Objective Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors associated with cognitive decline. We investigated the relationship between MetS and cognition in middle-aged adults. We hypothesized that higher numbers of MetS components will relate to poorer performance on executive function (EF) tasks as frontal lobe regions critical to EF are particularly vulnerable to cardiovascular disease. Methods 197 adults (ages 40–60) participated. MetS was evaluated using established criteria. Composite scores for cognitive domains were computed as follows: Global cognitive function (subtests from the Wechsler Abbreviated Scale of Intelligence, 2nd Edition), EF (Stroop Color Word, Digit Span Backward, and Trails A and B), and memory (California Verbal Learning Test, 2 Edition). Results Higher number of MetS components was related to weaker EF—F(4, 191) = 3.94, p = .004, MetS components ß = −.14, p = .044. A similar relationship was detected for tests of memory—F(4, 192) = 7.86, p < .001, MetS components ß = −.15, p = .032. Diagnosis of MetS was not significantly associated with EF domain score (ß = −.05, p = .506) but was significantly associated with memory scores—F(4, 189) = 8.81, p < .001, MetS diagnosis ß = −.19, p = .006. Conclusions Our findings support prior research linking MetS components at midlife to executive dysfunction and demonstrate that MetS, and its components are also associated with poorer memory function. This suggests that cognitive vulnerability can be detected at midlife. Interventions for MetS at midlife could alter cognitive outcomes.
Hypothesis-driven studies have demonstrated that sex moderates many of the relationships between brain health and cardiometabolic disease, which impacts risk for later-life cognitive decline. In the present study, we sought to further our understanding of the associations between multiple markers of brain integrity and cardiovascular risk in a midlife sample of 266 individuals by using network analysis, a technique specifically designed to examine complex associations among multiple systems at once. Separate network models were constructed for male and female participants to investigate sex differences in the biomarkers of interest, selected based on evidence linking them with risk for late-life cognitive decline: all components of metabolic syndrome (obesity, hypertension, dyslipidemia, and hyperglycemia); neuroimaging-derived brain-predicted age minus chronological age; ratio of white matter hyperintensities to whole brain volume; seed-based resting state functional connectivity in the Default Mode Network, and ratios of N-acetyl aspartate, glutamate and myo-inositol to creatine, measured through proton magnetic resonance spectroscopy. Males had a sparse network (87.2% edges = 0) relative to females (69.2% edges = 0), indicating fewer relationships between measures of cardiometabolic risk and brain integrity. The edges in the female network provide meaningful information about potential mechanisms between brain integrity and cardiometabolic health. Additionally, Apolipoprotein ϵ4 (ApoE ϵ4) status and waist circumference emerged as central nodes in the female model. Our study demonstrates that network analysis is a promising technique for examining relationships between risk factors for cognitive decline in a midlife population and that investigating sex differences may help optimize risk prediction and tailor individualized treatments in the future.
BackgroundSex differences in adult brain morphology are frequently reported. Hippocampal and medio‐temporal (MTL) cortices in women and men are frequently implicated in Alzheimer’s Disease (AD) pathology, and women are disproportionally more affected by AD than men. Modifications in these regions’ volumetry are described during aging and in pathology, but their specificities during midlife regarding sex are still debated. Also, the multifaceted interactions between sex and dementia risk factors in these brain areas are not fully established. The aim of this study is to precisely identify the differences between women and men in the volumetry of hippocampal and MTL subregions, as well as the moderation effects of risk factors for dementia such as hypertension (diastolic blood pressure), hypercholesterolemia, obesity (body mass index), physical inactivity, and inflammation (C‐Reactive Protein), on sex.MethodData from 210 cognitively healthy participants were analyzed (106 women; 104 men; age 40‐65). Automatic segmentation was performed to determine the volume of the bilateral anterior and posterior hippocampus, and of entorhinal, perirhinal (BA35 and BA36), and parahippocampal cortices (ASHS‐PMC‐T1 atlas). The total intracranial volume was obtained to calculate adjusted‐volumes for every participant. An analysis of covariance (ANCOVA) was performed to compare women and men subregions’ volumes, corrected for age. Linear regressions were performed to analyze the interactions between sex and dementia risk factors on the volumetry of these regions.ResultWomen and men were significantly different in the volume of the left (p < .001) and right (p < .001) hippocampus, on the right BA35 (p = .008), and on the left (p < .001) and right (p < .001) parahippocampal cortices. No significant interaction was highlighted between sex and risk factor variables.ConclusionBeyond basic demography, sex is essential to consider in research, as women and men appear to be inherently different in their brain morphometry, even from midlife. Volumetric differences in AD‐linked brain regions, regardless of potential dementia risk factors, may be an innocuous sex‐specific feature at the preclinical phase. In this regard, women’s vulnerability to AD may not occur until later in aging, potentially linked to hormonal decline.
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