Decreased hemoglobin levels, cerebral small-vessel disease, and cortical atrophy: among cognitively normal elderly women and men

Park, Sang Eon; Kim, Hojeong; Lee, Jeongmin; Lee, Na Kyung; Hwang, Jung Won; Yang, Jin‐Ju; Ye, Byoung Seok; Cho, Hanna; Kim, Hee Jin; Kim, Yeo Jin; Jung, Na-Yeon; Son, Tae Ok; Cho, Eun Bin; Jang, Eun Young; Hong, Chang Hyung; Lee, Jongmin; Kang, Mira; Shin, Hee‐Young; Na, Duk L.; Seo, Sang Won

doi:10.1017/s1041610215000733

Cited by 20 publications

(23 citation statements)

References 39 publications

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“…Many previous studies linking anemia and dementia have suggested various mechanisms, unfortunately none of which are fully established, including the following: Chronic brain hypoxia related to anemia may partially contribute to cognitive function decline through accelerating the accumulation of amyloid-β [ 27 ]. Anemia has shown an association with the progression of white matter hyperintensity [ 28 ] and cerebral cortical atrophy [ 29 ]. Iron deficiency in the brain may affect its neurotransmitter metabolism and function through interference with rate-limiting enzymes that are dependent on iron [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Anemia is associated with incidence of dementia: a national health screening study in Korea involving 37,900 persons

et al. 2017

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BackgroundThe aim of this study was to investigate whether anemia is associated with dementia incidence in the elderly.MethodsUsing the Korean National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS) database, we identified 66-year-old subjects (n = 37,900) who were free of dementia and stroke. Anemia (hemoglobin < 12 g/dl for women and < 13 g/dl for men) and the severity of anemia (mild, moderate, or severe) were defined using World Health Organization criteria. The incidence of dementia was identified using International Classification of Diseases, Tenth Revision, dementia diagnosis codes (F00, F01, F02, F03, and G30) with prescription of an antidementia drug. Cox proportional hazards regression models were used to assess HRs for dementia incidence according to anemia.ResultsAfter adjusting for sex, baseline cognitive state, body mass index, smoking status, household income, disability, depression, hypertension, diabetes, and dyslipidemia, we found a significant association between anemia and dementia incidence (adjusted HR 1.24; 95% CI 1.02–1.51). The adjusted HRs for incidence of dementia according to the severity of anemia were 1.19 (95% CI 0.98–1.45) for those with mild anemia, 1.47 (95% CI 0.97–2.21) for those with moderate anemia, and 5.72 (95% CI 1.84–17.81) for those with severe anemia, showing a significant p value for trend (p = 0.003).ConclusionsAnemia is an independent risk factor for dementia incidence, with a marked increase of risk associated with severe anemia.Electronic supplementary materialThe online version of this article (doi:10.1186/s13195-017-0322-2) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

“…Anemia has shown an association with the progression of white matter hyperintensity [ 28 ] and cerebral cortical atrophy [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Anemia is associated with incidence of dementia: a national health screening study in Korea involving 37,900 persons

et al. 2017

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“…Few studies have explored the link between decreased haemoglobin levels and neuroimaging markers of CSVD, and the results remain controversial. One study has reported a link between anaemia and white matter hyperintensity progression among patients with hypertension [ 13 ], whereas a recent study failed to find an association with white matter hyperintensity volume in a large community-based study [ 14 ]. The latter study also did not find any significant link with lacunes and cerebral microbleeds [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…Limited data has shown that anaemia is associated with a chronic hypoxic state that contributes to increased cerebrovascular burden, resulting in increased white matter hyperintensity volume [ 11 – 13 ]. However, a recent study showed no association between lower haemoglobin levels and the presence or progression of CSVD [ 14 ]. Moreover, the association of haemoglobin with cerebral microbleeds, and cortical cerebral microinfarcts remain unstudied.…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, the association of haemoglobin with cerebral microbleeds, and cortical cerebral microinfarcts remain unstudied. With respect to neurodegenerative markers, only one study reported that lower haemoglobin levels are linked to cortical thinning among cognitively normal women [ 14 ]. These differences in results may be attributed to heterogeneity in defining anaemia (binary criteria vs. percentiles) or small sample sizes, or they may be related to the study of particular disease populations (dementia, chronic kidney disease and hypertension).…”

