Hypertension, diabetes and obesity are associated with lower cognitive performance in community-dwelling elderly: Data from the FIBRA study

Oliveira, Monalisa Fernanda Bocchi de; Yassuda, Mônica Sanches; Aprahamian, Ivan; Neri, Anita Liberalesso; Guariento, Maria Elena

doi:10.1590/1980-57642016dn11-040009

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 11 (4) • Oct-Dec 2017 • https://doi.org/10.1590/1980-57642016dn11-040009 copy

Hypertension, diabetes and obesity are associated with lower cognitive performance in community-dwelling elderly: Data from the FIBRA study

A HIPERTENSÃO, O DIABETES E A OBESIDADE ESTÃO ASSOCIADOS AO MENOR DESEMPENHO COGNITIVO EM IDOSOS RESIDENTES NA COMUNIDADE: DADOS DO ESTUDO FIBRA

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Background:

Systemic hypertension (SH), diabetes mellitus (DM) and abdominal obesity may negatively impact cognitive performance.

Objective:

To evaluate the association between SH, DM and abdominal obesity and cognitive performance among cognitively unimpaired elderly.

Methods:

A cross-sectional study of individuals aged 65+ from seven Brazilian cities was conducted. SH and DM diagnoses were self-reported and abdominal circumference was objectively measured. Individuals who scored below the education-adjusted cutoff scores on the Mini-Mental State Examination (MMSE) were excluded.

Results:

Among 2,593 elderly, 321 (12.38%) had SH, DM and abdominal obesity concomitantly (Group I) and 421 (16.23%) had none of the three diseases (Group II). Group I had a higher proportion of individuals that were women, aged 70-74 years, illiterate and with lower income. Group I had a higher number of participants with low cognitive performance (28.04% vs. 17.58% in Group II). Variables associated with poor cognitive performance were: female gender (OR: 2.43, p < 0.001); and lower education (OR: 0.410, p < 0.001). The presence of the three diseases and age were not significant in the education-adjusted model.

Conclusion:

There was an association between cognition and the presence of SH, DM and obesity. However, education seems to be decisive in determining cognitive performance in the presence of these three conditions.

Key words:
cognition; hypertension; diabetes mellitus; obesity; elderly

	Group I (n= 321) Mean±SD	Group II (n=421) Mean±SD	p
Age	72.08 ± 5.59	72.46 ± 5.62	0.287
Education^* * years of formal education;	3.62 ± 3.77	4.56 ± 4.27	0.003
Income^ number of minimum wages earned; MMSE: Mini-Mental State Examination; SD: standard deviation.	3.73 ± 6.22	4.10 ± 4.50	0.011
MMSE	24.45 ± 3.45	25.18 ± 2.81	0.018

Variables	Categories	Group I	Group II	p
Gender	Male	50 (15.67%)	269 (84.33%)	< 0.001^a a χ2 = 173.50, dF = 1;
Gender	Female	271 (64.07%)	152 (35.93%)	< 0.001^a a χ2 = 173.50, dF = 1;
Age	65-69	135 (46.55%)	155 (53.45%)	0.476^b b χ2 = 2.50, dF = 3;
	70-74	89 (41.98%)	123 (58.02%)
	75-79	65 (41.67%)	91 (58.33%)
	>80	32 (38.10%)	52 (61.90%)
Education^* * years of formal education.	0	90 (28.04%)	78 (18.57%)	0.002^c c χ2 = 14.40, dF = 3.
	1-4	158 (49.22 %)	211 (50.24%)
	5-8	47 (14.64 %)	69 (16.43%)
	>9	26 (8.10 %)	62 (14.76%)

Education^* * years of formal education.	Lower cognitive performance (n=164)		Higher cognitive performance (n=577)		p
Education^* * years of formal education.	Group I	Group II	Group I	Group II	p
0	72 (80%)	49 (62.82%)	18 (20%)	29 (37.18%)	0.013^a a χ2 = 6.12, dF = 1;
1-4	18 (11.39%)	25 (11.85%)	140 (88.61%)	186 (88.15%)	0.893^b b χ2 = 0.02, dF=1.
5-8	0	0	47 (100%)	69 (100%)
>9	0	0	26 (100%)	62 (100%)

Variables	Categories	P	OR	95%CI
Gender	Male (ref.)	---	1.00	---
Gender	Female	0.001	1.85	1.28-2.67
Age (y)	65-69 (ref.)	---	1.00	---
	70-74	0.096	1.47	0.93-2.31
	75-79	0.002	2.08	1.30-3.33
	≥ 80	< 0.001	2.65	1.53-4.61
Presence of SH/DM and abdominal obesity	Group II (ref.)	---	1.00	---
Presence of SH/DM and abdominal obesity	Group I	< 0.001	1.83	1.29-2.59
Education^* * years of formal education.	Continuous variable (years)	< 0.001	0.420	0.366-0.483

Selected variables	Categories	P	OR	95%CI
Education	Continuous variable (years)	< 0.001	0.410	0.356-0.473
Gender	Male (Ref.)	---	1.00	---
Gender	Female	< 0.001	2.43	1.51-3.89

Selected variables	Categories	P	OR	95%CI
Presence of SH / DM / abdominal obesity	Group II (Ref.)	---	1.00	---
Presence of SH / DM / abdominal obesity	Group I	0.029	1.57	1.05-2.35
Age (y)	65-69 (Ref.)	---	1.00	---
	70-74	0.058	1.56	0.99-2.47
	75-79	0.001	2.17	1.35-3.50
	≥80	< 0.001	3.01	1.71-5.29
Gender	Male (Ref.)	---	1.00	---
Gender	Female	0.034	1.58	1.04-2.42

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Maria Elena Guariento. Departamento de Clínica Médica Faculdade de Ciências Médicas – Unicamp. Avenida Tessália Vieira de Camargo, 126 / Cidade Universitária “Zeferino Vaz” / Distrito de Barão Geraldo – 13083-887 Campinas SP – Brazil. E-mail: meguar@fcm.unicamp.br