Cognitive performance declined with increasing cardiometabolic burden, and the impact of demographic characteristics on cognition differed by domain, but higher education was consistently associated with higher cognitive scores.
Abstract
Objectives: Cardiometabolic risk factors are prevalent in the United States, and their association with cognitive outcomes is well-established. Opportunities to elucidate the unique and combined contributions of cardiometabolic burden to cognition are abound. Importantly, investigating the cognitive changes incurred as burden increases has scientific and clinical implications. Methods: Older adults (M = 69.3, SD = 8.35) from the National Neuropsychology Network (N = 4222) were included. Cardiometabolic burden, defined via ICD-10 diagnostic codes, and performance on cognitive measures were the primary variables. Domain-level cognitive differences were calculated using a multigroup confirmatory factor analysis. Structural equation modeling evaluated associations between cardiometabolic burden and cognition, adjusting for demographic characteristics. Results: Relative to those without cardiometabolic burden, persons with one condition performed worse on measures of attention and working memory (p < .001, d = 0.24) and visuoconstructional and visuoperceptual abilities (p < .01, d = 0.19), persons with two conditions performed worse on measures of language (p < .01, d = 0.24), attention and working memory (p < .01, d = 0.23), executive function (p < .001, d = 0.22), and visuoconstructional and visuoperceptual abilities (p < .01, d = 0.23), and persons with three or more conditions performed worse across all domains except language and immediate memory (drange = 0.27-0.48). The impact of demographic characteristics on cognition differed by domain, but higher education was consistently associated with higher cognitive scores. Conclusions: Cognitive performance declined with increasing cardiometabolic burden. More education was associated with higher cognitive scores. Our findings contribute to the literature linking cardiometabolic risk management and cognitive health. Future studies should investigate whether targeting specific cardiometabolic risk factors would effectively improve cognitive function longitudinally.
In cognitively healthy adults with prediabetes or well-controlled T2DM, higher HbA1c and triglycerides and lower HDL were associated with poorer domain-specific cognitive performance in the absence of overt cognitive impairment.
R. Hariharan, Simon M Bell, Arshad Majid et al.· Medical Science· 0 citations
It is suggested that higher CMI may indicate a greater risk of cognitive decline in older adults, and diabetes status significantly modified the CMI–GCF relationship.
Ying Liu, Qian Hu, Qin Li et al.· Medicine· 0 citations
Cognitive performance in people with Type 2 diabetes mellitus and their correlation with physical activity (PA)/fitness level and mood are examined and individuals with T2DM showed at least two to three times more frequent cognitive performances more than 1 SD below norm as compared with controls.
Sandra Rojas Vega, Andrea Solera-Herrera, Ramin Vafa et al.· Journal of Diabetes Research· 1 citation
Summary Background Insulin resistance is recognised as a midlife risk factor for cognitive decline, yet the pathways linking metabolic dysfunction to early brain changes remain unclear. Methods We cross-sectionally analysed 355 cognitively normal adults from the PREVENT cohort to test associations between insulin sensitivity (Homoeostatic Model Assessment for Insulin Resistance; HOMA-IR), frontal white matter hyperintensities (WMH), cerebral blood flow (CBF), hippocampal volume, and cognition. Findings Multivariable regression showed higher log-transformed HOMA-IR was associated with greater frontal WMH burden (β = 0.118, p = 0.026) and lower global cognitive performance (β = −0.132, p = 0.012). Decreased insulin sensitivity was not associated with global CBF (β = −0.019, p = 0.74). Adjusting for WMH burden, hippocampal volume, and CBF, lower insulin sensitivity remained associated with lower global cognition (β = −0.123, p = 0.021). Structural equation modelling (n = 328) demonstrated a direct negative association between higher HOMA-IR and cognition (β = −0.055, p = 0.042) and trended toward higher vascular burden (p = 0.06). The indirect pathway through vascular burden was non-significant (p = 0.23), as vascular burden, hippocampal volume, and CBF did not associate with cognition. Interpretation Decreased insulin sensitivity was linked to early small vessel disease and measurable cognitive differences, suggesting the cognitive association was largely direct rather than explained by vascular injury, hippocampal atrophy, or global perfusion. These findings point toward partially parallel metabolic and vascular pathways rather than a sequential process. These cross-sectional associations suggest that insulin sensitivity warrants investigation as a modifiable midlife factor for cognitive health; interventional studies are needed to determine whether targeting it preserves cognition before neurodegenerative markers emerge. Funding MRC Dementias Platform UK, NIHR, Alzheimer's Society, Alzheimer's Association, Race Against Dementia, and HRB.