Section: Introductionmentioning

confidence: 99%

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Haemoglobin, magnetic resonance imaging markers and cognition: a subsample of population-based study

Tan

Venketasubramanian

Vrooman³

et al. 2018

Alz Res Therapy

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BackgroundLow haemoglobin is highly prevalent among the elderly and has been associated with dementia. However, the mechanisms underlying this association with cognitive dysfunction, either through cerebrovascular disease or neurodegeneration, remain poorly understood. We aimed to examine the association of decreased haemoglobin levels with markers of cerebral small vessel disease (CSVD), neurodegeneration and cognitive impairment in an elderly Asian population.MethodsA total of 796 Chinese, Malay and Indian participants aged 60 years and older from the Epidemiology of Dementia in Singapore study were included in this study. After providing information on demographics, anthropometry and cardiovascular risk factors, participants underwent 3-T brain magnetic resonance imaging (MRI) to measure markers of CSVD, including cerebral microbleeds, cortical cerebral microinfarcts, lacunes, enlarged perivascular spaces and white matter hyperintensities, as well as neurodegenerative markers, including cortical thickness and subcortical structure volumes quantified using FreeSurfer. Cognition was assessed using a detailed neuropsychological assessment. Logistic and linear regression models were constructed, adjusting for age, gender, education, race, body mass index, smoking, hypertension, hyperlipidaemia, diabetes, glomerular filtration rate and other MRI markers, to test the association between haemoglobin levels and the MRI markers and cognition.ResultsDecreased haemoglobin levels were associated with cerebral microbleeds, specifically lobar microbleeds (OR, 1.21; 95% CI, 1.04–1.40; p = 0.015). Decreased haemoglobin levels were also associated with occipital cortical thinning (mean difference, − 0.011; 95% CI, − 0.019, − 0.004; p = 0.003) and smaller accumbens volume (mean difference, − 0.01; 95% CI, − 0.02, 0.00; p = 0.005). A significant association was also observed between decreased haemoglobin levels and poorer global cognitive performance (mean difference, − 0.04; 95% CI, − 0.09, 0.00; p = 0.048). In cognitive domain analysis, associations were again observed between decreased haemoglobin levels and worse performance on attention (mean difference, − 0.05; 95% CI, − 0.10, − 0.01; p = 0.028) and language (mean difference, − 0.06; 95% CI, − 0.12, 0.00; p = 0.048) domains; however, these associations did not survive multiple comparison.ConclusionsDecreased haemoglobin levels were associated with lobar microbleeds, neurodegenerative markers and cognitive dysfunction. Future studies should ascertain whether iron, folate or vitamin B12 supplementation is able to ameliorate the onset and progression of cognitive impairment and dementia associated with low haemoglobin.

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Low Hemoglobin Levels at Admission Are Independently Associated with Cognitive Impairment after Ischemic Stroke: a Multicenter, Population-Based Study

Fang

Zhang

et al. 2020

Transl. Stroke Res.

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Decreased hemoglobin levels, cerebral small-vessel disease, and cortical atrophy: among cognitively normal elderly women and men

Abstract: Our findings suggested that decreased hemoglobin levels affected cortical atrophy, but not increased CSVD, among women, although the association is modest. Given the paucity of modifiable risk factors for age-related cognitive decline, our results have important public health implications.

Cited by 20 publications

References 39 publications

Anemia is associated with incidence of dementia: a national health screening study in Korea involving 37,900 persons

Anemia is associated with incidence of dementia: a national health screening study in Korea involving 37,900 persons

Haemoglobin, magnetic resonance imaging markers and cognition: a subsample of population-based study

Low Hemoglobin Levels at Admission Are Independently Associated with Cognitive Impairment after Ischemic Stroke: a Multicenter, Population-Based Study

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