Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic
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 (Universidad de Zaragoza) ; De-la-Cámara, Concepción (Universidad de Zaragoza) ; Lobo, Elena (Universidad de Zaragoza) ; Sachdev, Perminder S. ; Xu, Xin
Resumen: 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.
Idioma: Inglés
DOI: 10.1016/j.lanwpc.2024.101198
Año: 2024
Publicado en: The Lancet Regional Health - Western Pacific 51 (2024), 101198 [16 pp.]
ISSN: 2666-6065
Factor impacto JCR: 8.1 (2024)
Categ. JCR: HEALTH CARE SCIENCES & SERVICES rank: 5 / 185 = 0.027 (2024) - Q1 - T1
Categ. JCR: PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH rank: 15 / 419 = 0.036 (2024) - Q1 - T1
Categ. JCR: PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH rank: 15 / 419 = 0.036 (2024) - Q1 - T1
Factor impacto SCIMAGO: 2.534 - Geriatrics and Gerontology (Q1) - Health Policy (Q1) - Infectious Diseases (Q1) - Public Health, Environmental and Occupational Health (Q1) - Obstetrics and Gynecology (Q1) - Pediatrics, Perinatology and Child Health (Q1) - Psychiatry and Mental Health (Q1) - Internal Medicine (Q1)
Financiación: info:eu-repo/grantAgreement/ES/DGA-FEDER/B15-17R
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/G03-128R
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/01-0255
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/03-0815
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/06-0617
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/12-02254
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/16-00896
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/19-01874
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/94-1562
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/97-1321E
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/98-0103
Tipo y forma: Article (Published version)
Área (Departamento): Area Psiquiatría (Dpto. Medicina, Psiqu. y Derm.)
Área (Departamento): Área Medic.Prevent.Salud Públ. (Dpto. Microb.Ped.Radio.Sal.Pú.)
Exportado de SIDERAL (2025-09-22-14:48:12)
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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.
Idioma: Inglés
DOI: 10.1016/j.lanwpc.2024.101198
Año: 2024
Publicado en: The Lancet Regional Health - Western Pacific 51 (2024), 101198 [16 pp.]
ISSN: 2666-6065
Factor impacto JCR: 8.1 (2024)
Categ. JCR: HEALTH CARE SCIENCES & SERVICES rank: 5 / 185 = 0.027 (2024) - Q1 - T1
Categ. JCR: PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH rank: 15 / 419 = 0.036 (2024) - Q1 - T1
Categ. JCR: PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH rank: 15 / 419 = 0.036 (2024) - Q1 - T1
Factor impacto SCIMAGO: 2.534 - Geriatrics and Gerontology (Q1) - Health Policy (Q1) - Infectious Diseases (Q1) - Public Health, Environmental and Occupational Health (Q1) - Obstetrics and Gynecology (Q1) - Pediatrics, Perinatology and Child Health (Q1) - Psychiatry and Mental Health (Q1) - Internal Medicine (Q1)
Financiación: info:eu-repo/grantAgreement/ES/DGA-FEDER/B15-17R
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/G03-128R
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/01-0255
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/03-0815
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/06-0617
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/12-02254
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/16-00896
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/19-01874
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/94-1562
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/97-1321E
Financiación: info:eu-repo/grantAgreement/ES/MINECO-ISCIII/FIS/98-0103
Tipo y forma: Article (Published version)
Área (Departamento): Area Psiquiatría (Dpto. Medicina, Psiqu. y Derm.)
Área (Departamento): Área Medic.Prevent.Salud Públ. (Dpto. Microb.Ped.Radio.Sal.Pú.)
Exportado de SIDERAL (2025-09-22-14:48:12)
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Este artículo se encuentra en las siguientes colecciones:
articulos > articulos-por-area > medicina_preventiva_y_salud_publica
articulos > articulos-por-area > psiquiatria
Notice créée le 2024-10-03, modifiée le 2025-09-23