Anemia and 9-year domain-specific cognitive decline in community-dwelling older women: The Women's Health and Aging Study II

Relationship between hemoglobin and specific cognitive domain among older adults using network analysis

OBJECTIVES

Hemoglobin (Hgb) is associated with cognitive function, with low and high levels of Hgb leading to impaired cerebral oxygenation and perfusion. Yet, current studies focused on understanding the association between Hgb and cognitive function without consideration for each cognitive domain. Thus, this study aims to identify and visualize potentially interactive associations between Hgb and specific cognitive domains among older adults.

METHOD

This is a secondary data analysis using Wave II data from the National Social Life, Health, and Aging Project (NSHAP) and included 1022 older adults aged between 65 and 85 years. The network structure of three different models was estimated to understand the association between specific cognitive domains and Hgb in a mixed graphical model using the R-package 'mgm'. Model 1 did not adjust for any covariates, Model 2 adjusted for age and gender, and Model 3 adjusted for all covariates.

RESULTS

Among all cognitive domains, the visuospatial (edge weight = 0.06-0.10) and memory domains (0.04-0.07) were associated with Hgb in all three models Though not present in Model 3, the attention domain was associated with Hgb in Model 1 and Model 2 (0.08-0.11). In addition, the predictability of Hgb was the highest (8.1%) in Model 3.

CONCLUSION

Findings from this study suggest that cognition should be considered as a multidimensional construct, and its specific cognitive domain should be carefully assessed and managed in relation to Hgb among older adults.

Lower serum ferritin levels are associated with worse cognitive performance in aging

OBJECTIVES

Iron is important for neurogenesis, synaptic development, and neurotransmitter synthesis. Serum ferritin (SF) is a reliable marker for assessing iron stores. Therefore, we evaluated the cognitive function associated with SF levels. We also assessed brain iron content using R2* Magnetic Resonance Imaging (MRI) and its association with SF levels.

DESIGN

Data from three cross-sectional observational studies were used. Aging Imageomics (n = 1030) was conducted on aged subjects. Health Imageomics (n = 971) and IR0NMET (n = 175) were conducted in middle-aged subjects.

SETTING AND PARTICIPANTS

Participants were enrolled at Dr. Josep Trueta University Hospital facilities. The three cohorts included a total of 2176 subjects (mean age, 52 years; 48% men).

MEASUREMENTS

SF levels were measured by standard laboratory methods. Total Digits Span (TDS), and Phonemic Verbal Fluency (PVF) were used to assess executive function. Language function was assessed by semantic verbal fluency (SVF), attention by the Symbol Digit Modalities Test, and memory by the Memory Binding Tests - Total Free Recall and Total Delayed Free Recall. MRI was used to assess the iron content of the brain by R2*.

RESULTS

In subjects aged 65 years or older, SF levels were associated with increased TDS (β = 0.003, p = 0.02), PVF (β = 0.004, p = 0.01), and SVF (β = 0.004, p = 0.002) scores. After stratification by sex, these findings were significant only in men, where SF was associated with increased TDS (β = 0.003, p = 0.01), PVF (β = 0.004, p = 0.03), and SVF (β = 0.004, p = 0.009) scores. In middle-aged subjects, SF was also associated with increased SVF scores (β = 0.005, p = 0.011). Lastly, in men, SF levels were negatively associated with R2*, a surrogate marker of brain iron content, in both the left frontal inferior opercular area (r = -0.41, p = 0.005) and the right frontal inferior opercular area (r = -0.44, p = 0.002).

CONCLUSIONS

SF is significantly and positively associated with cognition. In older people with low SF levels, iron supplementation may be a promising therapy to improve cognition.

Preoperative serum cortisone levels are associated with cognition in preschool-aged children with tetralogy of Fallot after corrective surgery: new evidence from human populations and mice

BACKGROUND

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Children with TOF would be confronted with neurological impairment across their lifetime. Our study aimed to identify the risk factors for cerebral morphology changes and cognition in postoperative preschool-aged children with TOF.

METHODS

We used mass spectrometry (MS) technology to assess the levels of serum metabolites, Wechsler preschool and primary scale of intelligence-Fourth edition (WPPSI-IV) index scores to evaluate neurodevelopmental levels and multimodal magnetic resonance imaging (MRI) to detect cortical morphological changes.

RESULTS

Multiple linear regression showed that preoperative levels of serum cortisone were positively correlated with the gyrification index of the left inferior parietal gyrus in children with TOF and negatively related to their lower visual spaces index and nonverbal index. Meanwhile, preoperative SpO2 was negatively correlated with levels of serum cortisone after adjusting for all covariates. Furthermore, after intervening levels of cortisone in chronic hypoxic model mice, total brain volumes were reduced at both postnatal (P) 11.5 and P30 days.

CONCLUSIONS

Our results suggest that preoperative serum cortisone levels could be used as a biomarker of neurodevelopmental impairment in children with TOF. Our study findings emphasized that preoperative levels of cortisone could influence cerebral development and cognition abilities in children with TOF.

An Examination of the Non-linear Relationship Between Cognition and Total Hemoglobin Among the Cognitively Normal Older Adults by Gender

Objectives: This exploratory study aimed to identify the potential non-linear relationship between hemoglobin (Hgb) and cognition among cognitively normal older adults and how this relationship differs in terms of gender in generalized additive models (GAM). Methods: This is a secondary data analysis using Wave II (2010-2011) data from the National Social Life, Health, and Aging Project. A generalized additive model was used to understand the non-linear relationship between Hgb and cognition, and to identify critical Hgb point related to cognition. Results: While both genders had a non-linear association between Hgb and cognition, the degree of non-linearity was more pronounced in male older adults with EDF value close to 2. The inflection point of 15.10 g/dL for male older adults and inflection point of 11.72 g/dL for female older adults were obtained. Conclusion: Further studies are needed to validate these results and develop precision medicine approaches to integrate these results into clinical practice.

Associations between the use of common nonsteroidal anti-inflammatory drugs, genetic susceptibility and dementia in participants with chronic pain: A prospective study based on 194,758 participants from the UK Biobank

OBJECTIVE

To investigate the potential relationship between common nonsteroidal anti-inflammatory drugs (NSAIDs), genetic susceptibility and all-cause dementia (ACD), Alzheimer's disease (AD), and vascular dementia (VD) among individuals experiencing chronic pain.

METHODS

This study was based on 194,758 chronic pain participants form UK biobank with a median follow-up of 13.7 years. Participants were categorized into different NSAIDs painkiller regimen groups: No NSAIDs group, Aspirin group, Ibuprofen group, Paracetamol group, and 2-3 NSAIDs group. Cox proportional risk models were used to examine the correlation between regular NSAIDs usage and the risk of ACD, AD, and VD. In addition, we further performed subgroup analyses and sensitivity analyses.

RESULTS

1) Compared to the No NSAIDs group, the aspirin group (HR = 1.12, 95% CI:1.01-1.24, P < 0.05), the paracetamol group (HR = 1.15, 95% CI:1.05-1.27, P < 0.01), and the 2-3 NSAIDs group (HR = 1.2, 95% CI:1.08-1.33, P < 0.05) showed a higher risk of ACD. Furthermore, the 2-3 NSAIDs group was also associated with a higher risk of VD (HR = 1.39, 95% CI: 1.08-1.33, P < 0.05). 2) At high dementia GRS participants with chronic pain, the paracetamol group (HR = 1.2, 95% CI: 1.03-1.43, P < 0.05) and the NSAIDs group (HR = 1.3, 95% CI: 1.07-1.59, P < 0.05) were associated with a higher risk of ACD compared to the no painkiller group. 3) There was no significant association between ibuprofen use and higher risk of dementia.

CONCLUSION

In individuals with chronic pain, the use of aspirin and paracetamol was associated with a higher risk of ACD, whereas the use of ibuprofen was not significantly associated with a higher risk of ACD.