Rohith Erukulla, Graham Reid, Courtney N. Yotter et al.· EBioMedicine· 0 citations
Background Social determinants of health (SDOH) are increasingly recognized as important drivers of cognitive outcomes. However, most existing evidence focuses on individual SDOH components and older populations. Objectives To develop a comprehensive SDOH index and examine its association with subsequent changes in cognitive function and structural brain measures in midlife. Design Prospective cohort study with repeated measures of cognition and brain imaging. Setting Community-based cohort from the Coronary Artery Risk Development in Young Adults (CARDIA) study. Participants A total of 3488 participants with SDOH data in early midlife (mean age 40.0 ± 3.6 years); 645 participants had repeated brain magnetic resonance imaging (MRI) data. Measurements A weighted aggregate SDOH index was constructed from 12 items across 5 domains: economic stability, community and social context, education, neighborhood and built environment, and health care access. Cognitive function was assessed using the Digit Symbol Substitution Test (DSST), Stroop Test, and Rey Auditory Verbal Learning Test (RAVLT). Brain MRI outcomes included white matter hyperintensities (WMHs) and total gray matter (GM) volume. Mixed linear regression models examined associations between SDOH quartiles and longitudinal cognitive and MRI outcomes, adjusting for demographics, vascular risk factors, depression, and intracranial volume (for MRI). Results At baseline, participants in the most disadvantaged SDOH quartile performed worse across all cognitive tests compared with the least disadvantaged quartile (p < 0.001). Over time, the most disadvantaged quartile showed steeper decline in DSST performance (adj. mean change: −0.72, 95% CI: −0.93 to −0.52 vs. −0.55, 95% CI: −0.76 to −0.34, p = 0.013), greater WMH accumulation (ratio: 1.07, 95% CI: 1.05 to 1.09 vs. 1.04, 95% CI: 1.03 to 1.05, p = 0.007), and steeper decline in total GM volume (−2.02 cm³, 95% CI: −2.39 to −1.65 vs. −1.46 cm³, 95% CI: −1.71 to −1.20, p = 0.011) per 5-year interval compared to the least disadvantaged quartile. Conclusions Greater social disadvantage in midlife is associated with worse baseline cognition and accelerated decline in cognitive function and brain integrity. These findings highlight the importance of SDOH as key determinants of brain health in midlife and suggest that strategies to mitigate social disadvantage may help preserve cognitive and brain health.
C. Dintica, Julia Cheunkarndee, R. Bryan et al.· The journal of prevention of...· 0 citations
Background: Mild cognitive impairment (MCI) represents an intermediate state between normal cognitive ageing and dementia. Given the increasing dementia burden in the country, there is a critical need for early detection through the assessment of MCI. However, studies that comprehensively examined the associations between micronutrients, neuronal markers, and cognitive impairment are scarce. Methods: A community-based cross-sectional study was conducted among 184 adults aged 55–85 years in Hyderabad between January 2024 and March 2025. Sociodemographic, anthropometric, biochemical, nutritional, and neuronal biomarkers were estimated. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) tool. Results: The study reported an MCI prevalence of 36.4% among older adults, significantly associated with higher HbA1c and systolic blood pressure, and elevated neuronal markers such as β-Amyloid, T tau, and Nfl. Vitamin D, B1, B2, B6, and B9 levels were significantly lower in the MCI group, with a higher burden of deficiency. Higher vitamin levels were correlated with better MoCA scores and a lower predicted probability of MCI, especially vitamins D and B6. In particular, B2 and B6 have shown associations with BDNF, tau, and Nfl markers. Conclusions: Lower levels of circulatory vitamins were significantly associated with a higher probability of MCI. Also, neuronal biomarkers were significantly associated with micronutrient deficiencies. These findings suggest that micronutrient deficiencies may be associated with MCI in older adults, highlighting the potential importance of maintaining adequate micronutrient status to support healthy cognitive aging and possibly reduce the risk of dementia. However, given the cross-sectional design of the present study, causal relationships cannot be established. Future longitudinal studies are warranted to validate these associations and further clarify the temporal relationship between micronutrient status and cognitive decline.
