Cognitive assessment in an elderly population with metabolic syndrome in Brazil

Shigaeff, Nadia; Jacinto, Alessandro Ferrari; Franco, Fabio Gazelato de Mello; Chiochetta, Gabriela; Cendoroglo, Maysa Seabra; Cítero, Vanessa de Albuquerque

doi:10.1590/S1980-57642013DN70200011

ABSTRACT

Chronic degenerative conditions are very common in the elderly. According to medical literature, there is a correlation between cognitive impairment among elders and arterial hypertension/hyperglycemia which in turn are common diseases among the elderly population worldwide. Nonetheless, data on the association between cognitive impairment and Metabolic Syndrome (MetS) remains controversial. Objective: To compare the cognitive status of Brazilian elderly outpatients with and without MetS. Methods: A cross-sectional case-control study with 49 subjects (25 MetS and 24 controls) who underwent a global geriatric and neuropsychological assessment was carried out. The scores for cognitive abilities (sustained attention, alternating attention, immediate memory, working memory, memory - immediate recall, memory - delayed recall, memory - recognition, executive function, ideomotor praxis, constructive praxis, naming ability, verbal fluency) were compared with the data for the normal population and differences between case and control groups were analyzed using Student's t-test or the Mann-Whitney test. Results: Forty-five patients (91.8%) were female, with a mean age of 73.9±5.9 years, and 3.0±1.0 years of schooling. A significant difference (p<0.01) was found between case and control groups regarding the MetS components. For cognitive abilities, no statistically significant difference was detected between the groups and all subjects presented low cognitive scores. Conclusion: The results obtained in the present study showed that MetS was not associated with cognitive impairment in this population. Further prospective studies are necessary to investigate the influence of well-controlled MetS on cognitive performance among elders.

Key words:
metabolic syndrome X; neuropsychological tests; cognition disorders; memory; attention; elderly

RESUMO

Quadros crônico-degenerativos são prevalentes na população idosa. Estudos prévios tem correlacionado prejuízo cognitivo em idosos com hipertensão e hiperglicemia que por sua vez são doenças bastante comuns do envelhecimento na população mundial. Apesar disso ainda existem dados controversos sobre a associação entre prejuízo cognitivo e síndrome metabólica (SMet). Objetivo: Comparar o estado cognitivo de pacientes brasileiros idosos em atendimento ambulatorial com e sem SMet. Métodos: Estudo de caso-controle transversal com 49 pacientes (25 com SMet e 24 controles) que foram submetidos à avaliação geriátrica global e neuropsicológica. Os escores de habilidades cognitivas (atenção sustentada, atenção alternada, memória imediata, memória operacional, memória tardia - evocação imediata, tardia e de reconhecimento -, função executiva, praxia ideomotora, praxia visuo-construtiva, habilidade de nomeação e fluência verbal) foram comparados com dados da população saudável e a diferença entre caso e controle foi analisada usando o teste t de Student ou o teste de Mann-Whitney. Resultados: Quarenta e cinco pacientes (91.8%) foram mulheres com idade média de 73.9±5.9 anos e escolaridade média de 3.0±1.0 anos. Observou-se uma diferença significativa (p<0.01) entre os grupos com relação aos critérios da SMet. Com relação às habilidades cognitivas não houve diferença estatística entre os grupos e todos os pacientes apresentaram baixo escore cognitivo. Conclusão: Os resultados obtidos no presente estudo indicaram que a SMet não foi associada com o prejuízo cognitivo nesta população. Outros estudos prospectivos são necessários para melhor investigar a influência de idosos bem compensados nos componentes da SMet no desempenho cognitivo ao longo do tempo.

Palavras-chave:
síndrome X metabólica; neuropsicologia; transtornos cognitivos; memória; atenção; idoso

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REFERENCES

Instituto Brasileiro de Geografia e Estatística. Perfil dos Idosos Responsáveis pelos Domicílios no Brasil - 2000, 9. Retrieved from: http://www.ibge.gov.br/home/estatistica/populacao/perfilidoso/perfidosos2000.pdf; 2002.
» http://www.ibge.gov.br/home/estatistica/populacao/perfilidoso/perfidosos2000.pdf
Instituto Brasileiro de Geografia e Estatística. Indicadores sócio-demográficos e de saúde no Brasil- 2009, 25. Retrieved from: http://www.ibge.gov.br/home/estatistica/populacao/indic_sociosaude/2009/indicsaude.pdf; 2009.
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Jacinto AF, Brucki S, Porto CS, Martins MA, Nitrini R. Detection of cognitive impairment in the elderly by general internists in Brazil. Clinics 2011;66:1379-1384.
Yaffe K, Blackwell T, Kanaya AM, Davidowitz N, Barrett-Connor E, Krueger K. Diabetes, impaired fasting glucose, and the development of cognitive impairment in older women. Neurology 2004;63:658-663.
Yeung SE, Thorton WL. Age-related effects of blood pressure on everyday cognitive function in community-dwelling women. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2011;18:733-755.
Cuevas A, Alvarez V, Carrasco F. Epidemic of metabolic syndrome in Latin America. Curr Opin Endocrinol Diabetes Obes 2011;18(2):134-138.
Dik MG, Jonker C, Cumijs HC, et al. Contribuition of Metabolic Syndrome Components to Cognition in Older Individuals. Diabetes Care 2007;30:2655-2660.
Grundy SM, Cleeman JI, Daniel SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112:2735-2752.
Hoth KF, Gonzales MM, Tarumi T, Miles SC, Tanaka H, Haley AP. Functional MR Imaging Evidence of Altered Functional Activation in Metabolic Syndrome. AJNR Am J Neuroradiol 2001;32:541-547.
Yaffe K. Metabolic syndrome and cognitive disorders: is the sum greater than its parts? Alzheimer Dis Assoc Disord 2007;21: 167-171.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions for use of the Mini Mental State Exam in Brazil. Arq Neuropsiquiatr 2003;61:777-781.
Lesak MD, Howieson DB, Loring DW. Basic Concepts. In: Neuropsychological Assessement (4rd Ed). New York: Oxford University Press; 2004:15-38.
Aballay LR, Eynard AR, Díaz M del P, Navarro A, Muñoz SE. Overweight and obesity: a review of their relationship to metabolic syndrome, cardiovascular disease, and cancer in South America. Nutr Rev 2013;71(3):168-179.
Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category Fluency as a Screening Test for Alzheimer Disease in Illiterate and Literate Patients. Alzheimer Dis Assoc Disord2007;21:65-67.
Laks J, Coutinho ESF, Junger W, et al. Education does not equally influence all the Mini Mental State Examination subscales and items: inferences from a Brazilian community sample. Rev Bras Psiquiatr 2010;32:223-230.
Lourenço RA, Ribeiro-Filho ST, Moreira IFH, Paradela EMP, Miranda AS. The Clock Drawing Test: performance among elderly with low educational level. Rev Bras Psiquiatr2008;30:309-315.
Roberts RO, Geda YE, Knopman DS, et al. Metabolic Syndrome, Inflammation, and Non-Amnestic Mild Cognitive Impairment in Older Persons: a population-based study. Alzheimer Dis Assoc Disord2010;24:11-18.

