Diabetes and hyperlipidemia are associated with accelerated cognitive decline and are dementia risk factors. Metabolic Syndrome (MS) describes clustering of these risks. Diabetes adversely affects cognition in the elderly,1 however it is unclear whether MS does. Further, controversy exists as to whether statin-use may impair cognition.
Aim: We examined if MS and statin-use predicted greater cognitive decline in the elderly over 4 years.
Methods: Participants (n=678) were drawn from the Sydney Memory and Aging Study, a longitudinal population-derived cohort, assessed at baseline, 2 and 4y.1Cognition was measured by neuropsychological testing (cognitive domains: memory, processing speed, language, visuospatial and executive function).1 MS was defined using IDF criteria.1 Data were analyzed by repeated measures ANCOVA (covariates: age, sex, education, smoking, heart disease, stroke, diabetes, hypertension, blood pressure and apolipoproteinE e4 genotype [APOEe4]). Interactions between statin-use and dementia risk factors were examined.
Results: Mean age: 78.3±4.6 years, 47% males, BMI 27.1±4.9 kg/m2. Baseline prevalence: MS 54%, statin-use 52% and diabetes 11%.
Baseline global cognition was similar between MS+ and MS- (p=0.13). MS+ was not associated with greater decline in global cognition, nor within domains (p>0.05). Results were similar when subjects with diabetes were excluded.
Baseline global cognition was also similar between statin-users and never-users (-0.58±1.3 v -0.59±1.3, p=0.92). Statin-use was associated with a significantly greater decline in memory (-0.27±0.04 v. -0.07±0.05, p=0.001) only.
Significant interactions with statin-use were found with stroke (p=0.02), APOEe4 (p=0.04) and smoking (p=0.04) for a greater decline in memory over 4 years.
Conclusion: Statin-use in the elderly was associated with greater decline in memory at 4 years, with interactions with stroke, APOEe4 genotype and smoking, but not diabetes. Metabolic syndrome was not associated with accelerated cognitive decline. The impact of metabolic risk and its treatment on cognition in the elderly requires greater interrogation.