Anemia is associated with cognitive impairment in adolescent girls: A cross-sectional survey

Appl Neuropsychol Child. 2020 Apr-Jun;9(2):165-171. doi: 10.1080/21622965.2018.1550405. Epub 2019 Jan 20.


Anemia is associated with impairment in oxygen transport, affecting an individual's physical and mental wellbeing, and work performance. The aim of this study was to examine the prevalence of anemia and its possible association with serum antibody titers to Hsp27 (as an indicator of cellular stress), cognitive function, measures of emotion, and sleep patterns in adolescent girls. A total of 940 adolescent girls were assessed to evaluate neuropsychological function with validated questionnaires. A complete blood count was determined as part of the assessment of hematological parameters. Serum anti-Hsp27 was measured for each subject. Among the total of 940 participants, 99 girls (10.5%) were anemic [hemoglobin <12(g/dL)]. Serum anti-HSP27 was significantly higher in anemic compared to healthy girls (p < 0.05). There was no significant differences in depression, aggression, insomnia, daytime sleepiness and sleep apnea score between two groups. However, the total cognitive abilities score was significantly lower in the anemic girls (76.8 ± 2.1 vs. 85.7 ± 2.5, p = 0.002). Logistic regression analysis showed that anemic girls were 1.73 times more likely than nonanemic girls to have cognitive impairment (95% confidence interval [CI] = 1.07-2.78; P = 0.025). Anemia was associated with elevated levels of anti-HSP27 and supports the hypothesis that cellular stress may be associated with anemia. Anemia was adversely associated with an assessment of cognitive abilities and was an independent risk factor for cognitive impairment in this group.

Keywords: Cognitive ability; depression; heat shock protein; sleep disorder.

MeSH terms

  • Adolescent
  • Anemia / epidemiology*
  • Anemia / immunology
  • Autoantibodies / immunology
  • Child
  • Cognitive Dysfunction / epidemiology*
  • Cross-Sectional Studies
  • Female
  • Heat-Shock Proteins / immunology
  • Humans
  • Iran / epidemiology
  • Logistic Models
  • Molecular Chaperones / immunology
  • Risk Factors


  • Autoantibodies
  • HSPB1 protein, human
  • Heat-Shock Proteins
  • Molecular Chaperones