Non-alcoholic Fatty Liver Disease and Longitudinal Cognitive Changes in Middle-Aged and Elderly Adults

Abstract

Background and PurposeNon-alcoholic fatty liver disease (NAFLD) and cognitive impairment are common aging-related disorders. This study aims to explore the changes of cognitive function in middle-aged and elderly population with NAFLD from a Jidong impairment cohort.MethodsA total of 1,651 middle-aged and elderly participants (>40 years) without cognitive impairment were recruited into the current study in 2015 and were followed up until to 2019. Abdominal ultrasonography was used for diagnosis of NAFLD. Global cognitive function was assessed with the Mini-Mental State Examination (MMSE). Cognitive impairment was defined as a score <18 for illiterates, a score <21 for primary school graduates, and a score <25 for junior school graduates or above. Multivariable regression analysis was performed to evaluate the association between NAFLD and the four-year cognitive changes.ResultsOut of 1,651 participants, 795 (48.2%) of them had NAFLD in 2015. Cognitive impairment occurred in 241 (14.6%) participants in 2019. Patients with NAFLD had higher 4-year incidence of cognitive impairment than non-NAFLD patients did (17.7 vs. 11.7%, p < 0.001). Multivariable linear regression analysis showed significant association of baseline NAFLD with lower MMSE score in 2019 (β = −0.36, p < 0.05). Multivariable logistic analysis found that the adjusted odds ratio (OR) with 95% confidence interval (CI) of baseline NAFLD was 1.45 (1.00–2.11) for cognitive impairment in 2019 (p = 0.05). We also identified effects of baseline NAFLD on subsequent cognitive impairment as modified by age (interaction p < 0.01) and carotid stenosis (interaction p = 0.05) but not by gender.ConclusionsNAFLD is associated with cognitive decline, especially in middle-aged and with carotid stenosis population.

Risk of dementia or cognitive impairment in non-alcoholic fatty liver disease: A systematic review and meta-analysis

“…Of these 9 articles, 8 failed to provide relevant data and outcomes and 1 article provided incomplete data. Ultimately, 7 studies (Labenz et al, 2021 ; Lampignano et al, 2021 ; Shang et al, 2021 ; Jeong et al, 2022 ; Kim et al, 2022 ; Liu et al, 2022 ; Yu et al, 2022 ) were included in this study. The search selection process is presented in Figure 1 .…”

“…Seven studies were included in this review. Five studies (Labenz et al, 2021 ; Shang et al, 2021 ; Jeong et al, 2022 ; Kim et al, 2022 ; Liu et al, 2022 ) were cohort studies and 2 studies (Lampignano et al, 2021 ; Yu et al, 2022 ) were case–control studies. The 7 studies were published from 2020 to 2022 and involved a total of 891,562 individuals, with sample sizes ranging from 1542 to 608,994 individuals per study.…”

“…There were 2 studies (Jeong et al, 2022 ; Kim et al, 2022 ) from Korea, 1 (Yu et al, 2022 ) from the United States, 1 (Liu et al, 2022 ) from China, 1 (Shang et al, 2021 ) from Switzerland, 1 (Labenz et al, 2021 ) from Germany, and 1 from (Lampignano et al, 2021 ) Italy. The results of 5 studies (Labenz et al, 2021 ; Lampignano et al, 2021 ; Shang et al, 2021 ; Jeong et al, 2022 ; Kim et al, 2022 ) described outcome measures of dementia, and the 2 other studies (Liu et al, 2022 ; Yu et al, 2022 ) involved cognitive impairment. The main characteristics of the included studies are shown in Table 1 .…”

“…Two studies (Liu et al, 2022 ; Yu et al, 2022 ) assessed the association between NAFLD and risk of cognitive impairment. As shown in Figure 2 , data analysis showed a strong link between NAFLD and cognitive impairment (OR = 1.44; 95% CI: 1.17–1.78; I 2 = 0%; P = 0.001).…”

“…As shown in Figures 4, 5 studies (Labenz et al, 2021;Lampignano et al, 2021;Shang et al, 2021;Jeong et al, 2022;Kim et al, 2022;Liu et al, 2022;Yu et al, 2022) described the association of all-cause dementia with NAFLD; however, results from the data showed that the relationship between NAFLD and an increased risk of all-cause dementia was not obvious (OR = 1.03; 95% CI: 0.97-1.09; I 2 = 84.7%; P = 0.341). Since Alzheimer Disease (AD) and vascular dementia (VD) belong to the category of dementia, we extracted the data of AD and VD separately for reanalysis.…”