145159 20260217205529.0 doi 10.1016/j.lanwpc.2024.101198 sideral 139961 ART-2024-139961 eng Zhao, Xuhao Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic 2024 Access copy available to the general public Unrestricted Background 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. Methods 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. Findings 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. Interpretation 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. info:eu-repo/grantAgreement/ES/DGA-FEDER/B15-17R info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/G03-128R info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/01-0255 info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/03-0815 info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/06-0617 info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/12-02254 info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/16-00896 info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/19-01874 info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/94-1562 info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/97-1321E info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/98-0103 info:eu-repo/semantics/openAccess by-nc-nd https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es 8.1 2024 HEALTH CARE SCIENCES & SERVICES 5 / 188 = 0.027 2024 Q1 T1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH 15 / 421 = 0.036 2024 Q1 T1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH 15 / 421 = 0.036 2024 Q1 T1 2.534 2024 Geriatrics and Gerontology 2024 Q1 Health Policy 2024 Q1 Infectious Diseases 2024 Q1 Public Health, Environmental and Occupational Health 2024 Q1 Obstetrics and Gynecology 2024 Q1 Pediatrics, Perinatology and Child Health 2024 Q1 Psychiatry and Mental Health 2024 Q1 Internal Medicine 2024 Q1 11.4 2024 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion 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 Universidad de Zaragoza (orcid)0000-0002-9098-655X De-la-Cámara, Concepción Universidad de Zaragoza (orcid)0000-0003-2284-7862 Lobo, Elena Universidad de Zaragoza (orcid)0000-0002-1252-2397 Sachdev, Perminder S. Xu, Xin 1007 745 Universidad de Zaragoza Dpto. Medicina, Psiqu. y Derm. Area Psiquiatría 1011 615 Universidad de Zaragoza Dpto. Microb.Ped.Radio.Sal.Pú. Área Medic.Prevent.Salud Públ. 51 (2024), 101198 [16 pp.] The Lancet Regional Health - Western Pacific 2666-6065 896285 http://zaguan.unizar.es/record/145159/files/texto_completo.pdf Versión publicada 2372724 http://zaguan.unizar.es/record/145159/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:145159 articulos driver 2026-02-17-20:31:58 ARTICLE