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August 06, 2013; 81 (6) Article

Anemia and risk of dementia in older adults

Findings from the Health ABC study

Chang Hyung Hong, Cherie Falvey, Tamara B. Harris, Eleanor M. Simonsick, Suzanne Satterfield, Luigi Ferrucci, Andrea L. Metti, Kushang V. Patel, Kristine Yaffe
First published July 31, 2013, DOI: https://doi.org/10.1212/WNL.0b013e31829e701d
Chang Hyung Hong
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Cherie Falvey
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Tamara B. Harris
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Eleanor M. Simonsick
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Suzanne Satterfield
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Luigi Ferrucci
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Andrea L. Metti
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Kushang V. Patel
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Kristine Yaffe
From the Department of Psychiatry and Institute on Aging (C.H.H.), Ajou University School of Medicine, Suwon, Republic of Korea; Departments of Psychiatry (C.F., K.Y.), Epidemiology and Biostatistics (K.Y.), and Neurology (K.Y.), School of Medicine, University of California, San Francisco; San Francisco Veterans Affairs Medical Center (C.F., K.Y.), San Francisco; Laboratory of Epidemiology, Demography, and Biometry, Intramural Research Program (T.B.H.), and Clinical Research Branch (E.M.S., L.F.), National Institute on Aging, Baltimore, MD; Department of Preventive Medicine (S.S.), University of Tennessee Health Science Center, Memphis; Department of Epidemiology (A.L.M.), Graduate School of Public Health, University of Pittsburgh, PA; and Department of Anesthesiology and Pain Medicine (K.V.P.), University of Washington, Seattle.
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Citation
Anemia and risk of dementia in older adults
Findings from the Health ABC study
Chang Hyung Hong, Cherie Falvey, Tamara B. Harris, Eleanor M. Simonsick, Suzanne Satterfield, Luigi Ferrucci, Andrea L. Metti, Kushang V. Patel, Kristine Yaffe
Neurology Aug 2013, 81 (6) 528-533; DOI: 10.1212/WNL.0b013e31829e701d

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  • Anemia and risk of dementia in older adults: Findings from the Health ABC study - September 03, 2013
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Abstract

Objective: To determine whether anemia is associated with incident dementia in older adults.

Methods: We studied 2,552 older adults (mean age 76.1 years; 38.9% black; 51.8% female) participating in the Health, Aging, and Body Composition study and free of dementia at baseline. We defined anemia using WHO criteria (hemoglobin concentration <13 g/dL for men and <12 g/dL for women). Dementia diagnosis was determined by dementia medication use, hospital records, or a change in Modified Mini-Mental State (3MS) score of more than 1.5 SD from mean. Discrete time Cox proportional hazard regression models were used to examine the hazard for developing dementia associated with anemia.

Results: Of 2,552 participants, 392 (15.4%) older adults had anemia at baseline. Over 11 years of follow-up, 455 (17.8%) participants developed dementia. In the unadjusted model, those with baseline anemia had an increased risk of dementia (23% vs 17%, hazard ratio = 1.64; 95% confidence interval 1.30, 2.07) compared to those without anemia. The association remained significant after adjusting for demographics, APOE ε4, baseline 3MS score, comorbidities, and renal function. Additional adjustment for other anemia measures (mean corpuscular volume, red cell distribution width), erythropoietin, and C-reactive protein did not appreciably change the results. There was no interaction by sex and race on risk of developing dementia.

Conclusion: Among older adults, anemia is associated with an increased risk of developing dementia. Findings suggest that further study of anemia as a risk factor for dementia and a target for intervention for cognitive health is warranted.

GLOSSARY

3MS=
Modified Mini-Mental State;
CI=
confidence interval;
CRP=
C-reactive protein;
DM=
diabetes mellitus;
GFR=
glomerular filtration rate;
Health ABC=
Health, Aging, and Body Composition study;
HR=
hazard ratio;
HTN=
hypertension;
MCV=
mean corpuscular volume;
MI=
myocardial infarct;
RDW=
red cell distribution width;
REALM=
Rapid Estimate of Adult Literacy in Medicine

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received March 4, 2013.
  • Accepted in final form April 18, 2013.
  • © 2013 American Academy of Neurology
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