Obesity, Cognitive Ageing, and Dementia: The Usefulness of Longitudinal Studies to Understand the Obesity Paradox

  • Anna Dahl AslanEmail author
Part of the International Perspectives on Aging book series (Int. Perspect. Aging, volume 10)


Obesity is a global health problem that has reached epidemic proportions (World Health Organization 2000). It is estimated that worldwide approximately one billion adults are overweight and an additional 475 million are obese. In Europe, approximately 60 % of the adult population is either overweight or obese. During the last decade, an increasing focus has been put on the potential influence of obesity on cognitive functions and dementia. While midlife obesity is associated with lower cognitive functions in late life and a greater risk of dementia, the association between late life obesity, cognitive ageing, and dementia is less clear. In late life, being overweight and/or obese is often associated with better cognitive functions and decreased risk of dementia. The main focus of this chapter is to try to unravel this shift in association, often referred to as the obesity paradox, by evaluating results from studies with a longitudinal design. Issues such as interference of preclinical dementia, weight changes, age at assessments, and the follow-up time will be discussed. These issues seem to be essential to understand the obesity paradox.


Body Mass Index Waist Circumference High Body Mass Index Verbal Ability Cognitive Ageing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This work was supported by the Future Leaders of Ageing Research in Europe (FLARE) postdoctoral grant, coordinated by the European Research Area in Ageing (ERA-AGE) and funded by the Swedish Council for Working Life and Social Research (FAS, 2010-1852). I also want to thank Dr. Milan Chang and the editor of this book Dr. Anja Leist for helpful comments and suggestions for improvements of this chapter.


  1. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  2. Anstey KJ, Cherbuin N, Budge M, Young J (2011) Body mass index in midlife and late-life as a risk factor for dementia: a meta-analysis of prospective studies. Obes Rev 12(5):e426–e437. doi: 10.1111/j.1467-789X.2010.00825.x CrossRefGoogle Scholar
  3. Arnaiz E, Almkvist O (2003) Neuropsychological features of mild cognitive impairment and preclinical Alzheimer’s disease. Acta Neurol Scand Suppl 179:34–41CrossRefGoogle Scholar
  4. Atti AR, Palmer K, Volpato S, Winblad B, De Ronchi D, Fratiglioni L (2008) Late-life body mass index and dementia incidence: nine-year follow-up data from the Kungsholmen project. J Am Geriatr Soc 56(1):111–116. doi: 10.1111/j.1532-5415.2007.01458.x CrossRefGoogle Scholar
  5. Barrett-Connor E (2007) An introduction to obesity and dementia. Curr Alzheimer Res 4(2):97–101CrossRefGoogle Scholar
  6. Batty GD, Wennerstad KM, Smith GD, Gunnell D, Deary IJ, Tynelius P, Rasmussen F (2009) IQ in early adulthood and mortality by middle age: cohort study of 1 million Swedish men. Epidemiology 20(1):100–109. doi: 10.1097/EDE.0b013e31818ba076 CrossRefGoogle Scholar
  7. Benito-Leon J, Mitchell AJ, Hernandez-Gallego J, Bermejo-Pareja F (2013) Obesity and impaired cognitive functioning in the elderly: a population-based cross-sectional study (NEDICES). Eur J Neurol 20(6):899–906. doi: 10.1111/ene.12083, e876-897CrossRefGoogle Scholar
  8. Beydoun MA, Beydoun HA, Wang Y (2008) Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis. Obes Rev 9(3):204–218. doi: 10.1111/j.1467-789X.2008.00473.x CrossRefGoogle Scholar
  9. Brubacher D, Monsch A, Stähelin H (2004) Weight change and cognitive performance. Int J Obes Relat Metab Disord 28(9):1163–1167CrossRefGoogle Scholar
  10. Buchman A, Wilson R, Bienias J, Shah R, Evans D, Bennett D (2005) Change in body mass index and risk of incident Alzheimers disease. Neurology 65(6):892–897CrossRefGoogle Scholar
