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Published on: November 30, 2015
Infectious burden and cognitive function: the Northern Manhattan Study
Mira Katan1, Yeseon Park Moon, Myunghee Cho Paik
1Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA. mk3270@columbia.edu
Insights
Infectious burden (IB), a measure of past infections, was linked to poorer cognitive performance in a multiethnic cohort. This suggests infections may play a role in cognitive impairment.
Area of Science:
- Neurology
- Infectious Disease Epidemiology
- Cognitive Science
Background:
- Vascular risk factors are associated with cognitive decline.
- Infectious burden (IB), a serologic measure of exposure to common pathogens, is linked to vascular risk.
Purpose of the Study:
- To investigate the association between infectious burden (IB) and cognitive performance.
- To determine if IB is associated with cognitive impairment in a multiethnic cohort.
Main Methods:
- Cognition assessed using Mini-Mental State Examination (MMSE) and Telephone Interview for Cognitive Status (TICS-m).
- Adjusted linear, logistic regressions, and generalized estimating equation models used to analyze associations between IB and cognitive measures.
Main Results:
- Higher IB was associated with worse cognitive performance (MMSE and TICS-m).
- IB was associated with a higher likelihood of MMSE ≤24 (indicating cognitive impairment).
- IB was not associated with cognitive decline over time.
Conclusions:
- Infectious burden is independently associated with cognitive performance in a multiethnic cohort.
- Past infections may contribute to cognitive impairment.
Objective:
We hypothesized that infectious burden (IB), a composite serologic measure of exposure to common pathogens (i.e., Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus 1 and 2) associated with vascular risk in the prospective Northern Manhattan Study (NOMAS), would also be associated with cognition.
Methods:
Cognition was assessed using the Mini-Mental State Examination (MMSE) at enrollment and the modified Telephone Interview for Cognitive Status (TICS-m) at annual follow-up visits. Adjusted linear and logistic regressions were used to measure the association between IB index and MMSE. Generalized estimating equation models were used to evaluate associations with TICS-m and its change over time.
Results:
Serologies and cognitive assessments were available in 1,625 participants of the NOMAS cohort. In unadjusted analyses, higher IB index was associated with worse cognition (change per standard deviation [SD] of IB for MMSE was -0.77, p < 0.0001, and for first measurements of TICS-m was -1.89, p < 0.0001). These effects were attenuated after adjusting for risk factors (for MMSE adjusted change per SD of IB = -0.17, p = 0.06, for TICS-m adjusted change per SD IB = -0.68, p < 0.0001). IB was associated with MMSE ≤24 (compared to MMSE >24, adjusted odds ratio 1.26 per SD of IB, 95% confidence interval 1.06-1.51). IB was not associated with cognitive decline over time. The results were similar when IB was limited to viral serologies only.
Conclusion:
A measure of IB associated with stroke risk and atherosclerosis was independently associated with cognitive performance in this multiethnic cohort. Past infections may contribute to cognitive impairment.
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