CONCLUSION

In our study, MetS is not associated with cognitive performance in elderly Chinese population. However, elderly Chinese with diabetes would have lower cognition function, and the dyslipidemia might be reversely associated with the cognitive function.

Understanding Risk in the Oldest Old: Frailty and the Metabolic Syndrome in a Chinese Community Sample Aged 90+ Years

OBJECTIVES

To investigate the relationship between frailty and the metabolic syndrome and to evaluate how these contribute to mortality in very old people.

DESIGN

Secondary analysis of data from the Project of Longevity and Aging in Dujiangyan.

SETTING

Community sample from Sichuan Province, China.

PARTICIPANTS

People aged 90+ years (n=767; baseline age=93.7±3.4 years; 68.0% women.

MEASUREMENTS

After a baseline health assessment, participants were followed for four years (54.0% died). A frailty index (FI) was calculated as the sum of deficits present, divided by the 35 health-related deficits considered. Relationships between the FI and the metabolic syndrome were tested; their effect on death was examined.

RESULTS

The mean FI was 0.26 ±0.11. Higher FI scores were associated with a greater risk of death, adjusted for age, sex, education, and metabolic syndrome items. The hazard ratio was 1.03 (95% confidence interval 1.02, 1.04) for each 1% percent increase of the FI. The mortality risk did not change with the metabolic syndrome (odds ratio=0.99; 0.71-1.36).

CONCLUSIONS

In the oldest old, frailty was a significant risk for near-term death, regardless of the metabolic syndrome. Even using age-adjusted models, the epidemiology of late life illness may need to account for frailty routinely.

Prevalence and correlates of metabolic syndrome and its components in elderly Korean adults

PURPOSE

This study examined the determinants of the prevalence of factors related to five components of metabolic syndrome in the elderly.

METHODS

The study used raw data (2010-2012) from the Korea National Health and Nutrition Examination Survey-V. The 3971 study subjects were community-dwelling elderly adults aged over 65years. The criteria for the metabolic syndrome were based on those of the American Heart Association/National Heart, Lung and Blood Institute, and the waist circumference cutoff points for these factors were adapted from the standard suggested by the Korea Society for the Study of Obesity in 2005.

RESULTS

The overall prevalence of metabolic syndrome in Korean elderly adults was 43.6% (35.3% in men and 50.2% in women). Metabolic syndrome was 2.32 times more prevalent in women relative to men (95% confidence interval [CI]: 1.85-2.90, p<0.001), 1.26 times more prevalent in urban, relative to rural, residents (95% CI: 1.09-1.45, p=0.002), 1.43 times more prevalent in ex-smokers (95% CI: 1.14-1.80, p=0.002) and 1.45 times more prevalent in smokers (95% CI: 1.11-1.54, p=0.007) relative to nonsmokers, and 1.16 times more prevalent in sedentary, relative to active, subjects (95% CI: 1.02-1.32, p=0.028).

CONCLUSION

The results indicated that the prevalence of metabolic syndrome in elderly Korean adults was high, suggesting that the prevention and management of metabolic syndrome in the elderly should be addressed via individual components.

Association between metabolic syndrome and mild cognitive impairment and its age difference in a Chinese community elderly population

OBJECTIVE

To examine associations between metabolic syndrome (MetS) and its individual components with risk of mild cognitive impairment (MCI) among community elderly and explore the age difference.

DESIGN

Cross-sectional study.

SUBJECTS

About 2,102 aged 60 and older community residents in Beijing metropolitan area, China.

MEASUREMENTS

Cognitive function was assessed by Mini-Mental State Examination (MMSE). MetS was defined by the 2009 harmonizing definition. Overnight-fasting blood samples were obtained to measure biochemistry indicators.

RESULTS

The prevalence of MetS and MCI was 59·1% and 15·9%, respectively. After adjusting age, gender, other demographic factors, lifestyle variables and medication use, participants with MetS or its individual components are at significantly elevated risk for MCI. In terms of MMSE score, as the continuous dependent variable, the β (95% CI) of MetS was -0·68(-0·99, -0·37). For prevalence of MCI, as the dichotomy dependent variable, the odds ratio (OR) of Mets is 1·52 compared to control group (or baseline) with 95% confidence interval (CI) of 1·16 to 1·95. The multivariate association only showed significant results among participants aged less than 80 years old.

CONCLUSIONS

MetS is associated with worse cognitive function among younger elderly. Managing MetS, as well as its components, may contribute to control cognitive decline and reduce related disease and social burden.

Obesity in older persons

PURPOSE OF REVIEW

There is an increasing number of reports suggesting that indicators of obesity for the general adult population may need to be modified; that the magnitude of risk is attenuated or that adiposity may even be protective; and that additional adverse outcomes specific to older persons need to be considered. Finally, there are benefits and adverse effects of weight loss programmes for older persons. This article reviews publications addressing these issues from 2013 to March 2014.

RECENT FINDINGS

BMI was not considered to be as good an indicator of obesity because of loss of muscle mass with age. Higher body weight seems to be protective among older persons with chronic diseases or geriatric syndromes. Increased adiposity together with decreased muscle mass (sarcopenic obesity) is associated with adverse outcomes, although there is no consensus regarding the definition. Intentional weight loss has health benefits but is accompanied by muscle and bone loss, and therefore programmes should include components to counteract these changes.

SUMMARY

The magnitude of health risk associated with obesity is attenuated with age, and mild increase in adiposity may be beneficial for those who are frail and/or with chronic diseases. Weight loss programmes should include resistance exercises to counteract muscle loss.

Detection of impaired cognitive function in rat with hepatosteatosis model and improving effect of GLP-1 analogs (exenatide) on cognitive function in hepatosteatosis

The aims of the study were to evaluate (1) detection of cognitive function changing in rat with hepatosteatosis model and (2) evaluate the effect of GLP-1 analog (exenatide) on cognitive function in hepatosteatosis. In the study group, 30% fructose was given in nutrition water to perform hepatosteatosis for 8 weeks to 18 male rats. Six male rats were chosen as control group and had normal nutrition. Fructose nutrition group were stratified into 3 groups. In first group (n = 6), intracerebroventricular (ICV) infusion of exenatide (n = 6) was given. ICV infusion of NaCl (n = 6) was given to second group. And also, the third group had no treatment. And also, rats were evaluated for passive avoidance learning (PAL) and liver histopathology. Mean levels of latency time were statistically significantly decreased in rats with hepatosteatosis than those of normal rats (P < 0.00001). However, mean level of latency time in rats with hepatosteatosis treated with ICV exenatide was statistically significantly increased than that of rats treated with ICV NaCl (P < 0.001). Memory performance falls off in rats with hepatosteatosis feeding on fructose (decreased latency time). However, GLP-1 ameliorates cognitive functions (increased latency time) in rats with hepatosteatosis and releated metabolic syndrome.

Cognition and nutrition

PURPOSE OF REVIEW

Aging is associated with a decline in cognition. This review examines the available data on the effects of nutrition on cognitive impairment. It also explores the mechanism(s) by which food may enhance memory.

RECENT FINDINGS

An increasing body of evidence has supported the role of the Mediterranean diet and extra-virgin olive oil in protecting cognition. A number of nutritional formulations to improve deteriorating memory are being studied. Undernutrition is associated with cognitive decline. Hyperglycemia and hypertriglyceridemia cause cognitive impairment.

SUMMARY

There are increasing data to support the role of nutrition in maintaining cognition.