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Coexisting Anemia and Elevated C-Reactive Protein in Relation to Memory-Related Cognitive Outcomes: Evidence From
Jiahao Yang1, Sihui Wang1, Yu Wang1
1Department of Neurology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Insights
Anemia and elevated C-reactive protein (CRP) together are linked to worse memory in older adults. This dual vascular-inflammatory burden impacts cognitive function, particularly delayed recall and memory scores.
Area of Science:
- Gerontology
- Neuroscience
- Immunology
Background:
- Vascular and inflammatory processes are implicated in cognitive decline.
- Anemia and elevated C-reactive protein (CRP) represent potential markers of vascular and inflammatory burdens, respectively.
- The combined impact of anemia and elevated CRP on cognitive outcomes in aging populations remains underexplored.
Purpose of the Study:
- To investigate the association between coexisting anemia and elevated CRP with memory-related cognitive outcomes.
- To assess this association in middle-aged and older adults using longitudinal data from the China Health and Retirement Longitudinal Study (CHARLS) and the English Longitudinal Study of Ageing (ELSA).
Main Methods:
- Analysis of longitudinal data from 5166 CHARLS participants.
- Anemia defined by sex-specific hemoglobin thresholds; elevated CRP defined as > 3 mg/L.
- Participants categorized into four anemia-CRP exposure groups; multivariable linear regression models used to assess cognitive scores and change from 2011 to 2015.
Main Results:
- Participants with both anemia and elevated CRP exhibited poorer memory performance in 2015 compared to those with neither condition.
- Significant associations were found for immediate recall, delayed recall, and memory after false discovery rate (FDR) correction.
- Delayed recall (β = -0.541) and memory (β = -0.983) showed the strongest negative associations with the dual burden.
Conclusions:
- Coexisting anemia and elevated CRP are significantly associated with poorer memory-related cognitive performance in middle-aged and older adults.
- The findings suggest a dual vascular-inflammatory burden may negatively impact memory.
- Longitudinal cognitive changes associated with these conditions warrant cautious interpretation.
Aim:
To examine whether coexisting anemia and elevated C-reactive protein (CRP), reflecting a potential dual vascular-inflammatory burden, are associated with memory-related cognitive outcomes in middle-aged and older adults, using CHARLS as the primary cohort and ELSA for exploratory cross-cohort support.
Methods:
Longitudinal data from 5166 CHARLS participants were analyzed. Anemia was defined using sex-specific hemoglobin thresholds, and elevated CRP was defined as CRP > 3 mg/L. Participants were categorized into four anemia-CRP exposure groups. Multivariable linear regression models examined 2015 cognitive scores and cognitive change from 2011 to 2015. The primary outcomes were 2015 immediate recall, delayed recall, and memory scores. Other cognitive measures and cognitive change were secondary outcomes, whereas low cognitive performance and the CHARLS-ELSA pooled analysis were exploratory. Robustness was assessed using multiple sensitivity analyses, including bootstrap resampling, mixed-effects models, inverse probability weighting, and false discovery rate correction.
Results:
In CHARLS, participants with both anemia and elevated CRP had poorer 2015 memory-related cognitive performance than those with neither condition. After false discovery rate correction, associations remained significant across the memory-related outcomes, including immediate recall, delayed recall, and memory. The strongest associations were observed for delayed recall (β = -0.541, 95% CI: -0.888 to -0.194; FDR-adjusted p = 0.024) and memory (β = -0.983, 95% CI: -1.579 to -0.387; FDR-adjusted p = 0.024). Associations with global cognition and cognitive change were directionally consistent but did not remain statistically significant after FDR correction.
Conclusions:
Coexisting anemia and elevated CRP were associated with poorer memory-related cognitive performance in middle-aged and older adults. Longitudinal cognitive changes require cautious interpretation.
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