Hemoglobin, Anemia, and Cognitive Function: The Atherosclerosis Risk in Communities Study
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BACKGROUND: Our objective was to characterize the relationship of low and high hemoglobin concentrations and normocytic, microcytic, and macrocytic anemia with cross-sectional cognition and change in cognition over a median of 6 years. METHODS: Cross-sectional and prospective analyses of 13,133 participants (mean age 57 years, 56% women, 24% black, 10% anemia) in the Atherosclerosis Risk in Communities (ARIC) study (baseline 1990-1992) were carried out. Anemia was defined as hemoglobin concentrations lower than 13g/dl for men and lower than 12g/dl for women and was subclassified as normocytic (mean corpuscular volume [MCV] 80-100 fL), microcytic (MCV < 80 fL), and macrocytic (MCV > 100 fL). Cognition was assessed by delayed word recall test (DWRT), digit symbol substitution test (DSST), word fluency test (WFT), and global Z-score at Visit 2 (1990-1992) and Visit 4 (1996-1998). Adjusted linear regression models and splines were used. RESULTS: Cross-sectionally, anemia overall was associated with lower cognitive test scores on DSST and global Z-score among men and women (all p < .05), but not on DWRT or WFT. Anemia subtypes were associated similarly with cognition, with strongest associations for the DSST and global Z-score. Additionally, elevated hemoglobin level was associated with nonsignificantly worse cognition in cross-sectional analyses, suggesting a nonlinear association of hemoglobin with cognition. In contrast, anemia overall and anemia subtypes were not associated with cognition in prospective analyses (all p > .05). CONCLUSIONS: There was a cross-sectional, but not prospective, nonlinear association between hemoglobin concentrations and cognitive function, although only associations of low levels of hemoglobin (anemia) were statistically significant. Subtypes of anemia had similar magnitudes of associations with cognition.
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During anemia, when hemoglobin levels are decreased, oxygen delivery is impaired, with consequences for cognitive and physical performance, and perceived fatigue and tiredness.
“During anemia, i.e., when the levels of hemoglobin (the oxygen carrier) are decreased, oxygen delivery is impaired, with consequences for not only cognitive [36] and physical [35] performance, but also perceived fatigue and tiredness [37].”
From Vitamins and Minerals for Energy, Fatigue and Cognition: A Narrative Review of the Biochemical and Clinical Evidence (2020) · cites this paper as [36]
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Cites
Toprak, Ö., Kurt, H., Sarı, Y., Şarkış, C., Us, H., & Kırık, A. (2017) · Kidney & Blood Pressure Research · doi:10.1159/000468530 · Cited by 29,769 · see citing works
A New Equation to Estimate Glomerular Filtration Rate
Levey, A. S., Stevens, L. A., Schmid, C. H., Zhang, Y. (., Castro, A. F., Feldman, H. I., Kusek, J. W., Eggers, P., Van Lente, F., Greene, T., et al. (2009) · Annals of Internal Medicine · doi:10.7326/0003-4819-150-9-200905050-00006 · Cited by 25,603 · see citing works
Self-citationTHE ATHEROSCLEROSIS RISK IN COMMUNIT (ARIC) STUDY: DESIGN AND OBJECTIVES
THE ARIC INVESTIGATORS (1989) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115184 · Cited by 3,491 · see citing works
(1989) · PubMed · Cited by 3,139 · see citing works
Silent Brain Infarcts and the Risk of Dementia and Cognitive Decline
Vermeer, S. E., Prins, N. D., den Heijer, T., Hofman, A., Koudstaal, P. J., & Breteler, M. M. B. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022066 · Cited by 2,313 · see citing works
WAIS-R manual : Wechsler adult intelligence scale-revised
Wechsler, D. (1981) · Medical Entomology and Zoology · Cited by 1,575 · see citing works
Guralnik, J. M., Eisenstaedt, R. S., Ferrucci, L., Klein, H. G., & Woodman, R. C. (2004) · Blood · doi:10.1182/blood-2004-05-1812 · Cited by 1,450 · see citing works
Glymour, M. M., Weuve, J., Berkman, L. F., Kawachi, I. I., & Robins, J. M. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwi187 · Cited by 706 · see citing works
Oxidative stress and aberrant signaling in aging and cognitive decline
Dröge, W., & Schipper, H. M. (2007) · Aging Cell · doi:10.1111/j.1474-9726.2007.00294.x · Cited by 479 · see citing works
