Abstract
Background
The disease-modifying effects of diabetes mellitus (DM), hyperlipidemia, and overweight on risk and prognosis of amyotrophic lateral sclerosis (ALS) have gained significant attention in recent years. However, whether these well-known vascular risk factors increase the cognitive burden in patients with ALS remains unclear. We aim to evaluate the association between vascular risk factors (including hypertension, DM, hyperlipidemia, overweight and smoking) and cognitive function in patients with ALS.
Methods
Patients with ALS were consecutively recruited between June 2012 and November 2019 from a tertiary referral center for ALS at the West China Hospital. Vascular risk factors were confirmed based on clinical data, while cognitive function was evaluated by the Chinese version of the Addenbrooke’s Cognitive Examination-revised. Case-control design to investigate the association between vascular risk factors and cognitive impairment in ALS. With careful confounder adjustment, multivariable logistic regression analysis was performed separately (for each factor) and accumulatively (based on the sum of factors) to determine the association between cognitive impairment and vascular risk factors in ALS.
Results
Of 870 patients, 561 (64.5%) were men, the mean age at registeration was 54.1 (11.3) years and 266 had cognitive impairment. No cognitive burden from vascular risk factors was found in patients with ALS. On the contrary, we first observed that DM (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.25–0.98; P = 0.04) and hyperlipidemia (OR, 0.50; 95% CI, 0.26–0.97; P = 0.04) showed protective effects against cognitive decline in ALS, adjusted for age, sex, educational level, site of onset, Revised-ALS Functional Rating Scale score, predominant upper motor neuron phenotype, family history of ALS, and the remaining vascular risk factors. Furthermore, patients with > 2 vascular risk factors showed a significantly lower risk of cognitive impairment (OR, 0.18; 95% CI, 0.07–0.48; P = 0.001). Sensitivity analyses of sex did not substantially reverse the risk estimates.
Conclusions
DM and hyperlipidemia decrease the risk of cognitive impairment in patients with ALS. The fitness hypothesis in ALS has been tested and expanded in our work.
Cognitive Function in Adults Aging with Fabry Disease: A Case–Control Feasibility Study Using Telephone-Based Assessments
