Cardiometabolic-Inflammatory Risk Factors and Cognitive Decline Among Older Indians—Report From a Nationally Representative, Longitudinal Study

Abstract

Background: Rapid increase in cardiometabolic diseases in India may contribute to increased incidence of late-life cognitive impairment. This study focuses on associations between baseline cardiometabolic risk factors and subsequent decline in cognitive function among older adults in India, leveraging data from two waves (Wave 1: 2017–2020, Wave 2: 2022–2024) of the Longitudinal Aging Study in India–Diagnostic Assessment of Dementia (LASI-DAD). Methods: Analysis included longitudinal data of 1554 study participants. A summary measure of different cognitive functional domains was used. Cognitive decline was defined as annual decline in cognitive score ≥ 0.05 times the standard deviation of the summary score. Cardiometabolic risk was characterized using cardiovascular, metabolic, and inflammatory biomarkers. Multivariate, multinomial logistic regression analysis was used to examine the associations between cardiometabolic risk and cognitive decline. Results: At baseline, 71.7% of the sample had elevated homocysteine levels, 44.4% had elevated blood pressure, 23% had elevated glycosylated hemoglobin (HbA1c), and 6.7% had elevated uric acid levels. Between the two waves, 34.8% experienced significant cognitive decline, while 35.6% died. Multivariate multinomial logistic regression showed significant cognitive decline was associated with elevated blood pressure [odds ratio (OR): 1.7, 95% confidence interval (CI) 1.3–2.2], elevated HbA1c (OR: 1.1, 95% CI: 1.0–1.2), being overweight (OR: 1.4, 95% CI: 1.0–2.0), and elevated uric acid level (OR: 1.2, 95% CI: 1.0–1.3). Those with hypertension had 1.5 times higher odds of mortality (95% confidence interval: 1.2–2.0), while those with diabetes mellitus or elevated pro-brain natriuretic peptide had 1.2 times (95% CI: 1.1–1.4), and 1.8 times (95% CI: 1.1–1.4) higher odds of mortality. Conclusion: Cardiometabolic risk factors play a significant role in late-life cognitive decline and death among older Indians. These longitudinal relationships from LASI-DAD highlight potentially modifiable risk factors and inform potential prevention policies.