Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic
Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate...
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| Veröffentlicht in: | The Lancet regional health. Western Pacific 2024-10, Vol.51, p.101198, Article 101198 |
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| creator | Zhao, Xuhao Xu, Xiaolin Yan, Yifan Lipnicki, Darren M. Pang, Ting Crawford, John D. Chen, Christopher Cheng, Ching-Yu Venketasubramanian, Narayanaswamy Chong, Eddie Blay, Sergio Luis Lima-Costa, Maria Fernanda Castro-Costa, Erico Lipton, Richard B. Katz, Mindy J. Ritchie, Karen Scarmeas, Nikolaos Yannakoulia, Mary Kosmidis, Mary H. Gureje, Oye Ojagbemi, Akin Bello, Toyin Hendrie, Hugh C. Gao, Sujuan Guerra, Ricardo Oliveira Auais, Mohammad Gomez, José Fernando Rolandi, Elena Davin, Annalisa Rossi, Michele Riedel-Heller, Steffi G. Löbner, Margit Roehr, Susanne Ganguli, Mary Jacobsen, Erin P. Chang, Chung-Chou H. Aiello, Allison E. Ho, Roger Sanchez-Juan, Pascual Valentí-Soler, Meritxell Ser, Teodoro del Lobo, Antonio De-la-Cámara, Concepción Lobo, Elena Sachdev, Perminder S. Xu, Xin |
| description | Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.
Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.
Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, |
| doi_str_mv | 10.1016/j.lanwpc.2024.101198 |
| format | Article |
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Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.
Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies.
Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness.
Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.</description><identifier>ISSN: 2666-6065</identifier><identifier>EISSN: 2666-6065</identifier><identifier>DOI: 10.1016/j.lanwpc.2024.101198</identifier><identifier>PMID: 39308753</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Cardiometabolic multimorbidity ; Cognitive decline ; Depression ; Multi-regional study</subject><ispartof>The Lancet regional health. Western Pacific, 2024-10, Vol.51, p.101198, Article 101198</ispartof><rights>2024 The Author(s)</rights><rights>2024 The Author(s).</rights><rights>2024 The Author(s) 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2123-8767b11e09096da6350e1add632c0572b4e7db165d10f92a865ad27dafbf62ff3</cites><orcidid>0000-0002-1532-0002 ; 0000-0002-8863-2699 ; 0000-0003-4360-8174 ; 0000-0002-9595-3220 ; 0000-0001-8790-1220 ; 0009-0005-1267-1658 ; 0000-0002-1684-3577 ; 0000-0002-8203-9878</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11416683/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC11416683/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,27903,27904,53769,53771</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39308753$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhao, Xuhao</creatorcontrib><creatorcontrib>Xu, Xiaolin</creatorcontrib><creatorcontrib>Yan, Yifan</creatorcontrib><creatorcontrib>Lipnicki, Darren M.</creatorcontrib><creatorcontrib>Pang, Ting</creatorcontrib><creatorcontrib>Crawford, John D.</creatorcontrib><creatorcontrib>Chen, Christopher</creatorcontrib><creatorcontrib>Cheng, Ching-Yu</creatorcontrib><creatorcontrib>Venketasubramanian, Narayanaswamy</creatorcontrib><creatorcontrib>Chong, Eddie</creatorcontrib><creatorcontrib>Blay, Sergio Luis</creatorcontrib><creatorcontrib>Lima-Costa, Maria Fernanda</creatorcontrib><creatorcontrib>Castro-Costa, Erico</creatorcontrib><creatorcontrib>Lipton, Richard B.</creatorcontrib><creatorcontrib>Katz, Mindy J.</creatorcontrib><creatorcontrib>Ritchie, Karen</creatorcontrib><creatorcontrib>Scarmeas, Nikolaos</creatorcontrib><creatorcontrib>Yannakoulia, Mary</creatorcontrib><creatorcontrib>Kosmidis, Mary H.</creatorcontrib><creatorcontrib>Gureje, Oye</creatorcontrib><creatorcontrib>Ojagbemi, Akin</creatorcontrib><creatorcontrib>Bello, Toyin</creatorcontrib><creatorcontrib>Hendrie, Hugh C.</creatorcontrib><creatorcontrib>Gao, Sujuan</creatorcontrib><creatorcontrib>Guerra, Ricardo Oliveira</creatorcontrib><creatorcontrib>Auais, Mohammad</creatorcontrib><creatorcontrib>Gomez, José Fernando</creatorcontrib><creatorcontrib>Rolandi, Elena</creatorcontrib><creatorcontrib>Davin, Annalisa</creatorcontrib><creatorcontrib>Rossi, Michele</creatorcontrib><creatorcontrib>Riedel-Heller, Steffi G.</creatorcontrib><creatorcontrib>Löbner, Margit</creatorcontrib><creatorcontrib>Roehr, Susanne</creatorcontrib><creatorcontrib>Ganguli, Mary</creatorcontrib><creatorcontrib>Jacobsen, Erin P.</creatorcontrib><creatorcontrib>Chang, Chung-Chou H.</creatorcontrib><creatorcontrib>Aiello, Allison E.</creatorcontrib><creatorcontrib>Ho, Roger</creatorcontrib><creatorcontrib>Sanchez-Juan, Pascual</creatorcontrib><creatorcontrib>Valentí-Soler, Meritxell</creatorcontrib><creatorcontrib>Ser, Teodoro del</creatorcontrib><creatorcontrib>Lobo, Antonio</creatorcontrib><creatorcontrib>De-la-Cámara, Concepción</creatorcontrib><creatorcontrib>Lobo, Elena</creatorcontrib><creatorcontrib>Sachdev, Perminder S.</creatorcontrib><creatorcontrib>Xu, Xin</creatorcontrib><creatorcontrib>for Cohort Studies of Memory in an International Consortium (COSMIC)</creatorcontrib><title>Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic</title><title>The Lancet regional health. Western Pacific</title><addtitle>Lancet Reg Health West Pac</addtitle><description>Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.
Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.
Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies.
Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness.
Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.</description><subject>Cardiometabolic multimorbidity</subject><subject>Cognitive decline</subject><subject>Depression</subject><subject>Multi-regional study</subject><issn>2666-6065</issn><issn>2666-6065</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9Uctu1TAQjRCIVqV_gJCXbHLxI3ESFiBU8ahUiQ2sLccep3OV2Bc7uVW_jZ_DuSlV2SBZ9shzHqM5RfGa0R2jTL7b70bt7w5mxymv1i_Wtc-Kcy6lLCWV9fMn9VlxmdKeUsprJlhHXxZnohO0bWpxXvy-9hYOkC8_E-0t2Qdcq5SCQT1j8IkER4yOFsMEs-7DiIZMyzjjFGKPFuf7EzHLREgpM0g-JgweZzwCcYs3q8574tBb9EMiLoZpkygjDLmnx0y4DXFOJ6kBPEQ9YjoNsMFNmKbFr2ZzIGZEj-ZV8cLpMcHlw3tR_Pzy-cfVt_Lm-9frq083peGMi7JtZNMzBrSjnbRaipoC09ZKwQ2tG95X0Nieydoy6jquW1lryxurXe8kd05cFB833cPST2BNXlWeTh0iTjreq6BR_dvxeKuGcFSMVUzKVmSFtw8KMfxaIM1qwmRgzCFCWJISjLaio01bZWi1QU0MKUVwjz6MqjV7tVdb9mrNXm3ZZ9qbpzM-kv4mnQEfNgDkTR0RokoGwRuwGMHMygb8v8MfYOfJQg</recordid><startdate>202410</startdate><enddate>202410</enddate><creator>Zhao, Xuhao</creator><creator>Xu, Xiaolin</creator><creator>Yan, Yifan</creator><creator>Lipnicki, Darren M.</creator><creator>Pang, Ting</creator><creator>Crawford, John D.</creator><creator>Chen, Christopher</creator><creator>Cheng, Ching-Yu</creator><creator>Venketasubramanian, Narayanaswamy</creator><creator>Chong, Eddie</creator><creator>Blay, Sergio Luis</creator><creator>Lima-Costa, Maria Fernanda</creator><creator>Castro-Costa, Erico</creator><creator>Lipton, Richard B.</creator><creator>Katz, Mindy J.</creator><creator>Ritchie, Karen</creator><creator>Scarmeas, Nikolaos</creator><creator>Yannakoulia, Mary</creator><creator>Kosmidis, Mary H.</creator><creator>Gureje, Oye</creator><creator>Ojagbemi, Akin</creator><creator>Bello, Toyin</creator><creator>Hendrie, Hugh C.</creator><creator>Gao, Sujuan</creator><creator>Guerra, Ricardo Oliveira</creator><creator>Auais, Mohammad</creator><creator>Gomez, José Fernando</creator><creator>Rolandi, Elena</creator><creator>Davin, Annalisa</creator><creator>Rossi, Michele</creator><creator>Riedel-Heller, Steffi G.</creator><creator>Löbner, Margit</creator><creator>Roehr, Susanne</creator><creator>Ganguli, Mary</creator><creator>Jacobsen, Erin P.</creator><creator>Chang, Chung-Chou H.</creator><creator>Aiello, Allison E.</creator><creator>Ho, Roger</creator><creator>Sanchez-Juan, Pascual</creator><creator>Valentí-Soler, Meritxell</creator><creator>Ser, Teodoro del</creator><creator>Lobo, Antonio</creator><creator>De-la-Cámara, Concepción</creator><creator>Lobo, Elena</creator><creator>Sachdev, Perminder S.</creator><creator>Xu, Xin</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-1532-0002</orcidid><orcidid>https://orcid.org/0000-0002-8863-2699</orcidid><orcidid>https://orcid.org/0000-0003-4360-8174</orcidid><orcidid>https://orcid.org/0000-0002-9595-3220</orcidid><orcidid>https://orcid.org/0000-0001-8790-1220</orcidid><orcidid>https://orcid.org/0009-0005-1267-1658</orcidid><orcidid>https://orcid.org/0000-0002-1684-3577</orcidid><orcidid>https://orcid.org/0000-0002-8203-9878</orcidid></search><sort><creationdate>202410</creationdate><title>Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic</title><author>Zhao, Xuhao ; Xu, Xiaolin ; Yan, Yifan ; Lipnicki, Darren M. ; Pang, Ting ; Crawford, John D. ; Chen, Christopher ; Cheng, Ching-Yu ; Venketasubramanian, Narayanaswamy ; Chong, Eddie ; Blay, Sergio Luis ; Lima-Costa, Maria Fernanda ; Castro-Costa, Erico ; Lipton, Richard B. ; Katz, Mindy J. ; Ritchie, Karen ; Scarmeas, Nikolaos ; Yannakoulia, Mary ; Kosmidis, Mary H. ; Gureje, Oye ; Ojagbemi, Akin ; Bello, Toyin ; Hendrie, Hugh C. ; Gao, Sujuan ; Guerra, Ricardo Oliveira ; Auais, Mohammad ; Gomez, José Fernando ; Rolandi, Elena ; Davin, Annalisa ; Rossi, Michele ; Riedel-Heller, Steffi G. ; Löbner, Margit ; Roehr, Susanne ; Ganguli, Mary ; Jacobsen, Erin P. ; Chang, Chung-Chou H. ; Aiello, Allison E. ; Ho, Roger ; Sanchez-Juan, Pascual ; Valentí-Soler, Meritxell ; Ser, Teodoro del ; Lobo, Antonio ; De-la-Cámara, Concepción ; Lobo, Elena ; Sachdev, Perminder S. ; Xu, Xin</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2123-8767b11e09096da6350e1add632c0572b4e7db165d10f92a865ad27dafbf62ff3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Cardiometabolic multimorbidity</topic><topic>Cognitive decline</topic><topic>Depression</topic><topic>Multi-regional study</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Xuhao</creatorcontrib><creatorcontrib>Xu, Xiaolin</creatorcontrib><creatorcontrib>Yan, Yifan</creatorcontrib><creatorcontrib>Lipnicki, Darren M.</creatorcontrib><creatorcontrib>Pang, Ting</creatorcontrib><creatorcontrib>Crawford, John D.</creatorcontrib><creatorcontrib>Chen, Christopher</creatorcontrib><creatorcontrib>Cheng, Ching-Yu</creatorcontrib><creatorcontrib>Venketasubramanian, Narayanaswamy</creatorcontrib><creatorcontrib>Chong, Eddie</creatorcontrib><creatorcontrib>Blay, Sergio Luis</creatorcontrib><creatorcontrib>Lima-Costa, Maria Fernanda</creatorcontrib><creatorcontrib>Castro-Costa, Erico</creatorcontrib><creatorcontrib>Lipton, Richard B.</creatorcontrib><creatorcontrib>Katz, Mindy J.</creatorcontrib><creatorcontrib>Ritchie, Karen</creatorcontrib><creatorcontrib>Scarmeas, Nikolaos</creatorcontrib><creatorcontrib>Yannakoulia, Mary</creatorcontrib><creatorcontrib>Kosmidis, Mary H.</creatorcontrib><creatorcontrib>Gureje, Oye</creatorcontrib><creatorcontrib>Ojagbemi, Akin</creatorcontrib><creatorcontrib>Bello, Toyin</creatorcontrib><creatorcontrib>Hendrie, Hugh C.</creatorcontrib><creatorcontrib>Gao, Sujuan</creatorcontrib><creatorcontrib>Guerra, Ricardo Oliveira</creatorcontrib><creatorcontrib>Auais, Mohammad</creatorcontrib><creatorcontrib>Gomez, José Fernando</creatorcontrib><creatorcontrib>Rolandi, Elena</creatorcontrib><creatorcontrib>Davin, Annalisa</creatorcontrib><creatorcontrib>Rossi, Michele</creatorcontrib><creatorcontrib>Riedel-Heller, Steffi G.</creatorcontrib><creatorcontrib>Löbner, Margit</creatorcontrib><creatorcontrib>Roehr, Susanne</creatorcontrib><creatorcontrib>Ganguli, Mary</creatorcontrib><creatorcontrib>Jacobsen, Erin P.</creatorcontrib><creatorcontrib>Chang, Chung-Chou H.</creatorcontrib><creatorcontrib>Aiello, Allison E.</creatorcontrib><creatorcontrib>Ho, Roger</creatorcontrib><creatorcontrib>Sanchez-Juan, Pascual</creatorcontrib><creatorcontrib>Valentí-Soler, Meritxell</creatorcontrib><creatorcontrib>Ser, Teodoro del</creatorcontrib><creatorcontrib>Lobo, Antonio</creatorcontrib><creatorcontrib>De-la-Cámara, Concepción</creatorcontrib><creatorcontrib>Lobo, Elena</creatorcontrib><creatorcontrib>Sachdev, Perminder S.