Subjective Cognitive Decline Among Older Adults and its Link to Diabetes and Cardiovascular Disease: The BRFSS 2022 US Study

Abstract

Subjective Cognitive Decline (SCD) refers to the self-reported instances of increasing confusion or memory loss, as experienced by the individual. In the U.S., 11% of adults older than 45 years, have SCD. Diabetes is one of the known factors associated with cognition. Among adults with type 2 diabetes, the risk of mild cognitive impairment is doubled. Also, cardiovascular disease (CVD) is known as a significant risk factor for SCD. Compared to individuals who do not have SCD, heart diseases are twice as prevalent. This study aims to examine the association between SCD and diabetes, as well as the association between SCD and cardiovascular disease, focusing on Myocardial Infarction (MI), stroke, and Coronary Heart Disease (CHD)/angina. This study is among U.S. old adults aged 45 years and older, using the BRFSS 2022 data. SCD is treated as a binary outcome so logistic regression is used to explore associations. The results showed that 6,423 individuals, accounting for 10.45%, reported experiencing SCD. Out of them, 30.67% (n=1,761) reported having diabetes, with 90.25% (n=761) of them diagnosed with type 2 diabetes. CHD emerged as the most prevalent among SCD participants at 17.83% (n=1,011), followed by MI at 15.08% (n=865), and stroke in approximately 13.7% (n=795) of individuals. Unadjusted associations between SCD, primary predictors, and other covariates were computed, and the significant variables were used to build our adjusted models. Several models were built, and the primary predictors were mostly switched between the models. Our main model, the full model, encompassed all main predictors to discern the adjusted associations between each predictor accounting for the effect of all other predictors. In this model, diabetes, CHD, and stroke maintained their significance (p-value <0.05), whereas MI lost it with a p-value= 0.676>0.05. The most influential predictor for SCD, with the highest OR, is CHD (OR: 1.72; 95%CI: 1.34-2.20) followed by stroke (OR:1.63; 95% CI: 1.26,2.11), and diabetes (OR: 1.25; 95%CI: 1.01-1.54). Notably, CHD is the variable that leads to MI losing its significance. Furthermore, insulin use emerges as a significant predictor that increases SCD risk (OR: 1.31; 95% CI: 1.02-1.68). SCD is a critical issue that must warrant more focus, given its potential as a precursor to more severe cognitive impairments. This underscores the need for awareness and proactive screening for cognitive impairment among individuals with CVDs and diabetes, as cognitive dysfunction can significantly impact their overall well-being.