Homotherapy for heteropathy of Alzheimer's disease and anemia through reducing the expression of toll-like receptor and TNF by steamed Panax notoginseng

BACKGROUND

One of the effects of Steamed Panax notoginsen (SPN) is to replenish blood, which is mostly used to treat anemia in clinic. SPN has the effect of treating anemia and Alzheimer's disease (AD) in clinical and basic research. In traditional Chinese medicine, anemia and AD have the same characteristics, and their symptoms are qi and blood deficiency.

METHODS

First, data analysis was carried out through network pharmacology to predict the action targets of SPN homotherapy in the treatment of AD and anemia. Specifically, TCMSP and relevant literature were used to screen the main active ingredients of Panax notoginseng, and SuperPred was used to predict the action targets of the active ingredients. Disease targets related to AD and anemia were collected through Genecards database, and STRING and protein interaction (PPI) was used for enrichment analysis, Analyze the characteristics of the active ingredient target network on the Cytascape 3.9.0 platform, and use Metascape to enrich the gene ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes Pathway Enrichment (KEGG pathway). Then Drosophila was used as the AD animal model, and the effects of SPN on the climbing ability, olfactory memory and brain Aβ, with rats as anemia animal models, the improvement effect of SPN on blood routine and organ index of rats with blood deficiency induced by CTX and APH was analyzed to further explain the therapeutic effect of SPN on these two diseases. Finally, the regulatory effect of SPN on the key active target of allotherapy for AD and anemia was verified by PCR.

RESULTS

After the screening, 17 active components and 92 action targets of SPN were obtained. The degree values of components and the first 15 targets are NFKB1, IL10, PIK3CA, PTGS2, SRC, ECFR, CASP3, MTOR, IL1B, ESR1, AKT1, HSP90AA1, IL6, TNF, and Toll-like receptor, it is mainly related to inflammatory response, immune regulation and antioxidation. SPN improved the climbing ability, olfactory memory ability, and Aβ42 content in the brain of Aβ flies, and significantly reduced the expression of TNF and Toll-like receptor in the brain after treatment. SPN can significantly improve the blood routine index and organ index of anemia rats, and also significantly reduce the expression of TNF and Toll-like receptor in the brain after treatment.

CONCLUSION

SPN can regulate the expression of TNF and Toll-like receptor to achieve the same treatment of AD and anemia.

Association of Anemia with Cognitive Function and Dementia Among Older Adults: The Role of Inflammation

BACKGROUND

The association of anemia with cognitive function and dementia remains unclear.

OBJECTIVE

We aimed to investigate the association of anemia with cognitive function and dementia risk and to explore the role of inflammation in these associations.

METHODS

Within the UK Biobank, 207,203 dementia-free participants aged 60+ were followed for up to 16 years. Hemoglobin (HGB) and C-creative protein (CRP) were measured from blood samples taken at baseline. Anemia was defined as HGB <13 g/dL for males and <12 g/dL for females. Inflammation was categorized as low or high according to the median CRP level (1.50 mg/L). A subset of 18,211 participants underwent cognitive assessments (including global and domain-specific cognitive). Data were analyzed using linear mixed-effects model, Cox regression, and Laplace regression.

RESULTS

Anemia was associated with faster declines in global cognition (β= -0.08, 95% confidence interval [CI]: -0.14, -0.01) and processing speed (β= -0.10, 95% CI: -0.19, -0.01). During the follow-up of 9.76 years (interquartile range 7.55 to 11.39), 6,272 developed dementia. The hazard ratio of dementia was 1.57 (95% CI: 1.38, 1.78) for people with anemia, and anemia accelerated dementia onset by 1.53 (95% CI: 1.08, 1.97) years. The risk of dementia tended to be higher in people with both anemia and high CRP (1.89, 95% CI: 1.60, 2.22). There was a statistically significant interaction between anemia and CRP on dementia risk (p-interaction = 0.032).

CONCLUSIONS

Anemia is associated with cognitive decline (specifically for processing speed) and increased risk of dementia, especially in people with high inflammation.

Association of Anemia with Dementia and Cognitive Decline among Community-Dwelling Elderly

INTRODUCTION

The association of anemia with dementia in elders is controversial. We examined the potential association of anemia with dementia in a large population of elders.

METHODS

Historical-prospective registry-based study. Included 36,951 community-dwelling elders (65-113 years) that were followed during 2002-2012. Anemia of all kinds was defined according to Clalit Health Services (CHS) definitions: hemoglobin (HGB) <14 g/dL men, <12 g/dL women; and World Health Organization (WHO): HGB <13 g/dL men, <12 g/dL women. Anemia was categorized as mild (HGB 11-13 g/dL men, 11-12 g/dL women) or moderate-severe (HGB <8-10.9 g/dL men and women). Background data, laboratory values, and diagnosis of dementia and cognitive decline (DCD) were reviewed.

RESULTS

During the 10-year follow-up period, DCD was newly diagnosed in 7,180 subjects (19.4%). Subjects with DCD had a higher rate of anemia than those without DCD. Time to development of DCD was 1.5 years shorter in those with than without anemia. On multivariate Cox regression analysis adjusted for age and sex, the hazard ratio (HR) for DCD was 1.45 (95% CI: 1.37-1.54) by CHS and 1.51 (95% CI: 1.41-1.61) WHO anemia criteria. The more severe the anemia, the greater the risk of DCD development (HGB 13-14 g/dL [men only], HR = 1.20 [95% CI: 1.09-1.32]; mild anemia, HR = 1.38 [95% CI: 1.28-1.49]; moderate-severe anemia, HR = 1.64 [CI: 1.41-1.90]). Every decrease in 1 standard deviation of HGB (1.4 g/dL) increased the DCD risk by 15%. A competing risk model has weakened the association of anemia with DCD risk.

CONCLUSIONS AND IMPLICATIONS

Anemia in community-dwelling elders appears to be associated with an increased DCD risk in a dose-response manner. Application of the WHO anemia criteria in men may miss patients with mild anemia that places them at DCD risk. Further research should look at anemia as a cause of reversible dementia.

The Association of Pain Levels and Low Physical Activity among Older Women

There is an integral research gap regarding whether there is a relationship between pain levels and low physical activity among older women. This is a secondary analysis of a longitudinal cohort study, the Women’s Health and Aging Study (WHAS) II. Our analyses included 436 community-dwelling women between the ages of 70 and 79, who were followed for 10.5 years. We employed marginal structural modeling, which controls for time-dependent confounding, with the aim of assessing the potential direct association between pain levels and low physical activity and assess a graded relationship. Compared to women with no pain, those with widespread pain were nearly half as likely to be moderately active versus low active (aOR: 0.46, 95% confidence interval (CI): 0.22, 0.96). A graded association was observed across the four pain levels (no pain or mild pain, other pain, moderate or severe lower extremity pain, and widespread pain) on low physical activity. Our findings indicate that reducing chronic widespread pain in older women may increase moderate physical activity, and therefore reduce the downstream health risks of low physical activity, including morbidity and mortality risk.

Cerebral Hypoxia: Its Role in Age-Related Chronic and Acute Cognitive Dysfunction

Postoperative cognitive dysfunction (POCD) has been reported with widely varying frequency but appears to be strongly associated with aging. Outside of the surgical arena, chronic and acute cerebral hypoxia may exist as a result of respiratory, cardiovascular, or anemic conditions. Hypoxia has been extensively implicated in cognitive impairment. Furthermore, disease states associated with hypoxia both accompany and progress with aging. Perioperative cerebral hypoxia is likely underdiagnosed, and its contribution to POCD is underappreciated. Herein, we discuss the various disease processes and forms in which hypoxia may contribute to POCD. Furthermore, we outline hypoxia-related mechanisms, such as hypoxia-inducible factor activation, cerebral ischemia, cerebrovascular reserve, excitotoxicity, and neuroinflammation, which may contribute to cognitive impairment and how these mechanisms interact with aging. Finally, we discuss opportunities to prevent and manage POCD related to hypoxia.

Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program

Background and objectives

The present study aimed to investigate the relation between anemia and hemoglobin (Hgb) concentration, physical performance, and cognitive function in a large sample of Iranian elderly population.

Methods

Data were collected from Bushehr elderly health (BEH) program. A total of 3000 persons aged ≥60 years were selected through multistage random sampling. Hemoglobin values lower than 12 and 13 g/dL were considered as anemia for women and men, respectively. The cognitive function was measured using the Mini-cog test and Category fluency test (CFT), and the physical function was measured using handgrip strength (muscle strength), Relative handgrip strength (RHGS), and 4.57-m usual gait speed. Univariate and adjusted multivariate logistic regression and linear regression with Stata MP (version 15) were run, and a p-value of < 0.05 was used as statistically significant for all analyses.

Results

Among participants, 7.43% were anemic, and 115 (51.57%) simultaneously had anemia and cognitive disorder. There were significant associations between red blood cell count (RBC), hemoglobin (Hgb), platelet count (PLT), and hematocrit percentage (HCT) with cognitive impairment. Additionally, Hgb concentration was significantly associated with all physical measures (Mean handgrip, Relative handgrip, and usual gait speed) and late recall (mini-cog) among the whole participants. This association remained statistically significant after considering multi-cofounders. In contrast, after stratifying the participants by gender, the association between Hgb concentration and usual gait speed was decreased in both men and women; moreover, Hgb association with cognitive measures (category fluency test and late recall) was no longer significant (all p-values > 0.05).

Conclusion

There was a cross-sectional and significant association between anemia and functional variables (e.g., Relative and mean handgrip) in Iranian elderly population, whereas Semantic memory, Late recall, and walking were more affected by gender.

Anemia and Cognitive Performance in the ELSA-Brasil Cohort Baseline

OBJECTIVE

The association between cognitive performance and hemoglobin concentration has long been a topic of debate, but few data for middle-aged persons have been explored. The authors examined the association between anemia and cognitive performance at baseline assessment in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a multicenter cohort study of individuals from six Brazilian cities.

METHODS

A total of 13,624 participants (mean age=51.6 years [SD=9.0]) were included in this cross-sectional study. Cognitive performance was evaluated by using standardized scores for verbal learning, late recall, word recognition, a semantic verbal fluency test, and the Trail-Making Test, Part B (TMT-B). The association between anemia and cognitive performance was examined by using linear regression models adjusted for sociodemographic characteristics and cardiovascular risk factors.

RESULTS

Anemia was diagnosed in 713 (5.2%) participants. No association was found between anemia and worse cognitive performance for the main models. Global cognitive scores were similar between participants with and without anemia in adjusted models for the entire sample (β=-0.004; 95% CI=-0.052, 0.044) or for men (β=0.047; 95% CI=-0.053, 0.146) and women (β=-0.015; 95% CI=-0.070, 0.040) separately. In addition, hemoglobin levels (in quintile groups) were not associated with global cognitive scores. Similarly, no significant associations with anemia or hemoglobin levels were observed when each cognitive performance test was evaluated separately.

CONCLUSIONS

Anemia and hemoglobin levels were not associated with worse cognitive performance in this large cohort.

Blood Hemoglobin, in-vivo Alzheimer Pathologies, and Cognitive Impairment: A Cross-Sectional Study

Background: Despite known associations between low blood hemoglobin level and Alzheimer's disease (AD) or cognitive impairment, the underlying neuropathological links are poorly understood. We aimed to examine the relationships of blood hemoglobin levels with in vivo AD pathologies (i.e., cerebral beta-amyloid [Aβ] deposition, tau deposition, and AD-signature degeneration) and white matter hyperintensities (WMHs), which are a measure of cerebrovascular injury. We also investigated the association between hemoglobin level and cognitive performance, and then assessed whether such an association is mediated by brain pathologies.

Methods: A total of 428 non-demented older adults underwent comprehensive clinical assessments, hemoglobin level measurement, and multimodal brain imaging, including Pittsburgh compound B-positron emission tomography (PET), AV-1451 PET, fluorodeoxyglucose (FDG)-PET, and magnetic resonance imaging. Episodic memory score and global cognition scores were also measured.

Results: A lower hemoglobin level was significantly associated with reduced AD-signature cerebral glucose metabolism (AD-CM), but not Aβ deposition, tau deposition, or WMH volume. A lower hemoglobin level was also significantly associated with poorer episodic memory and global cognition scores, but such associations disappeared when AD-CM was controlled as a covariate, indicating that AD-CM has a moderating effect.

Conclusion: The present findings suggest that low blood hemoglobin in older adults is associated with cognitive decline via reduced brain metabolism, which seems to be independent of those aspects of AD-specific protein pathologies and cerebrovascular injury that are reflected in PET and MRI measures.

Global cognition modifies the relationship between anemia and depression in old age: A longitudinal analysis of the IMIAS Study

OBJECTIVES

To examine the relationship between anemia and depression and whether sex and global cognition modify this relationship over a 4-year follow-up.

DESIGN

Longitudinal analysis of an international cohort study SETTINGS AND PARTICIPANTS: Older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline.

METHODS

Participants were recruited in Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). The study outcome was depression, defined by a score of ≥16 in the Center for Epidemiologic Studies Depression Scale. Longitudinal associations over a 4-year follow-up were examined using generalized estimating equations. Cognition was ascertained with the Leganes Cognitive Test with scores ≤ 22 indicating poor cognition. Models were also adjusted for research sites, marital status, alcohol drinking status, body mass index, chronic conditions, activities of daily life disabilities, and polypharmacy.

RESULTS

Anemia and poor cognition at baseline were associated with an increased risk of depression at follow-up (OR = 5.73, 95% CI: 1.58-20.78). Global cognition was also an effect modifier of the longitudinal association between the severity of anemia and depression.

CONCLUSIONS

In international samples of older adults, anemia, as well as the severity of anemia, were independent risk factors for depression, and the effect of these associations was modified by global cognition. The findings highlight an important issue as to whether depression in old age may be at least partially preventable through public health interventions to correct low Hb levels.

The cross-sectional association between mean corpuscular volume level and cognitive function in Chinese over 45 years old: Evidence from the China Health and Retirement Longitudinal Study

Fewer studies have focused on the independent association between mean corpuscular volume (MCV) and cognitive performance. This study was designed to characterize the cross-sectional association between MCV and cognitive performance in a large sample of Chinese residents (age≥45 years) from the China Health and Retirement Longitudinal Study (CHARLS). A total of 4023 male and 4173 female adults with MCV ≥ 80 fl were included for analysis. By multivariable linear regression analysis, for the total subjects, MCV level was significantly negatively associated with global cognitive function and episodic memory. When adjusted by sex, only in male subjects, higher MCV level was associated with reduced scores for global cognitive function, episodic memory and mental status. Via binary logistic regression analysis, the higher MCV level (MCV>100 fl) was associated with poor global cognitive function (OR = 1.601; 95% CI = 1.198–2.139; p = 0.001), episodic memory (OR = 1.679; 95% CI = 1.281–2.201; p<0.001), and mental status (OR = 1.422; 95% CI = 1.032–1.959; p = 0.031) for the whole participants. When testing this association by sex, the significant relationship between higher MCV level with worse episodic memory was observed both in male (OR = 1.690; 95% CI = 1.211–2.358; p = 0.002) and female (OR = 1.729; 95% CI = 1.079–2.770; p = 0.023) subjects; while the association between higher MCV level and poor global cognitive function (OR = 1.885; 95% CI = 1.329, 2.675; p<0.001) and mental status (OR = 1.544; 95% CI = 1.034, 2.306; p = 0.034) only existed in male subjects. Further studies are warranted to clarify the association between MCV level and cognitive performance by considering sex into consideration both cross-sectionally and longitudinally.

