Control of diabetes and fibrinogen levels as well as improvement in health care might delay low cognitive performance in societies aging progressively

Lopes, Daniele Almeida; Moraes, Suzana Alves de; Freitas, Isabel Cristina Martins de

doi:10.1590/0004-282X20140189

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Arquivos de Neuro-Psiquiatria

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Articles • Arq. Neuro-Psiquiatr. 73 (1) • Jan 2015 • https://doi.org/10.1590/0004-282X20140189 copy

Control of diabetes and fibrinogen levels as well as improvement in health care might delay low cognitive performance in societies aging progressively

Controle do diabetes e dos níveis de fibrinogênio, bem como melhora no cuidado com a saúde, podem retardar o baixo desempenho cognitivo em sociedades que apresentam envelhecimento progressivo

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective

To know the prevalence and factors associated to low cognitive performance in a representative sample of the adult population in a society aging progressively.

Method

Cross-sectional population-based study carried out in a three-stage sampling: 81 census tracts (primary sampling unity) were randomly selected, followed by 1,672 households and 2,471 participants (weighted sample) corresponding to the second and third stages, respectively. The outcome prevalence was calculated according sociodemographic, behavioral and health related variables. Crude and adjusted prevalence ratios were estimated using Poisson regression.

Results

The prevalence of low cognitive performance was high, mainly among females, and indicated linear trends into categories of age, schooling, income, plasma fibrinogen and self-reported health status. In multivariate models, gender, diabetes, fibrinogen and self-reported health status presented positive associations, while schooling, employment and sitting time presented negative associations with the outcome.

Conclusion

Interventions related to diabetes and fibrinogen levels control as well as improvement in health care might delay low cognitive performance in societies aging progressively as such the study population.

cognitive impairment; adults; associated factors; cross-sectional studies

	N_w	%	95%CI
Gender
Male	995.70	40.30	37.21-43.36
Female	1,475.00	59.70	56.64-62.69
Age groups
30-39 years	661.30	26.76	23.40-30.42
40-49 years	765.70	30.99	28.30-33.81
50-59 years	507.30	20.53	18.26-23.00
≥ 60 years	536.60	21.72	18.85-24.89
Schooling
0-3 years	343.80	14.06	11.52-17.05
4-7 years	739.80	30.25	26.60-34.16
8-11 years	821.50	33.59	30.34-37.00
≥ 12 years	540.80	22.11	17.03-28.19
Individual income (in R$)
No income	848.90	34.35	31.60-37.21
1^st tertile ( ≥ 50.00 ≤ 700.00)	549.70	22.25	19.28-25.53
2^nd tertile (> 700.00 ≤ 1,400.00)	506.00	20.48	17.99-23.20
3^rd tertile (> 1,400.00)	566.40	22.92	19.25-27.06
Marital status
Without partner	824.80	33.38	30.07-36.86
With partner	1,646.00	66.62	63.14-69.93
Employment
No	847.80	34.31	31.55-37.17
Yes	1,623.00	65.69	62.83-68.45

Age groups	Male (n_w= 995.7)*		Female (n_w= 1,475.0)*
Age groups	> 25% [95%CI]	≤ 25% [95%CI]	> 25% [95%CI]	≤ 25% [95%CI]
30-39 years	79.85 [72.73-85.48]	20.15 [14.52-27.27]	72.43 [61.44-81.24]	27.57 [18.76-38.56]
40-49 years	76.13 [67.03-83.34]	23.87 [16.66-32.97]	68.17 [58.74-76.31]	31.83 [23.69-41.26]
50-59 years	73.34 [62.14-82.18]	26.66 [17.82-37.86]	64.49 [54.79-73.12]	35.51 [26.88-45.21]
≥ 60 years	62.93 [50.51-73.85]	37.07 [26.15-49.49]	47.30 [37.39-57.42]	52.70 [42.58-62.61]
Total	74.27 [69.07-78.87]	25.73 [21.13-30.93]	63.47 [57.94-68.66]	36.53 [31.34-42.06]

	LCP prevalence [95%CI]	Crude PR [95%CI]	Adjusted PR [95%CI]
Gender
Male	25.73 [21.13-30.93]	1	1
Female	36.53 [31.34-42.06]	1.42 [1.16-1.72]	1.25 [1.04-1.50]
Age groups
30-39 years	23.80 [18.38-30.23]	1	1
40-49 years	28.97 [22.84-35.98]	1.21 [0.92-1.60]	1.04 [0.80-1.34]
50-59 years	32.25 [25.47-39.86]	1.35 [1.01-1.81]	0.99 [0.74-1.32]
≥ 60 years	47.05 [38.50-55.78]	1.97 [1.47-2.65]	1.09 [0.83-1.45]
Schooling
0-3 years	69.87 [61.20-77.32]	1	1 ^†
4-7 years	39.82 [33.92-46.03]	0.56 [0.47-0.68]	0.60 [0.49-0.73]
8-11 years	20.24 [16.01-25.25]	0.28 [0.22-0.36]	0.32 [0.25-0.41]
≥ 12 years	13.71 [10.07-18.40]	0.19 [0.14-0.27]	0.22 [0.15-0.31]
Marital status
Without partner	36.08 [30.77-41.76]	1	1
With partner	30.26 [25.44-35.57]	0.83 [0.69-1.01]	0.98 [0.83-1.15]
Employment
No	45.62 [38.92-52.49]	1	1
Yes	25.27 [21.23-29.78]	0.55 [0.46-0.65]	0.82 [0.70-0.96]

