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P3‐118: Larger head circumference and greater education provide protection against incident dementia independent of the severity of Alzheimer pathology: The Nun Study
Author(s) -
Mortimer James A.,
Snowdon David A.,
Markesbery William R.
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.04.1093
Subject(s) - dementia , neuropathology , medicine , hazard ratio , head circumference , circumference , proportional hazards model , gerontology , disease , confidence interval , pregnancy , geometry , mathematics , biology , genetics , gestational age
Background: There is some evidence from population-based studies that clustering of vascular risk factors in the metabolic syndrome (MetS) is associated with cognitive dysfunction. It is, however, unclear whether MetS increases risk of cognitive dysfunction more than its individual components. The aim of this study was first to examine the association of MetS with several domains of cognitive dysfunction, and second to assess whether MetS increased the risk of cognitive dysfunction more than that of the sum of its individual components. Methods: For this study, data on 823 participants (mean age 58 6 10 years) was used from the SMART (Second Manifestation of ARTerial disease) study, a cohort study among patients with atherosclerotic disease. MetS was defined according to the NCEP-ATPIII criteria. Three or more of the following metabolic abnormalities were required: abdominal obesity, low HDL cholesterol, high triglycerides, high blood pressure, or hyperglycemia. Neuropsychological tests assessing memory performance, executive functioning, and visuospatial functioning were performed. Subjects with scores in the lowest 10th percentile were considered to have cognitive dysfunction. Regression analyses were performed to assess the association of MetS and its individual components with cognitive dysfunction. To examine whether MetS increased risk of cognitive dysfunction more than its individual components we tested whether there was interaction on an additive scale by calculating the Relative Excess Risk due to Interaction (RERI). Analyses were adjusted for age, sex, education, and markers of macroand microvascular disease. Results: MetS was associated with increased risk of poor memory (OR 2.0; 95%CI 1.2-3.4) and visuospatial functioning (OR 1.8; 95%CI 1.2-2.7) but not with executive functioning. Furthermore, risk of memory and visuospatial dysfunction was increased with increasing number of MetS components. However, risk of memory and visuospatial dysfunction for having all MetS components was not greater than that of the sum of the individual components (RERI: 0.1 and -0.1, respectively). Conclusions: In this population, MetS is related to increased risk of cognitive dysfunction but not more than that of the sum of its individual components. Our findings suggest that clinicians would be better off addressing the individual risk factors rather than ‘‘treating the syndrome.’’