  11. Chandola T, Deary IJ, Blane D, Batty GD (2006) Childhood IQ in relation to obesity and weight gain in adult life: the National Child Development (1958) Study. Int J Obes (Lond) 30(9):1422–1432. doi: 10.1038/sj.ijo.0803279 CrossRefGoogle Scholar
  12. Chang M, Jonsson PV, Snaedal J, Bjornsson S, Saczynski JS, Aspelund T, Eiriksdottir G, Jonsdottir MK, Lopez OL, Harris TB, Gudnason V, Launer LJ (2010) The effect of midlife physical activity on cognitive function among older adults: AGES–Reykjavik Study. J Gerontol A Biol Sci Med Sci 65(12):1369–1374. doi: 10.1093/gerona/glq152 CrossRefGoogle Scholar
  13. Corley J, Gow AJ, Starr JM, Deary IJ (2010) Is body mass index in old age related to cognitive abilities? the Lothian birth cohort 1936 study. Psychol Aging 25(4):867–875CrossRefGoogle Scholar
  14. Cournot M, Marquie JC, Ansiau D, Martinaud C, Fonds H, Ferrieres J, Ruidavets JB (2006) Relation between body mass index and cognitive function in healthy middle-aged men and women. Neurology 67(7):1208–1214. doi: 10.1212/01.wnl.0000238082.13860.50 CrossRefGoogle Scholar
  15. Craft S (2009) The role of metabolic disorders in Alzheimer disease and vascular dementia: two roads converged. Arch Neurol 66(3):300–305. doi: 10.1001/archneurol.2009.27 CrossRefGoogle Scholar
  16. Dahl AK, Hassing LB (2013) Obesity and cognitive aging. Epidemiol Rev 35:22–32. doi: 10.1093/epirev/mxs002 CrossRefGoogle Scholar
  17. Dahl A, Berg S, Nilsson S (2007) Dementia identification in epidemiological research: a study on the usefulness of different data sources. Aging Clin Exp Res 19(5):381–389CrossRefGoogle Scholar
  18. Dahl A, Lopponen M, Isoaho R, Berg S, Kivela SL (2008) Overweight and obesity in old age are not associated with greater dementia risk. J Am Geriatr Soc 56(12):2261–2266. doi: 10.1111/j.1532-5415.2008.01958.x CrossRefGoogle Scholar
  19. Dahl A, Hassing LB, Fransson E, Berg S, Gatz M, Reynolds CA, Pedersen NL (2010) Being overweight in midlife is associated with lower cognitive ability and steeper cognitive decline in late life. J Gerontol A Biol Sci Med Sci 65(1):57–62. doi: 10.1093/gerona/glp035 CrossRefGoogle Scholar
  20. Dahl AK, Andel R, Xu W, Gatz M (2013a) Obesity, blood glucose, and risk of dementia. Gerontologist 53:9CrossRefGoogle Scholar
  21. Dahl AK, Hassing LB, Fransson EI, Gatz M, Reynolds CA, Pedersen NL (2013b) Body mass index across midlife and cognitive change in late life. Int J Obes (Lond) 37:296–302. doi: 10.1038/ijo.2012.37 CrossRefGoogle Scholar
  22. Dahl AK, Reynolds CA, Fall T, Magnusson PK, Pedersen NL (2013c) Multifactorial analysis of changes in body mass index across the adult life course. Int J Obes (Lond); doi:  10.1038/ijo.2013.204
  23. De Michele M, Panico S, Iannuzzi A, Celentano E, Ciardullo AV, Galasso R, Sacchetti L, Zarrilli F, Bond MG, Rubba P (2002) Association of obesity and central fat distribution with carotid artery wall thickening in middle-aged women. Stroke 33(12):2923–2928CrossRefGoogle Scholar
  24. Dore G, Elias M, Robbins M, Budge M, Elias P (2008) Relation Between Central Adiposity and Cognitive Function in the Maine–Syracuse Study: Attenuation by Physical Activity. Behav Med 35(3):341–350CrossRefGoogle Scholar
  25. Feart C, Samieri C, Rondeau V, Amieva H, Portet F, Dartigues JF, Scarmeas N, Barberger-Gateau P (2009) Adherence to a Mediterranean diet, cognitive decline, and risk of dementia. JAMA 302(6):638–648. doi: 10.1001/jama.2009.1146 CrossRefGoogle Scholar
  26. Finkel D, Reynolds C, McArdle JJ, Gatz M, Pedersen NL (2003) Latent growth curve analyses of accelerating decline in cognitive abilities in late adulthood. Dev Psychol 39(3):535–550CrossRefGoogle Scholar
  27. Finkel D, Reynolds CA, Larsson M, Gatz M, Pedersen NL (2011) Both odor identification and ApoE-epsilon4 contribute to normative cognitive aging. Psychol Aging 26(4):872–883. doi: 10.1037/a0023371 CrossRefGoogle Scholar
  28. Gorospe EC, Dave JK (2007) The risk of dementia with increased body mass index. Age Ageing 36(1):23–29. doi: 10.1093/ageing/afl123 CrossRefGoogle Scholar
