Cognitive function and survival in older adults

  • Rostamian S & al.
  • Am J Med
  • 19 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Poorer performance in both executive function and memory tests was associated with increased risk for all-cause, cardiovascular (CV) and non-CV mortality in dementia-free older adults.
  • This association was independent of CV risk factors and diseases, brain structural abnormalities, and cerebral blood flow.

Why this matters

  • Although the link between global cognitive impairment and mortality is well-established, few studies have demonstrated conflicting results regarding the association between domain-specific cognitive function and mortality.
  • Cognitive assessment along with other clinical tools could be used to identify older adults at a greater risk for mortality.

Study design

  • 547 dementia-free participants (56.5% male, mean age 78 years) were included from the nested magnetic resonance imaging substudy of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER).
  • Funding: Bristol-Myers Squibb.

Key results

  • After adjustment for confounders, lower performance in executive function was associated with increased risk for all-cause (HR, 1.49; 95% CI, 1.31-1.70), CV (HR, 1.69; 95% CI, 1.36-2.11) and non-CV (HR, 1.36; 95% CI, 1.15-1.62) mortality (P<.001 for all>
  • Similarly, poorer performance in memory tests was linked to a higher risk for all-cause (HR, 1.47; 95% CI, 1.29-1.68), CV (HR, 1.45; 95% CI, 1.15-1.83) and non-CV (HR, 1.49; 95% CI, 1.27-1.76) mortality (P<.001 for all>
  • This association was similar in older adults with a variety of brain structural abnormalities and cerebral blood flow (all Pinteraction>.05).

Limitations

  • Study has limited generalisability to older adults with dementia and higher risk for CV disease.