Iron Status is Associated with Mood, Cognition, and Functional Ability in Older Adults: A Cross-Sectional Study

Several conditions are risk factors for iron deficiency (ID), some of which are highly prevalent in older individuals. Despite the amount of evidence pointing for a role of ID in cognition, mood and physical functional ability, the research addressing these associations in older individuals is still scarce. In the present study, 162 older community-dwelling individuals (29.53% classified as ID) were enrolled in a cross-sectional analysis and characterized regarding cognition, mood, functional ability, general nutritional intake and iron status. Assessment of iron status was performed using several blood biomarkers. Storage and erythropoiesis dimensions were positively associated with memory, along with an interaction (moderator effect) between iron storage and nutritional status. A more depressed mood was negatively associated with (iron) transport, transport saturation and erythropoiesis dimensions, and functional tiredness was positively associated with the erythropoiesis dimension. These observations indicate that lower iron status is associated with depressive mood, functional tiredness and poorer memory ability, with the latter moderated by nutritional status. These findings suggest that using iron as a continuous variable may be useful in finding associations with iron homeostasis, eventually missed when iron levels are considered within the usual classification groups.

Anemia and incidence of dementia in patients with new-onset type 2 diabetes: a nationwide population-based cohort study

INTRODUCTION

This study aimed to examine the association between anemia and the incidence of dementia in patients with new-onset type 2 diabetes.

RESEARCH DESIGN AND METHODS

This study used the Korean National Health Insurance Service-Health Screening Cohort and included 32 590 participants aged ≥40 years who were diagnosed with new-onset type 2 diabetes between 2004 and 2007 and followed up until 2013. Anemia was defined according to the criteria provided by the WHO, hemoglobin <120 g/L for women and <130 g/L for men, and was measured from after diagnosis date of type 2 diabetes to 2007. Dementia was defined by the Classification of Diseases 10th revision code as primary diagnosis and was measured from after hemoglobin measurement to 2013. We calculated the adjusted HR (AHR) and 95% CI to assess the risk of dementia using multivariable Cox proportional hazards regression models.

RESULTS

We identified 1682 patients who developed dementia within a 7.5-year follow-up. Among patients with type 2 diabetes, patients with anemia were associated with an increased risk of dementia than those without anemia (AHR, 1.21; 95% CI 1.06 to 1.39). Patients with mild (AHR, 1.18; 95% CI 1.03 to 1.38) and moderate (AHR, 1.39; 95% CI 1.06 to 1.83) anemia were associated with an increased risk of dementia than those without anemia among patients with type 2 diabetes. Men (AHR, 1.47; 95% CI 1.16 to 1.83) and middle-aged adults (AHR, 1.31; 95% CI 1.03 to 1.75) with anemia were associated with an increased risk of dementia than their counterparts without anemia among patients with type 2 diabetes.

CONCLUSIONS

Our findings suggest that anemia is significantly associated with an increased risk of dementia among patients with newly diagnosed type 2 diabetes.

Red Cell Distribution Width Is Directly Associated with Poor Cognitive Performance among Nonanemic, Middle-Aged, Urban Adults

BACKGROUND

Epidemiological evidence suggests that both anemia and elevated red cell distribution width (RDW) are associated with cognitive impairment. However, the interplay between these 2 predictors has been understudied.

OBJECTIVES

We examined sex- and anemia-specific associations between RDW and cognitive performance among urban adults in the United States.

METHODS

Data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study (Baltimore, MD; participants aged 30-65 y at baseline, ∼59% African-American, 45% men) were used. Participants were selected based on the completion of 11 cognitive tasks at baseline (2004-2009) and follow-up (2009-2013) visits (mean time between visits: 4.64 ± 0.93 y) and availability of exposure and covariate data, yielding a sample of between 1526 and 1646 adults out of the initial 3720 adults recruited at baseline. Multiple linear mixed-effects regression models were conducted with RDW as the main exposure of interest and anemia/sex as the key effect modifiers.

RESULTS

Overall, high RDWs were linked to poorer baseline performance on the California Verbal Learning Test (CVLT) List A (per 1 unit increase in RDW %, main effect: γ01 = -0.369 ± 0.114; P = 0.001) and to slower rates of decline on the CVLT Delayed Free Recall (per 1 unit increase in RDW %, RDW × time: γ11 = +0.036 ± 0.013; P = 0.007). Among nonanemic participants, RDWs were consistently associated with poorer baseline performance on the Trailmaking Test, Part A (γ01 = +3.11 ± 0.89; P < 0.001) and on the CVLT List A (γ01 = -0.560 ± 0.158; P < 0.001). Moreover, RDWs were associated with poorer baseline performance on the Brief Test of Attention in the total population (γ01 = -0.123 ± 0.039; P = 0.001) and among men (γ01 = -0.221 ± 0.068; P = 0.001). We did not detect an association between hemoglobin (Hb) and baseline cognitive performance or changes over time.

CONCLUSIONS

Elevated RDW had a consistent cross-sectional association with poor cognitive performance in the domains of verbal memory and attention among the nonanemic group in a sample of middle-aged, urban adults. Anemia and Hb concentrations were not associated with cognition. More longitudinal studies are needed to replicate our findings.

Association between anemia and cognitive decline among Chinese middle-aged and elderly: evidence from the China health and retirement longitudinal study

Background

Our objective was to characterize the relationship of anemia and hemoglobin concentrations with cross-sectional cognitive functions and changes in cognitive functions over 2 years in a large sample of Chinese middle aged and elderly.

Methods

Ten thousand nine hundred eighteen adults aged 45 years or older participating in the China Health and Retirement Longitudinal Study (CHARLS) were used for cross-sectional analyses and 9324 were used for longitudinal analysis. Cognitive functions were assessed by memory recall (episodic memory), mental status (TICS), and global cognitive function at baseline survey (Visit 1) and first follow-up survey (Visit 2). The lower the cognitive test score, the worse the cognitive function. Anemia was defined as hemoglobin concentrations lower than 13 g/dl for men and lower than 12 g/dl for women. Adjusted multivariate regression analyses were used to explore the relationships of different cognitive domains with anemia and hemoglobin concentration.

Results

Overall, the prevalence of anemia was 12.86% and the mean hemoglobin concentration was 14.37 ± 2.20 g/dl. After adjusting for socio-demographic and health-related covariates, the cross-sectional association between anemia and global cognitive function [β (95%CI) = − 0.49(− 0.69~ − 0.29)], episodic memory [β (95%CI) = − 0.14(− 0.23~ − 0.05)], and TICS [β (95%CI) = − 0.23(− 0.38~ − 0.08)] were significant and did not differ by gender. The hemoglobin concentration was also associated with global cognitive function among the whole sample (P < 0.05 for all). The longitudinal analyses showed global cognitive function and episodic memory were associated with anemia independent of covariates (P < 0.05 for all). Sensitivity analyses further provided significant results showing the association between anemia and cognition decline (P < 0.05).

Conclusion

There was a cross-sectional and longitudinal association between anemia and accelerated decline in cognitive functions in Chinese middle-aged and elderly. This suggests that anemia and low hemoglobin concentrations are independent risk factors of cognitive decline.

[Prevalence of anemia and correlation between the concentration of hemoglobin and cognitive factors among the elderly]

The scope of this study was to determine the prevalence of anemia and the correlation between the concentration of hemoglobin and cognitive factors in an elderly population group resident in Campina Grande, Paraiba, Brazil. It was a cross-sectional study with individuals aged 60 or older. Men with hemoglobin levels <13 g / dL and women with levels <12 g / dL were considered anemic. Sociodemographic, cognitive condition and nutritional status variables were analyzed. Statistical analysis was performed by means of simple and multiple linear regression. Among the 360 elderly patients evaluated (67.2% women), the prevalence of anemia was 12.5%. The average concentration of hemoglobin found was 13.5 g / dL and was correlated to sex variables (β = -0.44, 95% CI: -1.35, -0.85), age (β = -0.14 ; 95% CI: -0.03, -0.01), nutritional status (β = 0.16; 95% CI: 0.01, 0.06), memory impairment (β = 0.12; 95% CI: - 0.06, -0.01), and dementia (β = -0.13, 95% CI: -0.06, -0.01). Routine blood testing among the elderly makes it possible to detect and treat anemia at an early stage. Actions geared towards the elderly who show a cognitive decline should be developed in the Basic Family Health Units in order to improve the quality of life of this population.