  29. Grundman M, Corey-Bloom J, Jernigan T, Archibald S, Thal LJ (1996) Low body weight in Alzheimer’s disease is associated with mesial temporal cortex atrophy. Neurology 46(6):1585–1591CrossRefGoogle Scholar
  30. Gunstad J, Lhotsky A, Rice Wendell C, Ferrucci L, Zonderman AB (2010) Longitudinal Examination of Obesity and Cognitive Function: Results from the Baltimore Longitudinal Study of Aging. Neuroepidemiology 34(4):222–229CrossRefGoogle Scholar
  31. Gustafson D (2006) Adiposity indices and dementia. Lancet Neurol 5(8):713–720CrossRefGoogle Scholar
  32. Gustafson D, Rothenberg E, Blennow K, Steen B, Skoog I (2003) An 18-year follow-up of overweight and risk of Alzheimer disease. Arch Intern Med 163:1524–1528CrossRefGoogle Scholar
  33. Gustafson DR, Backman K, Waern M, Ostling S, Guo X, Zandi P, Mielke MM, Bengtsson C, Skoog I (2009) Adiposity indicators and dementia over 32 years in Sweden. Neurology 73(19):1559–1566. doi: 10.1212/WNL.0b013e3181c0d4b6 CrossRefGoogle Scholar
  34. Hamer M, Chida Y (2009) Physical activity and risk of neurodegenerative disease: a systematic review of prospective evidence. Psychol Med 39(1):3–11. doi: 10.1017/S0033291708003681 CrossRefGoogle Scholar
  35. Hassing LB, Dahl A, Thorvaldsson V, Berg S, Gatz M, Pedersen NL, Johansson B (2008) Overweight in midlife and risk of dementia: a 40-year follow-up study. Int J Obes (Lond) 33:893–898CrossRefGoogle Scholar
  36. Hassing LB, Dahl AK, Pedersen NL, Johansson B (2010) Overweight in midlife is related to lower cognitive function 30 years later: a prospective study with longitudinal assessments. Dement Geriatr Cogn Disord 29(6):543–552. doi: 10.1159/000314874 CrossRefGoogle Scholar
  37. Hayden KM, Zandi PP, Lyketsos CG, Khachaturian AS, Bastian LA, Charoonruk G, Tschanz JT, Norton MC, Pieper CF, Munger RG, Breitner JCS, Welsh-Bohmer KA (2006) Vascular risk factors for incident Alzheimer disease and vascular dementia: the Cache County Study. Alzheimer Dis Assoc Disord 20:93–100CrossRefGoogle Scholar
  38. Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM (2004) Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291(23):2847–2850. doi: 10.1001/jama.291.23.2847 CrossRefGoogle Scholar
  39. Hendrie HC (1998) Epidemiology of dementia and Alzheimer’s disease. Am J Geriatr Psychiatry 6(2 Suppl 1):S3–S18CrossRefGoogle Scholar
  40. Herghelegiu AM, Prada GI (2014) Impact of metabolic control on cognitive function and health-related quality of life in older diabetics. In: Leist AK, Kulmala J (eds) Health and cognition in old age. Springer, New YorkGoogle Scholar
  41. Hu X, Okamura N, Arai H, Higuchi M, Maruyama M, Itoh M, Yamaguchi K, Sasaki H (2002) Neuroanatomical correlates of low body weight in Alzheimer’s disease: a PET study. Prog Neuropsychopharmacol Biol Psychiatry 26(7–8):1285–1289CrossRefGoogle Scholar
  42. International Obesity Taskforce (2013) The Global Epidemic. Accessed 25 Jul 2013
  43. Jackson AS, Stanforth PR, Gagnon J, Rankinen T, Leon AS, Rao DC, Skinner JS, Bouchard C, Wilmore JH (2002) The effect of sex, age and race on estimating percentage body fat from body mass index: the Heritage Family Study. Int J Obes Relat Metab Disord 26(6):789–796CrossRefGoogle Scholar
  44. Kerwin DR, Gaussoin SA, Chlebowski RT, Kuller LH, Vitolins M, Coker LH, Kotchen JM, Nicklas BJ, Wassertheil-Smoller S, Hoffmann RG, Espeland MA (2011) Interaction between body mass index and central adiposity and risk of incident cognitive impairment and dementia: results from the Women’s Health Initiative Memory Study. J Am Geriatr Soc 59(1):107–112. doi: 10.1111/j.1532-5415.2010.03219.x CrossRefGoogle Scholar
  45. Knopman DS, Edland SD, Cha RH, Petersen RC, Rocca WA (2007) Incident dementia in women is preceded by weight loss by at least a decade. Neurology 69(8):739–746CrossRefGoogle Scholar
