Hemoglobin level in older persons and incident Alzheimer disease
Prospective cohort analysis
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Abstract
Objective: To test the hypothesis that level of hemoglobin is associated with incident Alzheimer disease (AD).
Methods: A total of 881 community-dwelling older persons participating in the Rush Memory and Aging Project without dementia and a measure of hemoglobin level underwent annual cognitive assessments and clinical evaluations for AD.
Results: During an average of 3.3 years of follow-up, 113 persons developed AD. In a Cox proportional hazards model adjusted for age, sex, and education, there was a nonlinear relationship between baseline level of hemoglobin such that higher and lower levels of hemoglobin were associated with AD risk (hazard ratio [HR] for the quadratic of hemoglobin 1.06, 95% confidence interval [CI] 1.01–1.11). Findings were unchanged after controlling for multiple covariates. When compared to participants with clinically normal hemoglobin (n = 717), participants with anemia (n = 154) had a 60% increased hazard for developing AD (95% CI 1.02–2.52), as did participants with clinically high hemoglobin (n = 10, HR 3.39, 95% CI 1.25–9.20). Linear mixed-effects models showed that lower and higher hemoglobin levels were associated with a greater rate of global cognitive decline (parameter estimate for quadratic of hemoglobin = −0.008, SE −0.002, p < 0.001). Compared to participants with clinically normal hemoglobin, participants with anemia had a −0.061 z score unit annual decline in global cognitive function (SE 0.012, p < 0.001), as did participants with clinically high hemoglobin (−0.090 unit/year, SE 0.038, p = 0.018).
Conclusions: In older persons without dementia, both lower and higher hemoglobin levels are associated with an increased hazard for developing AD and more rapid cognitive decline.
Footnotes
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Study funding: Supported by the NIH/NIA R01AG17917 and R01AG24480, the Illinois Department of Public Health, and the Robert C. Borwell Endowment Fund.
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Editorial, page 206
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Supplemental data at www.neurology.org
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- AD=
- Alzheimer disease;
- CI=
- confidence interval;
- FEV1=
- forced expiratory volume in 1 second;
- FVC=
- forced vital capacity;
- HR=
- hazard ratio;
- MCI=
- mild cognitive impairment
- Received September 3, 2010.
- Accepted December 22, 2010.
- Copyright © 2011 by AAN Enterprises, Inc.
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