Association Between Non-Iron-Deficient Anemia and Insomnia Symptoms in Community-Dwelling Older Adults: The Baltimore Longitudinal Study of Aging

Background

Anemia is associated with poorer sleep in children, and clinically, anemia is linked to insomnia. However, the association between anemia and insomnia in older adults is understudied.

Methods

We examined the cross-sectional association between anemia and insomnia in 1,053 adults (71.4 ± 10.6 years) in the Baltimore Longitudinal Study of Aging. Participants were classified as nonanemic, non-iron-deficient anemic, or iron-deficient anemic based on hemoglobin, ferritin, transferrin saturation, and mean cell volume. Insomnia symptoms were evaluated by the Women's Health Initiative Insomnia Rating Scale (WHIIRS). A total score (range 0-20) was generated, and participants were also classified as having 0, 1, or 2+ symptoms.

Results

Overall, 10.5% of participants had non-iron-deficient anemia, 0.9% had iron-deficient anemia, and 88.5% had no anemia. Due to its low prevalence, the iron-deficient anemic group was dropped from analyses. In models adjusted for demographics, number of medical conditions, and Center for Epidemiologic Studies Depression Scale score, non-iron-deficient anemic individuals had significantly higher WHIIRS total scores, indicating greater insomnia severity, compared to those without anemia (predicted adjusted mean WHIIRS of 7.24 [95% confidence interval (CI): 6.40-8.08] vs 5.92 [95% CI: 5.65-6.19]). They also had twice the risk of reporting ≥2 insomnia symptoms (vs 0 symptoms; relative risk ratio = 2.20, 95% CI: 1.25-3.89).

Conclusions

Results suggest that individuals with non-iron-deficient anemia are more likely to experience insomnia symptoms than those who are nonanemic. These results may have implications for insomnia treatment or the identification of underlying frailty in individuals with sleep problems.

Anemia is associated with incidence of dementia: a national health screening study in Korea involving 37,900 persons

BACKGROUND

The aim of this study was to investigate whether anemia is associated with dementia incidence in the elderly.

METHODS

Using the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database, we identified 66-year-old subjects (n = 37,900) who were free of dementia and stroke. Anemia (hemoglobin < 12 g/dl for women and < 13 g/dl for men) and the severity of anemia (mild, moderate, or severe) were defined using World Health Organization criteria. The incidence of dementia was identified using International Classification of Diseases, Tenth Revision, dementia diagnosis codes (F00, F01, F02, F03, and G30) with prescription of an antidementia drug. Cox proportional hazards regression models were used to assess HRs for dementia incidence according to anemia.

RESULTS

After adjusting for sex, baseline cognitive state, body mass index, smoking status, household income, disability, depression, hypertension, diabetes, and dyslipidemia, we found a significant association between anemia and dementia incidence (adjusted HR 1.24; 95% CI 1.02-1.51). The adjusted HRs for incidence of dementia according to the severity of anemia were 1.19 (95% CI 0.98-1.45) for those with mild anemia, 1.47 (95% CI 0.97-2.21) for those with moderate anemia, and 5.72 (95% CI 1.84-17.81) for those with severe anemia, showing a significant p value for trend (p = 0.003).

CONCLUSIONS

Anemia is an independent risk factor for dementia incidence, with a marked increase of risk associated with severe anemia.

Adults with sickle cell disease may perform cognitive tests as well as controls when processing speed is taken into account: a preliminary case-control study

AIMS

This study aimed to: (1) evaluate cognitive function among adults with sickle cell disease using a computer-administered neuropsychological test; and (2) replicate previously identified differences in processing speed between patients with sickle cell disease and controls.

BACKGROUND

Previous evidence suggests that, compared with controls, adult patients with sickle cell disease have poorer cognitive functioning across most domains but the most significant deficits appear to be in the area of processing speed.

DESIGN

Cross-sectional case-control study conducted from June 2008-June 2010.

METHODS

Cognitive functioning was measured using computerized, self-administered, neuropsychological tests among 31 patients with sickle cell disease and 17 controls matched for age, gender and race. The assessment averaged 30 minutes and scores were recorded for seven computerized tests: verbal and visual memory, finger tapping, symbol digit coding, Stroop test, shifting attention and continuous performance.

RESULTS

Patients with sickle cell disease scored 10·76 points lower on the CNS Vital Signs processing speed domain than controls. Although non-significant, patients scored 5·73 points lower on the full index than controls but after adjusting for processing speed, mean scores for patients were 3 points greater compared with controls. Differences in executive functioning and attention were not significant and memory did not differ between groups.

CONCLUSION

Using a brief, computer-administered 30-minute neuropsychological test, we were able to replicate previous findings showing a greater than 10-point deficit in processing speed among patients with sickle cell disease. When differences in processing speed are taken into account, patients perform equally well or better than controls on cognitive tasks.

Differences in Risk Factors for Anemia Between Adolescent and Adult Women

BACKGROUND

Iron deficiency anemia (IDA) affects 2%-5% of reproductive-age women. Screening is based on risk factors, such as a low-iron diet and menstruation. However, published IDA risk factors fail to consider age-related risks specific to adolescent women, potentially limiting identification of high-risk adolescents for objective testing. The goal of the study was to examine IDA risk factors in a nationally representative sample of younger (12-21 years) and older (22-49 years) reproductive-age women.

MATERIALS AND METHODS

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 2003-2010. IDA was defined using hemoglobin, ferritin, soluble transferrin receptor, standard NHANES laboratory measures. Sex-, age-, and race-specific hemoglobin values defined anemia. Iron deficiency was calculated using ferritin and soluble transferrin receptor in the body iron formula. Logistic regression assessed the association of potential risk factors (race, body mass index, poverty, iron intake, tobacco/nicotine exposure, physical activity, menses, and contraceptive use) with IDA in younger and older women.

RESULTS

The prevalence of IDA was 2.4% and 5.5% among younger and older women, respectively. Among younger women, contraceptive use was marginally protective from IDA (risk ratio 0.50, 95% confidence interval [CI] 0.25-1.00). Among older women, significant variables included Black race (risk ratio 2.31, 95% CI 1.33-4.02) and increased years menstruating (≥25 years vs. <25 years; risk ratio 1.93, 95% CI 0.99-3.76).

CONCLUSIONS

Risk factors for IDA among older reproductive-age women do not apply to adolescent women. To better inform the timing and frequency of screening recommendations, further research must identify adolescent-specific IDA risk factors.

Hemoglobin, Anemia, and Cognitive Function: The Atherosclerosis Risk in Communities Study

BACKGROUND

Our objective was to characterize the relationship of low and high hemoglobin concentrations and normocytic, microcytic, and macrocytic anemia with cross-sectional cognition and change in cognition over a median of 6 years.

METHODS

Cross-sectional and prospective analyses of 13,133 participants (mean age 57 years, 56% women, 24% black, 10% anemia) in the Atherosclerosis Risk in Communities (ARIC) study (baseline 1990-1992) were carried out. Anemia was defined as hemoglobin concentrations lower than 13g/dl for men and lower than 12g/dl for women and was subclassified as normocytic (mean corpuscular volume [MCV] 80-100 fL), microcytic (MCV < 80 fL), and macrocytic (MCV > 100 fL). Cognition was assessed by delayed word recall test (DWRT), digit symbol substitution test (DSST), word fluency test (WFT), and global Z-score at Visit 2 (1990-1992) and Visit 4 (1996-1998). Adjusted linear regression models and splines were used.