  46. Knopman DS, Mosley TH, Catellier DJ, Coker LH (2009) Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study. Alzheimers Dement 5(3):207–214. doi: 10.1016/j.jalz.2009.01.027 CrossRefGoogle Scholar
  47. Kopelman PG (2000) Obesity as a medical problem. Nature 404(6778):635–643Google Scholar
  48. Kuo H-K, Jones RN, Milberg WP, Tennstedt S, Talbot L, Morris JN, Lipsitz LA (2006) Cognitive function in normal-weight, overweight, and obese older adults: an analysis of the advanced cognitive training for independent and vital elderly cohort. J Am Geriatr Soc 54(1):97–103CrossRefGoogle Scholar
  49. Laitala VS, Kaprio J, Koskenvuo M, Raiha I, Rinne JO, Silventoinen K (2011) Association and causal relationship of midlife obesity and related metabolic disorders with old age cognition. Curr Alzheimer Res 8(6):699–706CrossRefGoogle Scholar
  50. Lathe R (2001) Hormones and the hippocampus. J Endocrinol 169(2):205–231CrossRefGoogle Scholar
  51. Lawlor DA, Clark H, Davey Smith G, Leon DA (2006) Childhood intelligence, educational attainment and adult body mass index: findings from a prospective cohort and within sibling-pairs analysis. Int J Obes (Lond) 30(12):1758–1765. doi: 10.1038/sj.ijo.0803330 CrossRefGoogle Scholar
  52. Luchsinger JA, Gustafson DR (2009) Adiposity and Alzheimer’s disease. Curr Opin Clin Nutr Metab Care 12(1):15–21. doi: 10.1097/MCO.0b013e32831c8c71 CrossRefGoogle Scholar
  53. Luchsinger JA, Patel B, Tang M-X, Schupf N, Mayeux R (2007) Measures of adiposity and dementia risk in the elderly. Arch Neurol 64(3):392–398CrossRefGoogle Scholar
  54. Luchsinger JA, Biggs ML, Kizer JR, Barzilay J, Fitzpatrick A, Newman A, Longstreth WT, Lopez O, Siscovick D, Kuller L (2013) Adiposity and cognitive decline in the cardiovascular health study. Neuroepidemiology 40(4):274–281. doi: 10.1159/000345136 CrossRefGoogle Scholar
  55. McClearn GE, Johansson B, Berg S, Pedersen NL, Ahern F, Petrill SA, Plomin R (1997) Substantial genetic influence on cognitive abilities in twins 80 or more years old. Science 276(5318): 1560–1563CrossRefGoogle Scholar
  56. Nourhashémi F, Deschamps V, Larrieu S, Letenneur L, Dartigues J-F, Barberger-Gateau P (2003) Body mass index and incidence of dementia: the PAQUID study. Neurology 60:117–119CrossRefGoogle Scholar
  57. Pedersen NL, Plomin R, Nesselroade JR, McClearn GE (1992) A quantitative genetic analysis of cognitive abilities during the second half of the life span. Psychol Sci 3(6):346–352. doi: 10.1111/j.1467-9280.1992.tb00045.x CrossRefGoogle Scholar
  58. Qiu C (2014) Lifestyle factors in the prevention of dementia: a life-course perspective. In: Leist AK, Kulmala J (eds) Health and cognition in old age. Springer, New YorkGoogle Scholar
  59. Ridker PM, Buring JE, Cook NR, Rifai N (2003) C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-Up of 14 719 initially healthy American women. Circulation 107(3):391–397. doi: 10.1161/01.cir.0000055014.62083.05 CrossRefGoogle Scholar
  60. Sabia S, Kivimaki M, Shipley MJ, Marmot MG, Singh-Manoux A (2009) Body mass index over the adult life course and cognition in late midlife: the Whitehall II Cohort Study. Am J Clin Nutr 89(2):601–607. doi: 10.3945/ajcn.2008.26482 CrossRefGoogle Scholar
  61. Schaie KW (2005) Developmental influences on adult intelligence—the Seattle Longitudinal Study. Oxford University Press, New York, NYCrossRefGoogle Scholar
  62. Schmidt R, Schmidt HJ, Curb D, Masaki K, White LR, Launer LJ (2002) Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia aging study. Ann Neurol 52(2):168–174CrossRefGoogle Scholar
  63. Sellbom KS, Gunstad J (2012) Cognitive function and decline in obesity. J Alzheimers Dis 30:S89–S95. doi: 10.3233/JAD-2011-111073 Google Scholar
  64. Smith E, Hay P, Campbell L, Trollor JN (2011) A review of the association between obesity and cognitive function across the lifespan: implications for novel appraches to prevention and treatment. Obes Rev 12:740–755Google Scholar
