The association between atherogenic index of plasma and cognitive impairment among older adults in Southern Iran: findings from the Bushehr elderly health program

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INTRODUCTION: Cognitive decline is a major challenge to global public health, especially among older adults. A high Atherogenic Index of Plasma (AIP) is linked to cerebral small vessel disease, which may increase the risk of cognitive decline. This study aims to evaluate the association between AIP and cognitive impairment in a sample of older adults in Iran. METHODS: The study enrolled 2373 individuals (51.5% women) aged more than 60 years participating in the second phase of the Bushehr Elderly Health Program. Cognitive impairment was defined by combining the two methods: Categorical verbal fluency tests, and Mini-Cog. The AIP was obtained by Log (molar serum triglyceride/HDL). The connection between AIP and cognitive function was evaluated. Since statin use is an essential factor affecting the lipid profile, the analysis was stratified according to statin use and adjusted for possible confounders as well. RESULTS: According to either assessment method, 1423 (60%) individuals were determined to have cognitive impairment. Overall, those with impaired cognition differed significantly from others regarding age, sex (higher in women), marital status, antihyperlipidemic medication (either fibrates or statins), diabetes, depression, low physical activity, and some lipid parameters (Cholesterol, LDL-C, non-HDL-C). After stratification, we observed that in statin users, high-risk AIP category (AIP > 0.21) was significantly associated with cognitive impairment [OR: 1.38 (1.02-1.87)] and continued to be significant after adjustment for confounders [1.48 (1.07-2.05)]. Other significant contributing factors include age [1.08 (1.06, 1.11); 1.07 (1.04, 1.10)] and sex [0.36 (0.28, 0.46); 0.47 (0.33, 0.65)] in non-statin and statin users; smoking [1.16 (1.01, 1.33)], low physical activity [1.42 (1.02, 1.99)], depression [1.6 (1.09, 2.35)], and diabetes [1.68 (1.28, 2.19)] in non-statin group; and education levels [1.53 (1.06, 2.19)] in statin users. CONCLUSION: Our finding suggests that a high AIP despite using statins, is associated with an increased risk of cognitive impairment. Smoking, low physical activity, depression, and diabetes in non-statin users, and low education in statin users are determinants of impaired cognitive function. It is important to monitor AIP levels and address associated risk factors to mitigate the risk of cognitive impairment and neurodegenerative conditions.

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