Publication Dates

Publication in this collection
Apr-Jun 2013

History

Received
30 Mar 2012
Accepted
31 May 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Instituto Brasileiro de Geografia e Estatística. Perfil dos Idosos Responsáveis pelos Domicílios no Brasil - 2000, 9. Retrieved from: http://www.ibge.gov.br/home/estatistica/populacao/perfilidoso/perfidosos2000.pdf; 2002.
» http://www.ibge.gov.br/home/estatistica/populacao/perfilidoso/perfidosos2000.pdf

[2] Instituto Brasileiro de Geografia e Estatística. Indicadores sócio-demográficos e de saúde no Brasil- 2009, 25. Retrieved from: http://www.ibge.gov.br/home/estatistica/populacao/indic_sociosaude/2009/indicsaude.pdf; 2009.
» http://www.ibge.gov.br/home/estatistica/populacao/indic_sociosaude/2009/indicsaude.pdf

[3] Jacinto AF, Brucki S, Porto CS, Martins MA, Nitrini R. Detection of cognitive impairment in the elderly by general internists in Brazil. Clinics 2011;66:1379-1384.

[4] Yaffe K, Blackwell T, Kanaya AM, Davidowitz N, Barrett-Connor E, Krueger K. Diabetes, impaired fasting glucose, and the development of cognitive impairment in older women. Neurology 2004;63:658-663.

[5] Yeung SE, Thorton WL. Age-related effects of blood pressure on everyday cognitive function in community-dwelling women. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn 2011;18:733-755.

[6] Cuevas A, Alvarez V, Carrasco F. Epidemic of metabolic syndrome in Latin America. Curr Opin Endocrinol Diabetes Obes 2011;18(2):134-138.

[7] Dik MG, Jonker C, Cumijs HC, et al. Contribuition of Metabolic Syndrome Components to Cognition in Older Individuals. Diabetes Care 2007;30:2655-2660.

[8] Grundy SM, Cleeman JI, Daniel SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005; 112:2735-2752.

[9] Hoth KF, Gonzales MM, Tarumi T, Miles SC, Tanaka H, Haley AP. Functional MR Imaging Evidence of Altered Functional Activation in Metabolic Syndrome. AJNR Am J Neuroradiol 2001;32:541-547.

[10] Yaffe K. Metabolic syndrome and cognitive disorders: is the sum greater than its parts? Alzheimer Dis Assoc Disord 2007;21: 167-171.

[11] Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions for use of the Mini Mental State Exam in Brazil. Arq Neuropsiquiatr 2003;61:777-781.

[12] Lesak MD, Howieson DB, Loring DW. Basic Concepts. In: Neuropsychological Assessement (4rd Ed). New York: Oxford University Press; 2004:15-38.

[13] Aballay LR, Eynard AR, Díaz M del P, Navarro A, Muñoz SE. Overweight and obesity: a review of their relationship to metabolic syndrome, cardiovascular disease, and cancer in South America. Nutr Rev 2013;71(3):168-179.

[14] Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category Fluency as a Screening Test for Alzheimer Disease in Illiterate and Literate Patients. Alzheimer Dis Assoc Disord2007;21:65-67.

[15] Laks J, Coutinho ESF, Junger W, et al. Education does not equally influence all the Mini Mental State Examination subscales and items: inferences from a Brazilian community sample. Rev Bras Psiquiatr 2010;32:223-230.

[16] Lourenço RA, Ribeiro-Filho ST, Moreira IFH, Paradela EMP, Miranda AS. The Clock Drawing Test: performance among elderly with low educational level. Rev Bras Psiquiatr2008;30:309-315.

[17] Roberts RO, Geda YE, Knopman DS, et al. Metabolic Syndrome, Inflammation, and Non-Amnestic Mild Cognitive Impairment in Older Persons: a population-based study. Alzheimer Dis Assoc Disord2010;24:11-18.

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