  65. Stewart R, Masaki K, Xue Q-L, Peila R, Petrovitch H, White LR, Launer LJ (2005) A 32-year prospective study of change in body weight and incident dementia: the Honolulu-Asia Aging Study. Arch Neurol 62(1):55–60CrossRefGoogle Scholar
  66. Stunkard AJ, Harris JR, Pedersen NL, McClearn GE (1990) The body-mass index of twins who have been reared apart. N Engl J Med 322(21):1483–1487CrossRefGoogle Scholar
  67. Sturman MT, Mendes de Leon CF, Bienias JL, Morris JC, Wilson RS, Evans DA (2008) Body mass index and cognitive decline in a biracial community population. Neurology 70(5): 360–367CrossRefGoogle Scholar
  68. Tabert MH, Liu X, Doty RL, Serby M, Zamora D, Pelton GH, Marder K, Albers MW, Stern Y, Devanand DP (2005) A 10-item smell identification scale related to risk for Alzheimer’s disease. Ann Neurol 58:155–160CrossRefGoogle Scholar
  69. Tilvis RS, Kahonen-Vare MH, Jolkkonen J, Valvanne J, Pitkala KH, Strandberg TE (2004) Predictors of cognitive decline and mortality of aged people over a 10-year period. J Gerontol A Biol Sci Med Sci 59(3):268–274CrossRefGoogle Scholar
  70. Tolppanen AM, Ngandu T, Kareholt I, Laatikainen T, Rusanen M, Soininen H, Kivipelto M (2013) midlife and late-life body mass index and late-life dementia: results from a Prospective Population-Based Cohort. J Alzheimers Dis 38(1):201–209. doi: 10.3233/JAD-130698 Google Scholar
  71. Visscher TL, Seidell JC, Menotti A, Blackburn H, Nissinen A, Feskens EJ, Kromhout D (2000) Underweight and overweight in relation to mortality among men aged 40-59 and 50-69 years: the Seven Countries Study. Am J Epidemiol 151(7):660–666CrossRefGoogle Scholar
  72. West NA, Haan MN (2009) Body adiposity in late life and risk of dementia or cognitive impairment in a longitudinal community-based study. J Gerontol A Biol Sci Med Sci 64(1):103–109. doi: 10.1093/gerona/gln006 CrossRefGoogle Scholar
  73. Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry C, Yaffe K (2005) Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study. Br Med J 330:1360–1364CrossRefGoogle Scholar
  74. Williams IL, Wheatcroft SB, Shah AM, Kearney MT (2002) Obesity, atherosclerosis and the vascular endothelium: mechanisms of reduced nitric oxide bioavailability in obese humans. Int J Obes Relat Metab Disord 26(6):754–764. doi: 10.1038/sj.ijo.0801995 CrossRefGoogle Scholar
  75. Wilson RS, Beckett LA, Bennett DA, Albert MS, Evans DA (1999) Change in cognitive function in older persons from a community population: relation to age and Alzheimer disease. Arch Neurol 56(10):1274–1279CrossRefGoogle Scholar
  76. Wilson RS, Beckett LA, Barnes LL, Schneider JA, Bach J, Evans DA, Bennett DA (2002) Individual differences in rates of change in cognitive abilities of older persons. Psychol Aging 17(2):179–193CrossRefGoogle Scholar
  77. Wolf PA, Beiser A, Elias MF, Au R, Vasan RS, Seshadra S (2007) Relation of obesity to cognitive function: importance of central obesity and synergistic influence of concomitant hypertension. The Framingham Heart Study. Curr Alzheimer Res 4(2):111–116CrossRefGoogle Scholar
  78. World Health Organization (1995) Physical Status: the use and interpretation of anthropometry, Vol. 854. Technical Report. World Health Organization, GenevaGoogle Scholar
  79. World Health Organization (2000) Obesity—preventing and managing the global epidemic. WHO technical report series, GenevaGoogle Scholar
  80. Xu WL, Atti AR, Gatz M, Pedersen NL, Johansson B, Fratiglioni L (2011) Midlife overweight and obesity increase late-life dementia risk: a population-based twin study. Neurology 76(18): 1568–1574. doi: 10.1212/WNL.0b013e3182190d09 CrossRefGoogle Scholar
  81. Yaffe K, Kanaya A, Lindquist K, Simonsick EM, Harris T, Shorr RI, Tylavsky FA, Newman AB (2004) The metabolic syndrome, inflammation, and risk of cognitive decline. JAMA 292(18): 2237–2242CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
  2. 2.Institute of Gerontology, School of Health SciencesJönköping UniversityJönköpingSweden

Personalised recommendations