	LCP prevalence [95%CI]	Crude PR [95%CI]	Adjusted PR [95%CI]
Metabolic waste (metsminweek^-1)
≤ 346.50	33.53 [28.12-39.42]	1	1
> 346.50	30.85 [26.22-35.89]	0.91 [0.76-1.10]	0.89 [0.75-1.07]
Sitting time (min/day)
1^st tertile (≤ 180)	38.20 [32.10-44.69]	1	1
2^nd tertile (> 180 ≤ 308.61)	28.42 [22.70-34.93]	0.74 [0.60-0.91]	0.73 [0.59-0.89]
3^rd tertile (> 380.61)	29.34 [24.48-34.72]	0.76 [0.62-0.93]	0.75 [0.61-0.91]
AUDIT (scores)
No dependence (0-7)	32.72 [28.26-37.51]	1	1
Light dependence (8-15)	26.30 [19.39-34.60]	0.80 [0.60-1.06]	0.80 [0.60-1.07]
Moderate dependence (16-19)	38.35 [23.23-56.11]	1.17 [0.73-1.87]	1.20 [0.74-1.95]
Severe dependence (20-40)	47.33 [29.63-65.73]	1.44 [0.99-2.10]	1.42 [0.97-2.08]
Years of smoking
No smoking	31.45 [26.75-36.56]	1	1
1^st tertile (1-13)	35.98 [28.73-43.93]	1.14 [0.90-1.44]	1.14 [0.90-1.44]
2^nd tertile (14-25)	25.12 [18.66-32.91]	0.79 [0.60-1.04]	0.77 [0.57-1.02]
3^rd tertile (> 25)	39.23 [30.28-48.98]	1.24 [0.96-1.60]	1.25 [0.96-1.63]

	LCP prevalence [95%CI]	Crude PR [95%CI]	Adjusted PR [95%CI]
Diabetes
No	29.27 [24.80-34.18]	1	1
Yes	42.39 [34.55-50.64]	1.44 [1.17-1.79]	1.34 [1.07-1.67]
Hipertension
No	30.12 [25.55-35.12]	1	1
Yes	35.32 [29.60-41.50]	1.17 [0.97-1.40]	1.15 [0.93-1.41]
Ischemic heart disease
No	31.08 [26.67-35.87]	1	1
Yes	40.08 [31.35-49.50]	1.28 [1.01-1.65]	1.10 [0.86-1.41]
Nutritional status (in kg/m²)
Eutrophic (18.5-24.9)	33.51 [27.46-40.16]	1	1
Overweight (25.0-29.9)	30.57 [25.56-36.09]	0.91 [0.73-1.12]	0.83 [0.67-1.04]
Obesity (≥ 30)	32.64 [27.03-38.80]	0.97 [0.78-1.20]	0.81 [0.64-1.03]
Fibrinogen (in mg/dL)
1^st tertile (≤ 311.3)	28.23 [22.68-34.53]	1	1
2^nd tertile (> 311.3 ≤ 345.3)	29.31 [23.37-36.04]	1.03 [0.80-1.33]	1.08 [0.83-1.40]
3^rd tertile (> 345.3)	39.44 [33.77-45.41]	1.39 [1.10-1.76]	1.27 [1.00-1.67]
Cholesterolemia (in mg/dL)
< 200	29.93 [25.55-34.72]	1	1
≥ 200	35.09 [29.60-41.01]	1.17 [1.00-1.37]	1.07 [0.89-1.28]
CNS medications
No	30.92 [26.77-35.40]	1	1
Yes	40.13 [30.96-50.06]	1.29 [1.03-1.63]	1.14 [0.86-1.50]
Self reported health status
Same (compared to friends)	26.98 [22.32-32.21]	1	1^†
Worse (compared to friends)	34.54 [29.01-40.53]	1.28 [1.04-1.57]	1.25 [1.01-1.54]
Better (compared to friends)	47.32 [37.13-57.74]	1.75 [1.37-2.23]	1.68 [1.29-2.19]

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[1] Correspondence:
Suzana Alves de Moraes; Av. Bandeirantes, 3900; 14040-902 Ribeirão Preto SP, Brasil; E-mail: samoraes@usp.br