</creatorcontrib><creatorcontrib>Xu, Xin</creatorcontrib><creatorcontrib>for Cohort Studies of Memory in an International Consortium (COSMIC)</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Lancet regional health. Western Pacific</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhao, Xuhao</au><au>Xu, Xiaolin</au><au>Yan, Yifan</au><au>Lipnicki, Darren M.</au><au>Pang, Ting</au><au>Crawford, John D.</au><au>Chen, Christopher</au><au>Cheng, Ching-Yu</au><au>Venketasubramanian, Narayanaswamy</au><au>Chong, Eddie</au><au>Blay, Sergio Luis</au><au>Lima-Costa, Maria Fernanda</au><au>Castro-Costa, Erico</au><au>Lipton, Richard B.</au><au>Katz, Mindy J.</au><au>Ritchie, Karen</au><au>Scarmeas, Nikolaos</au><au>Yannakoulia, Mary</au><au>Kosmidis, Mary H.</au><au>Gureje, Oye</au><au>Ojagbemi, Akin</au><au>Bello, Toyin</au><au>Hendrie, Hugh C.</au><au>Gao, Sujuan</au><au>Guerra, Ricardo Oliveira</au><au>Auais, Mohammad</au><au>Gomez, José Fernando</au><au>Rolandi, Elena</au><au>Davin, Annalisa</au><au>Rossi, Michele</au><au>Riedel-Heller, Steffi G.</au><au>Löbner, Margit</au><au>Roehr, Susanne</au><au>Ganguli, Mary</au><au>Jacobsen, Erin P.</au><au>Chang, Chung-Chou H.</au><au>Aiello, Allison E.</au><au>Ho, Roger</au><au>Sanchez-Juan, Pascual</au><au>Valentí-Soler, Meritxell</au><au>Ser, Teodoro del</au><au>Lobo, Antonio</au><au>De-la-Cámara, Concepción</au><au>Lobo, Elena</au><au>Sachdev, Perminder S.</au><au>Xu, Xin</au><aucorp>for Cohort Studies of Memory in an International Consortium (COSMIC)</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic</atitle><jtitle>The Lancet regional health. Western Pacific</jtitle><addtitle>Lancet Reg Health West Pac</addtitle><date>2024-10</date><risdate>2024</risdate><volume>51</volume><spage>101198</spage><pages>101198-</pages><artnum>101198</artnum><issn>2666-6065</issn><eissn>2666-6065</eissn><abstract>Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical.
Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies.
Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. β = −0.207, 95% CI = (−0.255, −0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. β = −0.040, 95% CI = (−0.047, −0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies.
Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness.
Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>39308753</pmid><doi>10.1016/j.lanwpc.2024.101198</doi><orcidid>https://orcid.org/0000-0002-1532-0002</orcidid><orcidid>https://orcid.org/0000-0002-8863-2699</orcidid><orcidid>https://orcid.org/0000-0003-4360-8174</orcidid><orcidid>https://orcid.org/0000-0002-9595-3220</orcidid><orcidid>https://orcid.org/0000-0001-8790-1220</orcidid><orcidid>https://orcid.org/0009-0005-1267-1658</orcidid><orcidid>https://orcid.org/0000-0002-1684-3577</orcidid><orcidid>https://orcid.org/0000-0002-8203-9878</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2666-6065 |
| ispartof | The Lancet regional health. Western Pacific, 2024-10, Vol.51, p.101198, Article 101198 |
| issn | 2666-6065 2666-6065 |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_11416683 |
| source | DOAJ Directory of Open Access Journals; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Cardiometabolic multimorbidity Cognitive decline Depression Multi-regional study |
| title | Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic |
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