Wolf Philip A, Beiser Alexa, Elias Merrill F, Au Rhoda, Vasan Ramachandran S, Seshadri Sudha
Boston University School of Medicine, Boston, MA 02118-2526, USA.
Curr Alzheimer Res. 2007 Apr;4(2):111-6. doi: 10.2174/156720507780362263.
Obesity has been related to the incidence of dementia but its impact on cognitive performance in persons without dementia is less clear. We hypothesized that mid-life obesity may modulate the impact of conventional cardiovascular risk factors (CVRF) on cognitive impairment. We tested this hypothesis in the community-based Framingham Offspring Study sample.
At Examination cycle 4 (1988-90) of the Offspring Cohort, indices of obesity (BMI and Waist-Hip Ratio [WHR]) and baseline CVRF levels were ascertained in 1,814 men and women, aged 40-69 years. Obesity and hypertension were related to the score on each of 8 neurocognitive tests measured at Examination 8, 12 years later (1999-2002).
Midlife measures of central obesity (WHR in the uppermost quartile- Q4) and of hypertension (BP > or = 140 / > or = 90 or use of anti-hypertensive medication) were each significantly related to poorer performance on executive function & visuomotor skills (Trails B, Visual Reproductions-Immediate and Delayed Recall). Further, the relation of hypertension to neurocognitive performance was significantly modified by WHR; hypertension was not associated with neurocognitive performance in WHR Q1-Q3, but was associated with a marked adverse performance in Q4 WHR. Neither HTN nor obesity was individually or synergistically related to verbal memory (immediate or delayed recall).
Executive function and visuomotor skills were differentially affected by the combined presence of midlife hypertension and Q4 WHR while measures of verbal memory function were not related to these risk factors in our sample, a pattern consistent with vascular cognitive impairment. Control of mid-life elevated blood pressure and central obesity may be strategies to reduce cognitive decline with age.
肥胖与痴呆症的发病率有关，但其对无痴呆症人群认知表现的影响尚不清楚。我们假设中年肥胖可能会调节传统心血管危险因素（CVRF）对认知障碍的影响。我们在基于社区的弗雷明汉后代研究样本中验证了这一假设。
在后代队列的第4次检查周期（1988 - 1990年），确定了1814名年龄在40 - 69岁的男性和女性的肥胖指标（体重指数和腰臀比[WHR]）以及基线CVRF水平。肥胖和高血压与12年后（1999 - 2002年）第8次检查时测量的8项神经认知测试的每项得分相关。
中年中心性肥胖（WHR处于最高四分位数 - Q4）和高血压（血压≥140 /≥90或使用抗高血压药物）的指标均与执行功能和视觉运动技能（B线试验、视觉再现 - 即时和延迟回忆）表现较差显著相关。此外，高血压与神经认知表现的关系因WHR而有显著改变；在WHR Q1 - Q3中，高血压与神经认知表现无关，但在WHR Q4中与明显的不良表现相关。高血压和肥胖单独或协同与言语记忆（即时或延迟回忆）均无关联。
中年高血压和Q4 WHR共同存在时，执行功能和视觉运动技能受到不同影响，而在我们的样本中，言语记忆功能指标与这些危险因素无关，这一模式与血管性认知障碍一致。控制中年时升高的血压和中心性肥胖可能是减少随年龄增长认知衰退的策略。
