Metabolic syndrome over 10 years and cognitive functioning in late midlife: the Whitehall II study

Abstract

Objective: Evidence that the metabolic syndrome is a risk factor for poor cognition is mixed and is focused mainly on the elderly population; rarely is an adjustment made for socioeconomic factors. We examined this association in late midlife, with particular focus on cumulative effects and the role of socioeconomic circumstances.

Research design and methods: Analyses were performed for 4,150 white participants from the Whitehall II study. Metabolic syndrome, using the National Cholesterol Education Program Adult Treatment Panel III criteria, was assessed three times over the 10-year follow-up (1991-2001). Cognitive function was assessed using a battery of six tests at the end of the follow-up.

Results: After adjustment for demographic variables, health behaviors, and health status, participants with persistent metabolic syndrome (at least two of the three screenings) over the 10-year follow-up had lower cognitive performance than participants who never had metabolic syndrome. No significant differences in cognitive function were observed between participants with nonpersistent metabolic syndrome (one of the three screenings) and those who never had metabolic syndrome during the follow-up. Adjustment for adult occupational position attenuated this association by between 41 and 86%, depending on the measure of cognitive function. Adjustment for education had little effect.

Conclusions: Only persistent metabolic syndrome was associated with lower cognitive performance in late midlife. Adult occupational position but not education had a substantial impact on this association; these results highlight the importance of adult socioeconomic circumstances in identifying and targeting risk factors for cognitive aging.

Figure 1

Mean differences (95% CIs) in cognitive T scores across the cumulative exposure to the metabolic syndrome over the 10-year follow-up (n = 4,150), adjusted for sex and age. *Mean difference in cognitive T-scores statistically significant (P ≤ 0.05). MS, metabolic syndrome.

Figure 2

Mean differences (95% CIs) in cognitive T scores between participants with persistent metabolic syndrome and those with no metabolic syndrome after sequential adjustment for education and occupational position. White bars, model 1: analyses adjusted for sex and age; light gray bars, model 1 additionally adjusted for education; dark gray bars, model 1 additionally adjusted for occupational position.