RESULTS

Cross-sectionally, anemia overall was associated with lower cognitive test scores on DSST and global Z-score among men and women (all p < .05), but not on DWRT or WFT. Anemia subtypes were associated similarly with cognition, with strongest associations for the DSST and global Z-score. Additionally, elevated hemoglobin level was associated with nonsignificantly worse cognition in cross-sectional analyses, suggesting a nonlinear association of hemoglobin with cognition. In contrast, anemia overall and anemia subtypes were not associated with cognition in prospective analyses (all p > .05).

CONCLUSIONS

There was a cross-sectional, but not prospective, nonlinear association between hemoglobin concentrations and cognitive function, although only associations of low levels of hemoglobin (anemia) were statistically significant. Subtypes of anemia had similar magnitudes of associations with cognition.

An anemia of Alzheimer's disease

Lower hemoglobin is associated with cognitive impairment and Alzheimer's disease (AD). Since brain iron homeostasis is perturbed in AD, we investigated whether this is peripherally reflected in the hematological and related blood chemistry values from the Australian Imaging Biomarker and Lifestyle (AIBL) study (a community-based, cross-sectional cohort comprising 768 healthy controls (HC), 133 participants with mild cognitive impairment (MCI) and 211 participants with AD). We found that individuals with AD had significantly lower hemoglobin, mean cell hemoglobin concentrations, packed cell volume and higher erythrocyte sedimentation rates (adjusted for age, gender, APOE-ɛ4 and site). In AD, plasma iron, transferrin, transferrin saturation and red cell folate levels exhibited a significant distortion of their customary relationship to hemoglobin levels. There was a strong association between anemia and AD (adjusted odds ratio (OR)=2.43, confidence interval (CI) (1.31, 4.54)). Moreover, AD emerged as a strong risk factor for anemia on step-down regression, even when controlling for all other available explanations for anemia (adjusted OR=3.41, 95% CI (1.68, 6.92)). These data indicated that AD is complicated by anemia, which may itself contribute to cognitive decline.

Interleukin-6 directly impairs the erythroid development of human TF-1 erythroleukemic cells

Anemia of inflammation or chronic disease is a highly prevalent form of anemia. The inflammatory cytokine interleukin-6 (IL-6) negatively correlates with hemoglobin concentration in many disease states. The IL-6-hepcidin antimicrobial peptide axis promotes iron-restricted anemia; however the full role of IL-6 in anemia of inflammation is not well-defined. We previously reported that chronic inflammation had a negative impact on maturation of erythroid progenitors in a mouse model. We hypothesized that IL-6 may be responsible for impaired erythropoiesis, independent of iron restriction. To test the hypothesis we utilized the human erythroleukemia TF-1 cell line to model erythroid maturation and exposed them to varying doses of IL-6 over six days. At 10 ng/ml, IL-6 significantly repressed erythropoietin-dependent TF-1 erythroid maturation. While IL-6 did not decrease the expression of genes associated with hemoglobin synthesis, we observed impaired hemoglobin synthesis as demonstrated by decreased benzidine staining. We also observed that IL-6 down regulated expression of the gene SLC4a1 which is expressed late in erythropoiesis. Those findings suggested that IL-6-dependent inhibition of hemoglobin synthesis might occur. We investigated the impact of IL-6 on mitochondria. IL-6 decreased the mitochondrial membrane potential at all treatment doses, and significantly decreased mitochondrial mass at the highest dose. Our studies indicate that IL-6 may impair mitochondrial function in maturing erythroid cells resulting in impaired hemoglobin production and erythroid maturation. Our findings may indicate a novel pathway of action for IL-6 in the anemia of inflammation, and draw attention to the potential for new therapeutic targets that affect late erythroid development.

Association of lower hemoglobin level and neuropathology in community-dwelling older persons

Lower hemoglobin levels have been associated with cognitive decline in older persons. The objective of this study was to investigate the relationship between lower hemoglobin levels and common, age-related neuropathologies associated with cognitive decline. Hemoglobin and neuropathology measures were available in 113 deceased, community-dwelling, older adults participating in the Rush Memory and Aging Project, a prospective, observational, clinical pathology study of aging. The mean hemoglobin level was 13.0 g/dL (SD = 1.4) and was measured 3.2 (SD = 1.3) years prior to death. Thirty-five participants had at least one chronic macroscopic infarction and twenty-nine had at least one chronic microscopic infarction. Eleven participants had Lewy Bodies. The mean Alzheimer's disease pathology score based on a summary measure of neuritic plaques, diffuse plaques, and neurofibrillary tangles was 0.56 unit (SD = 0.56; range = 0, 2.34). Using logistic regression models adjusted for age at death, gender, and education, each g/dL lower hemoglobin level increased the odds for having a chronic macroscopic infarction by 37% (95% CI = 1.01, 1.86) but not for having a chronic microscopic infarction (OR = 1.11; 95% CI = 0.82, 1.52) or Lewy Bodies (OR = 1.07; 95% CI = 0.68, 1.68). In an adjusted multiple regression model, hemoglobin level was not associated with the global AD pathology measure (parameter estimate = -0.02, SE = 0.03, p = 0.6). In secondary analyses, lower hemoglobin levels were associated with higher odds of having a chronic macroscopic infarction in a subcortical region but not with higher total subcortical chronic macroscopic infarction volume. In conclusion, lower hemoglobin levels appear to be associated with chronic macroscopic infarctions but not other common age-related neuropathologies.

Investigation of the role of interleukin-6 and hepcidin antimicrobial peptide in the development of anemia with age

Anemia is common in older adults and associated with adverse health outcomes in epidemiological studies. A thorough understanding of the complex pathophysiological mechanisms driving anemia in the elderly is lacking; but inflammation, iron restriction, and impaired erythroid maturation are thought to influence the phenotype. We hypothesized that interleukin-6 contributes to this anemia, given its pro-inflammatory activities, its ability to induce hepcidin antimicrobial peptide, and its negative impact on several tissues in older adults. We tested this hypothesis by comparing changes in indices of inflammation, iron metabolism and erythropoiesis in aged C57BL/6 mice to aged mice with targeted deletions of interleukin-6 or hepcidin antimicrobial peptide. Circulating neutrophil and monocyte numbers and inflammatory cytokines increased with age. Decline in hemoglobin concentration and red blood cell number indicated that C57BL/6, interleukin-6 knockout mice, and hepcidin antimicrobial peptide knockout mice all demonstrated impaired erythropoiesis by 24 months. However, the interleukin-6 knock out genotype and the hepcidin antimicrobial peptide knock out genotype resulted in improved erythropoiesis in aged mice. Increased erythropoietic activity in the spleen suggested that the erythroid compartment was stressed in aged C57BL/6 mice compared to aged interleukin-6 knockout mice. Our data suggest C57BL/6 mice are an appropriate mammalian model for the study of anemia with age. Furthermore, although interleukin-6 and hepcidin antimicrobial peptide are not required, they can participate in the development of anemia in aging mice, and could be targeted, pre-clinically, with existing interventions to determine the feasibility of such agents for the treatment of anemia in older adults.

Anemia and risk of dementia in older adults: findings from the Health ABC study

OBJECTIVE

To determine whether anemia is associated with incident dementia in older adults.

METHODS

We studied 2,552 older adults (mean age 76.1 years; 38.9% black; 51.8% female) participating in the Health, Aging, and Body Composition study and free of dementia at baseline. We defined anemia using WHO criteria (hemoglobin concentration <13 g/dL for men and <12 g/dL for women). Dementia diagnosis was determined by dementia medication use, hospital records, or a change in modified mini-mental state (3MS) score of more than 1.5 SD from mean. Discrete time Cox proportional hazard regression models were used to examine the hazard for developing dementia associated with anemia.

