Abstract
OBJECTIVE: To determine the independent effects of obesity and hypertension on cognitive functioning.
METHODS: Using a prospective design, male (n=551) and female (n=872) participants of the Framingham Heart Study were classified by presence or absence of obesity and hypertension based on data collected over an 18-y surveillance period. All subjects were free from dementia, stroke, and clinically diagnosed cardiovascular disease up to the time of cognitive testing. Statistical models were adjusted for age, education, occupation, cigarette smoking, alcohol consumption, total cholesterol, and a diagnosis of type II diabetes. Body mass index status (nonobese or obese) and blood pressure status (normotensive or hypertensive) were then related to cognitive performance (learning, memory, executive functioning, and abstract reasoning) on tests administered 4–6 y later.
RESULTS: Adverse effects of obesity and hypertension on cognitive performance were observed for men only. Obese and hypertensive men performed more poorly than men classified as either obese or hypertensive, and the best performance was observed in nonobese, normotensive men.
CONCLUSIONS: The adverse effects of obesity and hypertension in men are independent and cumulative with respect to cognitive deficit.
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References
Elias MF, Elias PK, Robbins MA, Wolf PA, D'Agostino RB . Cardiovascular risk factors and cognitive functioning: an epidemiological perspective. In: Waldstein SR, Elias MF (eds). Neuropsychology of cardiovascular disease. Lawrence Erlbaum: Mahwah, NJ; 2001. pp 83–104.
Elias MF, Wolf PA, D'Agostino RB, Cobb J, White LR . Untreated blood pressure is inversely related to cognitive functioning: The Framingham Study. Am J Epidemiol 1993; 138: 353–364.
Elias PK, Elias MF, D'Agostino RB, Cupples LA, Wilson PW, Silbershatz H, Wolf PA . NIDDM and blood pressure as risk factors for poor cognitive performance. Diabetes Care 1997; 20: 1388–1395.
Knopman D, Boland LL, Mosely T, Howard G, Liao D, Szklo M, McGovern P, Folsom AR, for the Atherosclerosis Risk in Communities (ARIC) Study Investigators. Cardiovascular risk factors and cognitive decline in middle-aged adults. Neurology 2001; 56: 42–48.
Waldstein SR . Hypertension and neuropsychological function: a lifespan perspective. Exp Aging Res 1995; 21: 321–352.
Waldstein SR, Katzel LI . Hypertension and cognitive functioning. In: Waldstein SR, Elias MF (eds). Neuropsychology of cardiovascular disease. Lawrence Erlbaum: Mahwah, NJ; 2001. pp 15–36.
Desmond DW, Tatemichi TK, Paik M, Stern Y . Risk factors for cerebrovascular disease as correlates of cognitive function in a stroke-free cohort. Arch Neurol 1993; 50: 162–166.
Jennings JR, Muldoon MF, Ryan CM, Mintun MA, Meltzer CC, Townsend DW, Sutton-Tyrrell K, Shapiro AP, Manuck SB . Cerebral blood flow in hypertensive patients. An initial report of reduced and compensatory blood flow responses during performance of two cognitive tasks. Hypertension 1998; 31: 1216–1222.
Kuller LH . Epidemiology of obesity in adults in relationship to cardiovascular disease. In: Fletcher GF, Grundy SM, Hayman L (eds). Obesity: impact on cardiovascular disease. Futura Publishing Company: Armonk, NY; 1999. pp 3–29.
Hubert HB, Feinleib M, McNamara PM, Castelli WP . Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983; 67: 968–977.
Kilander L, Nyman H, Boberg M, Lithell H . Cognitive function, vascular risk factors and education: a cross-sectional study based on a cohort of 70-year-old men. J Intern Med 1997; 242: 313–321.
Sorensen TI, Sonne-Holm S, Christensen U, Kreiner S . Reduced intellectual performance in extreme overweight. Hum Biol 1982; 54: 765–775.
Hall JE, Brands MW, Jones DW, Shek EW, Henegar J . Mechanisms of obesity hypertension and relevance to essential hypertension. In: Fletcher GF, Grundy SM, Hayman L (eds). Obesity: impact on cardiovascular disease. Futura Publishing Company: Armonk, NY; 1999. pp 133–154.
Lowe LP, Tranel D, Wallace RB, Welty TK . Type II diabetes and cognitive function. A population-based study of Native Americans. Diabetes Care 1994; 17: 891–896.
Siegler IC, Bosworth HB, Elias MF . Adult development and aging in health psychology. In: Nezu AM, Nezu CM, Geller PA (eds). Comprehensive handbook of psychology. Health psychology, Vol 9. Wiley: New York; 2003. pp 487–510.
Elias MF, Elias PK, D'Agostino RB, Silbershatz H, Wolf PA . Role of age, education and gender on cognitive performance in the Framingham Heart Study: community-based norms. Exp Aging Res 1997; 23: 201–235.
NHLBI Obesity Education Initiative Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. The practical guide: indentification, evaluation, and treatment of overweight and obesity. NIH Publication No. 00-4084. National Instututes of Health: Washington, DC; 2000.
Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. The sixth report of the Joint National committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure. Arch Intern Med 1997; 157: 2413–2446.
Lezak MD . Neuropsychological assessment, 3rd edn. Oxford University Press: New York; 1995, p 549.
Harris RJ . A primer of multivariate statistics. Academic Press: New York; 1985.
LaCroix AZ . Gender effects and hypertension in women. In: Izzo Jr JL, Black HR (eds). Hypertension primer. American Heart Association: Dallas, TX; 1993. pp 150–152.
Meyer JS, Rauch GM, Crawford K, Rauch RA, Konno S, Akiyama H, Terayama Y, Haque A . Risk factors accelerating cerebral degenerative changes, cognitive decline and dementia. Int J Geriat Psychiatry 1999; 14: 1050–1061.
Ryan CM . Diabetes-associated cognitive dysfunction. In: Waldstein SR, Elias MF (eds). Neuropsychology of cardiovascular disease. Lawrence Erlbaum: Mahwah, NJ; 2001. pp 61–82.
Wilcosky T, Hyde J, Anderson JJ, Bangdiwala S, Duncan B . Obesity and mortality in the Lipid Research Clinics Program Follow-up Study. J Clin Epidemiol 1990; 43: 743–752.
Gillum RF, Mussolino ME, Madans JH . Body fat distribution, obesity, overweight, and stroke incidence in women and men: the NHANES I. Int J Obes Relat Metals Disord 2001; 25: 628–638.
Truett J, Cornfield J, Kannel WB . A multivariate analysis of risk of coronary heart disease in Framingham. J Chronic Dis 1967; 20: 511–524.
Kannel WB, Gordon T . Obesity and cardiovascular disease. The Framingham study. In: Burland LW, Samuel RD, Uudkin J (eds). Obesity. Churchill-Livingstone: Edinburgh; 1974. pp 24–51.
Murabito JM . Women and cardiovascular disease: contributions from the Framingham Heart Study. J Am Med Womans Assoc 1995; 50: 35–39.
Rossouw JE . Hormones, genetic factors, and gender differences in cardiovascular disease. Cardiovasc Res 2002; 53: 550–557.
Brownell KD, Wadden TA . Etiology and treatment of obesity: understanding a serious, prevalent, and refractory disorder. J Consult Clin Psychol 1992; 60: 505–517.
Horsten M, Mittleman MA, Wamala SP, Schenck-Gustafsson K, Orth-Gomer K . Depressive symptoms and lack of social integration in relation to prognosis of CHD in middle-aged women. The Stockholm Female Coronary Risk Study. Eur Heart J 2000; 21: 1072–1080.
Musselman DL, Evans DL, Nemeroff CB . The relationship of depression to cardiovascular disease: epidemiology, biology and treatment. Arch Gen Psychiatry 1998; 55: 580–592.
Takemura Y, Kikuchi S, Takagi H, Inaba Y, Nakagawa K . A cross-sectional study on the relationship between depression and left ventricular hypertrophy. Prev Med 1998; 27: 787–791.
Jorm AF . Is depression a risk factor for dementia or cognitive decline? A review. Gerontology 2000; 46: 219–227.
Elias MF, Sullivan LM, Elias PK, Wolf PA, Robbins MA, D'Agostino RB . Obesity predisposes to depression in younger but not older women: The Framingham Offspring Study. Abstract 347. Psychosom Med 2002; 64: 171.
Moore ME, Stunkard AJ, Srole L . Obesity, social class, and mental illness. J Am Med Assoc 1962; 181: 962–966.
Stunkard AJ . Obesity and the social environment: current status, future prospects. Ann NY Acad Sci 1977; 300: 298–320.
Whitelaw AG . Association of social class and sibling number with skinfold thickness in London school boys. Hum Biol 1971; 43: 414–420.
Cagney KA, Lauderdale DS . Education, wealth, and cognitive function in later life. J Geront B Psychol Sci Soc Sci 2002; 57B(2), P163–P172.
Wechsler D . The measurement and appraisal of adult intelligence, 4th edn. Williams and Wilkins: Baltimore; 1958. p 137.
Acknowledgements
This research was supported, in part, by research grants from the National Institutes of Health: 1-R01-HL65177-03 (National Lung, Blood and Heart Institute and the National Institute on Aging); 1-R01-NS17950-21 (National Institute of Neurological Diseases and Stroke); 1-R01-AG16495-04 (National Institute on Aging); and 3-R01 AG08122-12 (National Institute on Aging) and CONTRACT NO1-HC-25195 (NIH/NHLBI).
We extend our sincere appreciation to Dr Michael A Robbins, Kristin A Swenson, Gregory A Dore, and Barbara A Hermann, University of Maine, for their assistance in the preparation of the manuscript.
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Elias, M., Elias, P., Sullivan, L. et al. Lower cognitive function in the presence of obesity and hypertension: the Framingham heart study. Int J Obes 27, 260–268 (2003). https://doi.org/10.1038/sj.ijo.802225
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DOI: https://doi.org/10.1038/sj.ijo.802225
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