Nutritional Status and Risks of Cognitive Decline and Incident Neurocognitive Disorders: Singapore Longitudinal Ageing Studies

Abstract

Background

Studies suggest that nutritional interventions using the whole diet approach such as the Mediterranean diet may delay cognitive decline and dementia onset. However, substantial numbers of older adults are non-adherent to any ideally healthy dietary pattern and are at risk of malnutrition.

Objective

The present study investigated the relationship between global malnutrition risk and onsets of cognitive decline and neurocognitive disorders (NCD), including mild cognitive impairment (MCI) or dementia in community-dwelling older adults.

Methods

Participants aged ≥55 years in the Singapore Longitudinal Ageing Studies (SLAS) were assessed at baseline using the Elderly Nutritional Indicators for Geriatric Malnutrition Assessment (ENIGMA) and followed up 3–5 years subsequently on cognitive decline (MMSE drop ≥ 2) among 3128 dementia-free individuals, and incident neurocognitive disorders (NCD) among 2640 cognitive normal individuals.

Results

Individuals at high nutritional risk score (≥3) were more likely to develop cognitive decline (OR=1.42, 95%CI=1.01–1.99) and incident MCI-or-dementia (OR=1.64, 95%CI=1.03–2.59), controlling for age, sex, ethnicity, low education, APOE-e4, hearing loss, physical, social, and mental activities, depressive symptoms, smoking, alcohol, central obesity, hypertension, diabetes, low HDL, high triglyceride, cardiac disease, and stroke. Among ENIGMA component indicators, low albumin at baseline was associated with cognitive decline and incident NCD, and 5 or more drugs used, few fruits/vegetables/milk products daily, and low total cholesterol were associated with incident NCD.

Conclusion

The ENIGMA measure of global malnutrition risk predicts cognitive decline and incident neurocognitive disorders, suggesting the feasibility of identifying vulnerable subpopulations of older adults for correction of malnutrition risk to prevent neurocognitive disorders.

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Acknowledgements

We thank the following voluntary welfare organizations for their support: Geylang East Home for the Aged, Presbyterian Community Services, Thye Hua Kwan Moral Society (Moral Neighbourhood Links), Yuhua Neighbourhood Link, Henderson Senior Citizen’s Home, National Trade Union Congress Eldercare Co-op Ltd, Thong Kheng Senior Activity Centre (Queenstown) and Redhill Moral Seniors Activity Centre.

Funding

Funding Sources: This study was supported by research grants from the Agency for Science, Technology and Research (A*STAR) Biomedical Research Council (BMRC Grant 03/1/21/17/214) and Ministry of Health (MOH) National Medical Research Council (NMRC 08/1/21/19/567; NMRC/CG/NUHCS/2010).

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Authors

Contributions

Authors’ Contributions: LYX and TPN conceptualized and designed the study, reviewed the literature, drafted the manuscript and had primary responsibility for final content; TPN analysed data and performed statistical analyses; XYG, DQLC, TSL, WSL, MSC, FP, PY, KBY, TML, IR designed and conducted the research, including the clinical assessment of MCI and dementia; all authors reviewed and approved the final manuscript for publication.

Corresponding author

Correspondence to Tze Pin Ng.

Ethics declarations

Conflict of Interest (COI): The funding sources had no role in the design and conduct of the study: collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit manuscript for publication. The authors have no potential conflicts of interest.

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Lu, Y., Gwee, X., Chua, D.Q. et al. Nutritional Status and Risks of Cognitive Decline and Incident Neurocognitive Disorders: Singapore Longitudinal Ageing Studies. J Nutr Health Aging (2021). https://doi.org/10.1007/s12603-021-1603-9

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Key words

  • Malnutrition
  • mild cognitive impairment
  • dementia
  • dietary pattern