RESULTS

Of 2,552 participants, 393 (15.4%) older adults had anemia at baseline [corrected]. Over 11 years of follow-up, 455 (17.8%) participants developed dementia. In the unadjusted model, those with baseline anemia had an increased risk of dementia (23% vs. 17%, hazard ratio = 1.64; 95% confidence interval 1.30, 2.07) compared to those without anemia. The association remained significant after adjusting for demographics, APOE ε4, baseline 3MS score, comorbidities, and renal function. Additional adjustment for other anemia measures (mean corpuscular volume, red cell distribution width), erythropoietin, and C-reactive protein did not appreciably change the results. There was no interaction by sex and race on risk of developing dementia.

CONCLUSION

Among older adults, anemia is associated with an increased risk of developing dementia. Findings suggest that further study of anemia as a risk factor for dementia and a target for intervention for cognitive health is warranted.

Metabolic syndrome and hemoglobin levels in elderly adults: the Invecchiare in Chianti Study

OBJECTIVES

To assess the association between metabolic syndrome (MetS) and hemoglobin levels in older adults.

DESIGN

The Invecchiare in Chianti (InCHIANTI) Study, a cohort study with a 6-year follow-up.

SETTING

Tuscany, Italy.

PARTICIPANTS

Adults aged 65 and older (N = 1,036).

MEASUREMENTS

MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III criteria. The adjusted association between baseline hemoglobin and MetS was assessed using multivariable linear regression with hemoglobin as a continuous variable and using logistic regression with median hemoglobin level as the reference. Logistic regression was also performed with any incident decline in hemoglobin levels as the dependent variable.

RESULTS

MetS was diagnosed in 263 (25%) participants. At baseline, MetS was associated with higher hemoglobin levels (B = 0.18, 95% confidence interval (CI) = 0.03-0.33, P = .02) and with hemoglobin levels above the median value (odds ratio (OR) = 1.65, 95% CI = 1.17-2.32, P = .004) after adjusting. After 6 years, MetS was associated with lower adjusted probability of lower hemoglobin levels (OR = 0.34, 95% CI = 0.15-0.79, P = .012) but only in the oldest tertile of participants.

CONCLUSION

MetS is associated with higher hemoglobin levels in older subjects and with lower probability of hemoglobin loss over 6 years in those in the oldest age group.

Iron deficiency anemia in women across the life span

Anemia is a global health issue with disproportionately high prevalence in women. In addition to being an independent risk factor for decreased quality of life and increased morbidity and mortality, anemia in women has been linked to unfavorable outcomes of pregnancy and other issues for children born to anemic women. Iron deficiency is the leading cause of anemia in many populations. Guidelines recommend proactive screening for anemia, particularly in the preoperative setting. Once anemia is diagnosed, treatment should be based on etiology (most commonly, iron deficiency followed, in order of prevalence, by inflammation or chronic disease). Iron supplementation (oral and intravenous) offers safe and effective treatment for anemia associated with iron deficiency. Anemia of chronic disease may be more challenging to treat, and attention must be given to the underlying disease, along with use of hematinic agents. Given its enormous impact on the health and well-being of women and the availability of simple and effective treatment options, anemia should never be left unmanaged.

Medical outcome of patients with dementia in a free-standing psychiatric hospital

BACKGROUND

The hospital outcome of patients with dementia is significantly worse than that of cognitively intact persons of the same age admitted to medical or surgical units but has not been investigated in psychiatric settings.

AIM OF STUDY

To determine the medical outcome of patients with dementia admitted for behavioral disturbance to a free-standing psychiatric hospital.

METHODS

Emergency transfers from the psychiatric setting to a general hospital were used as proxies for medical deteriorations occurring among the 71 patients with dementia (age 78.4 ± 10.4 years; 40.1% males) and 71 age- and gender-matched nondementia control patients. The patients were identified in a cohort of 1000 patients consecutively admitted to a free-standing mental health institution. Logistic regression was used to determine the clinical and laboratory variables independently associated with medical deteriorations.

RESULTS

A total of 30 patients with dementia and 25 nondementia patients were transferred to a general hospital after an acute medical deterioration (42.3% vs 35.2%, P = .38). Febrile illnesses and falls with head trauma were the most common reasons for transfers in the dementia group, in which they constituted more than half of medical deteriorations, a proportion significantly higher than in the control group (P = .011). Admission hemoglobin levels were the only independent predictor of medical deterioration in this geriatric sample.

CONCLUSIONS

Although nearly 50% of patients with dementia admitted for behavioral disturbance to a free-standing psychiatric institution required transfer to a general hospital, their rate of medical deteriorations was similar to age-matched nondementia control patients.

Patterns of regional cerebral blood flow associated with low hemoglobin in the Baltimore Longitudinal Study of Aging

BACKGROUND

Anemia has been associated with elevated cerebral blood flow (CBF) in animal models and certain clinical conditions (eg, renal disease), but whether hemoglobin level variations across a relatively normal range are associated with local or diffuse CBF changes is unclear. We investigated whether lower hemoglobin is associated with regional increases in relative CBF in older individuals, and if these increases occur in watershed regions.

METHODS

Seventy-four older nondemented adults underwent serial (15)O water positron emission tomography scans. Voxel-based analysis was used to investigate regional relative CBF patterns in association with hemoglobin level and in individuals with and without anemia. Analyses of cross-sectional relations between regional CBF and anemia were performed separately at two time points, 2 years apart, to identify replicable patterns of associations.

RESULTS

Restricting results to associations replicated across two cross-sectional analyses, lower hemoglobin was associated with higher relative CBF within the middle/inferior frontal, occipital, precuneus, and cerebellar regions. In addition, individuals with anemia (n = 15) showed higher relative CBF in superior frontal, middle temporal, hippocampal, and gyrus rectus regions than those without anemia. In some regions (right superior temporal gyrus, left inferior frontal gyrus, midline cuneus, and right precuneus); however, lower hemoglobin was associated with lower relative CBF.

CONCLUSIONS

In nondemented individuals, lower hemoglobin is associated with elevated relative CBF in specific cortical areas but reduced CBF in other areas. Whether this association between anemia and CBF in the absence of chronic diseases and in a normal physiologic range is related to clinical endpoints warrants further study.

Not so benign haematology: anaemia of the elderly

Developed countries, such as the United Kingdom, are experiencing a change in demographics resulting in the largest proportion of adults over 65 years of age that our health systems have ever experienced. As such, haematologists must be prepared to evaluate and treat anaemia in a more complicated patient population, but sufficient evidence-based guidelines are lacking. Critical next steps that must be taken to ensure the best care of this population include the determination of appropriate haemoglobin concentrations for older adults in light of age, gender, race, and comorbidities; the development of interventional trials that address physical performance outcomes in addition to haemoglobin targets; and translational studies which address the molecular pathogenesis of anaemia in older adults with the most advanced scientific approaches.

Anemia and dementia among the elderly: the São Paulo Ageing & Health Study

BACKGROUND

Anemia and dementia are common diseases among the elderly, but conflicting data are available regarding an association between these two conditions. We analyzed data from the São Paulo Ageing & Health Study to address the relationship between anemia and dementia.

METHODS

This cross-sectional observational study included participants aged 65 years and older from a deprived area of the borough of Butantan, São Paulo, Brazil. Data about demographics, education, income, and cognitive and daily life function were collected, as well as blood samples. Anemia and dementia were defined according to WHO and DSM-IV criteria, respectively.

RESULTS

Of the 2267 subjects meeting the inclusion criteria, 2072 agreed to participate in the study; of whom 1948 had a valid total blood count and were included in the analysis. Anemia was diagnosed in 203 (10.2%) participants and dementia in 99 (5.1%). The frequency of anemia was higher in patients with dementia according to univariate analysis (odds ratio (OR) = 2.00, 95% confidence interval (CI) = 1.17-3.41, p = 0.01), but this association was not present after adjusting for age (OR = 1.33, 95% CI = 0.76-2.33, p = 0.32). Further multivariate adjustment did not change the results.

