Multiple chronic conditions and cognitive performance: a 5-year longitudinal study of patients aged 55-75 years at baseline

Javier Rubio Serrano, Ileana Gefaell Larrondo

Keywords: Multiple chronic conditions, Chronic diseases, Neuropsychological Tests, Cognitive Dysfunction, Latent class analysis

Background:

The aging population worldwide presents significant health challenges, particularly regarding cognitive function in older adults. Chronic diseases are prevalent in this group and may adversely affect cognitive performance.

Research questions:

Is there a relationship between the different clusters of chronic diseases and cognitive performance?

Method:

Study design: A 5-year longitudinal cohort study. Population: 930 Spanish patients aged 55-75 years from the NEDICES2-RISK cohort. Variables: sociodemographic (sex, age, educational level), 21 chronic diseases diagnosed in Primary Health Care. Cognitive performance—including global cognition, memory, premorbid intelligence, verbal fluency, and visuoconstruction—was assessed at baseline and follow-up using neuropsychological tests. Data collection: Clinical interview and medical history review. Analysis: Latent class analysis (LCA) was conducted to identify subgroups of chronic diseases. A generalised linear model was employed to analyse the influence of these subgroups on cognitive performance, adjusted for age, sex, educational level, sedentary lifestyle, and smoking.

Results:

The study included 930 participants. The median age was 67 (IQR: 62.00–71.0) years, and 52.4% were women. LCA revealed a three-cluster model as the best fit solution: non-diseased, depression-anxiety cluster, and cardiovascular diseases. At baseline, neuropsychological scores did not differ significantly across clusters. After 5 years, participants in the depression-anxiety cluster exhibited significantly worse global cognition on the 37-item version of the Mini-Mental State Examination (MMSE-37) (OR 2.05; 95% CI 1.12–3.76) and immediate memory (OR 1.96; 95% CI 1.07–3.59) compared to the non-diseased group.

Conclusions:

Whilst baseline cognitive performance was similar across groups, participants in the depression cluster experienced significant declines in global cognition and memory after 5 years compared to the non-diseased group.

Points for discussion:

This study is part of a 5 year follow up cohort, taking that into account, what should we recommend in the Primary Care setting to avoid future cognitive impairment?

How should patients with depression and anxiety be intervened?

Much emphasis is currently placed on cardiovascular risk factors as key predictors of cognitive decline. But are we underestimating the impact of mental illnesses such as depression and anxiety on cognitive function?

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