CONCLUSION

Although anemia and dementia are frequent disorders in older people, we found their relationship to be mediated exclusively by aging in this low-income population from São Paulo.

Pervasive cognitive impairment in acute rehabilitation inpatients without brain injury

OBJECTIVE

To establish feasibility for the hypothesis that patients in acute rehabilitation who are hospitalized for disorders not known to involve cerebral injury can have significant cognitive impairment.

DESIGN

A comparison of performances on neuropsychological tests between 2 samples of subjects: inpatients in an acute rehabilitation hospital without known cerebral disease and normal community-dwelling persons.

SETTING

Acute inpatient rehabilitation hospital.

PATIENTS AND PARTICIPANTS

Nineteen hospitalized patients without delirium who were screened for pre-existing cerebral and psychiatric illness, dementia, and dependency in basic self-care skills before hospitalization. Eighteen community-dwelling persons who were not different in terms of age and education served as the control group.

METHODS

Participants completed 10 commonly used neuropsychological tests of executive, language, and memory functions. Data were analyzed by using multivariate analysis of variance.

MAIN OUTCOME MEASUREMENTS

Raw scores on the 10 neuropsychological tests.

RESULTS

Hospitalized patients performed significantly worse on 9 of 10 tests than community-dwelling participants. Older hospitalized participants had significantly greater cognitive impairment than younger hospitalized participants, which suggested increased susceptibility to effects of hospitalization on cognition.

CONCLUSIONS

Patients hospitalized without brain injury, and especially elderly patients, should be carefully monitored for cognitive deficits that may affect posthospitalization quality of living. Further research is needed to determine whether the cognitive deficits in such patients persist after discharge and affect functional independence, and to identify mechanisms for the deficits. Furthermore, the use of hospitalized participants without brain injury as control subjects in neuropsychological studies of brain injury should be balanced with an additional comparison group of matched, neurologically healthy, normal subjects who live in the community to control for cognitive impairments that are associated with acute hospitalization.

Anemia associated with depressive symptoms in mild cognitive impairment with severe white matter hyperintensities

Depression with mild cognitive impairment (MCI) may be associated with a high risk of dementia. Likewise, anemia and subcortical ischemic changes might be associated with depression in the elderly individuals. We examined the relationship between anemia, subcortical ischemic changes, and depressive symptoms in 388 elderly patients with MCI (74.0% women, mean age = 71.8) who were evaluated at the Clinical Research Center for Dementia of South Korea. Blood samples were drawn from all consenting participants and depressive symptoms were assessed using the 15-item Geriatric Depression Scale (GDS-15). We also evaluated the severity of white matter hyperintensities (WMH) on brain using magnetic resonance imaging (MRI). After a multivariable adjustment, we found no significant differences in GDS-15 score between anemic and nonanemic groups (F = 3.0, P = .085) and among WMH level groups (F = 0.6, P = .574) independently. However, the interaction between anemia and the severity of WMH was significantly associated with depressive symptoms (analysis of covariance, F = 7.8, P < .001). In post hoc tests, a higher depressive symptom score was observed in anemic participants with severe WMH. Anemia with severe subcortical ischemic changes appears to be related to depressive symptoms in patients with MCI.

Occurrence of medical co-morbidity in mild cognitive impairment: implications for generalisation of MCI research

BACKGROUND

diagnosis of mild cognitive impairment (MCI) typically excludes individuals with medical co-morbidity. Interest in MCI screening raises the questions of what are the best criteria to identify a representative sample and what factors are associated with MCI progression to dementia.

OBJECTIVES

to compare the pattern of disease co-morbidity across different cognitive groups and to examine the role of health co-morbidity as a risk factor for dementia progression from MCI.

METHODS

individuals from the MRC Cognitive Function and Ageing Study were classified as having no cognitive impairment (NCI), MCI, other cognitive impairment no dementia (OCIND) or dementia. At 2 years dementia status was assessed.

FINDINGS

over 50% of individuals in each group reported one or more medical condition. The pattern of disease prevalence was similar in the NCI, MCI and OCIND groups. Anaemia was the only health factor associated with an increased risk of dementia progression from MCI.

CONCLUSION

classification of MCI using medical exclusions would exclude the majority of the population from a MCI diagnosis. This has implications for treatment decisions and clinical trial recruitment. This could not only make recruitment more difficult but also limit the generalisability of trial results. Medical co-morbidity does not help to distinguish progressive from non-progressive MCI.

Anemia in frailty

Although anemia is regarded as a relatively common occurrence in older adults, the vigor with which the medical community should intervene to correct this common problem is disputed. Epidemiologic data clearly correlate anemia with functional decline, disability, and mortality. Anemia may contribute to functional decline by restricting oxygen delivery to muscle, or to cognitive decline by restricting oxygen delivery to the brain. On the other hand, the erythron may be a separate target of the same biologic mediators that influence deterioration of physiologic systems that contribute to weakness, functional and cognitive decline, and mortality. Clinical trials aimed at treating anemia in older adults could assess whether physical performance is improved or whether mortality risk declines with improved hemoglobin, but sufficient evidence from such trials is currently lacking. With few guidelines regarding treatment of older adults and significant risk for adverse events associated with transfusion and erythroid stimulating agents, anemia often goes untreated or ignored in geriatric clinics. This article reviews the problem of anemia in older adults, with a particular emphasis on the frail elderly. The gaps in the evidence base for the treatment of anemia in older adults are reviewed and the options for advancing the field are assessed.

Hemoglobin concentration and cognitive impairment in the renal REasons for Geographic And Racial Differences in Stroke (REGARDS) Study

BACKGROUND

There is growing interest in determining the degree of anemia, which is clinically significant. The goal of this study was to determine the association between hemoglobin concentration and cognitive impairment in a large sample of U.S. adults.

METHODS

We used cross-sectional data from 19,701 adults participating in the REasons for Geographic And Racial Differences in Stroke study. Cognitive impairment was defined as a score of 4 or less on the six-item screener. Hemoglobin was analyzed in 1 g/dL increments relative to the World Health Organization (WHO) threshold (<13 g/dL for men and <12 g/dL for women).

RESULTS

The mean hemoglobin concentration was 13.7 ± 1.5 g/dL. The prevalence of cognitive impairment increased from 4.3% among individuals with a hemoglobin >3 g/dL above the WHO threshold to 16.8% for those with a hemoglobin ≥2 g/dL below the WHO threshold. After adjustment for demographics, chronic health conditions, health status, and inflammation, the association between reduced hemoglobin and cognitive impairment was attenuated and no longer significant, including among those with hemoglobin ≥2 g/dL below the WHO threshold (odds ratio 1.39, 95% confidence interval = 0.94-2.04). A test for linear trend was of borderline significance (p value = .06). For 94% of the sample within 2 g/dL of the WHO threshold, there was no relationship between hemoglobin concentration and the odds of cognitive impairment. The associations did not differ by sex and race.

CONCLUSIONS

Within a large sample of community-dwelling adults, there was no significant association between hemoglobin concentration and cognitive impairment after multivariable adjustment.

[Cognitive impairment and chronic kidney disease: which links?]

Ageing of the population leads to an increase of cognitive disorders and chronic renal failure incidence. Compared to the general population, prevalence of cognitive impairment is more important in renal failure patients, especially in dialyzed patients. No direct link has been established between renal failure and cognitive impairment. The care of older and older patients and the high frequency of vascular risk factors, in particular hypertension and diabetes, partially explain the prevalence of vascular dementia and Alzheimer disease in this population. Other factors as the anemia, phosphocalcic metabolism disorders facilitate the cognitive impairment. The present work reviews the links existing between chronic renal failure and cognitive impairment.