Alcohol, dementia and cognitive decline in the elderly: a systematic review
Peters, R., Peters, J., Warner, J., Beckett, N., & Bulpitt, C. (2008) · Age and Ageing · doi:10.1093/ageing/afn095 · Cited by 453 · see citing works
Prevalence and outcomes of anemia in geriatrics: a systematic review of the literature
Beghé, C., Wilson, A., & Ershler, W. B. (2004) · The American Journal of Medicine · doi:10.1016/j.amjmed.2003.12.009 · Cited by 450 · see citing works
A Verbal Memory Test With High Predictive Accuracy for Dementia of the Alzheimer Type
Knopman, D. S., & Ryberg, S. (1989) · Archives of Neurology · doi:10.1001/archneur.1989.00520380041011 · Cited by 313 · see citing works
Effect of infarcts on dementia in the Baltimore longitudinal study of aging
Troncoso, J. C., Zonderman, A. B., Resnick, S. M., Crain, B., Pletnikova, O., & O'Brien, R. J. (2008) · Annals of Neurology · doi:10.1002/ana.21413 · Cited by 219 · see citing works
Anaemia increases the risk of dementia in cognitively intact elderly
Atti, A. R., Palmer, K., Volpato, S., Zuliani, G., Winblad, B. G., & Fratiglioni, L. (2006) · Neurobiology of Aging · doi:10.1016/j.neurobiolaging.2005.02.007 · Cited by 152 · see citing works
Lucca, U., Tettamanti, M., Mosconi, P., Apolone, G., Gandini, F., Nobili, A., Tallone, M. V., Detoma, P., Giacomin, A., Clerico, M. A., et al. (2008) · PLoS ONE · doi:10.1371/journal.pone.0001920 · Cited by 146 · see citing works
Anaemia and cognitive performances in the elderly: a systematic review
Andro, M., Squere, P. L., Estivin, S., & Gentric, A. (2013) · European Journal of Neurology · doi:10.1111/ene.12175 · Cited by 146 · see citing works
Anemia and red blood cell transfusion in neurocritical care
Kramer, A. H., & Zygun, D. A. (2009) · Critical Care · doi:10.1186/cc7916 · Cited by 142 · see citing works
Hemoglobin level in older persons and incident Alzheimer disease
Shah, R. C., Buchman, A. S., Wilson, R. S., Leurgans, S. E., & Bennett, D. A. (2011) · Neurology · doi:10.1212/wnl.0b013e318225aaa9 · Cited by 136 · see citing works
Ihle‐Hansen, H., Thommessen, B., Wyller, T. B., Engedal, K., Øksengård, A. R., Stenset, V. T. V., Løken, K., Aaberg, M., & Fure, B. (2011) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000335361 · Cited by 123 · see citing works
Beard, C. M., Kokmen, E., O’Brien, P. C., Anía, B. J., & Melton, L. J. (1997) · Annals of Epidemiology · doi:10.1016/s1047-2797(97)00015-x · Cited by 110 · see citing works
Haemoglobin, anaemia, dementia and cognitive decline in the elderly, a systematic review
Peters, R. K., Burch, L., Warner, J. P., Beckett, N. S., Poulter, R., & Bulpitt, C. J. (2008) · BMC Geriatrics · doi:10.1186/1471-2318-8-18 · Cited by 104 · see citing works
Chaves, P. H. M., Carlson, M. C., Ferrucci, L., Guralnik, J. M., Semba, R. D., & Fried, L. P. (2006) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2006.00863.x · Cited by 104 · see citing works
Relation of Hemoglobin to Level of Cognitive Function in Older Persons
Shah, R. C., Wilson, R. S., Tang, Y., et al. (2008) · Neuroepidemiology · doi:10.1159/000170905 · Cited by 98 · see citing works
Deal, J. A., Carlson, M. C., Xue, Q., Fried, L. P., & Chaves, P. H. M. (2009) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2009.02400.x · Cited by 73 · see citing works
Schneider, A. L. C., Sharrett, A. R., Gottesman, R. F., Coresh, J., Coker, L. H., Wruck, L. M., Selnes, O. A., Deal, J. A., Knopman, D. S., & Mosley, T. H. (2014) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000042 · Cited by 69 · see citing works
Self-citationAlbumin, haemoglobin, BMI and cognitive performance in older adults
Ng, T. P., Feng, L., Niti, M., & Yap, K. B. (2008) · Age and Ageing · doi:10.1093/ageing/afn102 · Cited by 58 · see citing works
Gottesman, R. F., Sojkova, J., Beason‐Held, L. L., An, Y., Longo, D. L., Ferrucci, L., & Resnick, S. M. (2012) · The Journals of Gerontology Series A · doi:10.1093/gerona/gls121 · Cited by 50 · see citing works
Self-citationDeadmond, M. A., & Smith-Gagen, J. (2015) · Journal of Cancer Research and Clinical Oncology · doi:10.1007/s00432-015-1983-5 · Cited by 49 · see citing works
Education and Cognitive Change over 15 Years: The Atherosclerosis Risk in Communities Study
Schneider, A. L. C., Sharrett, A. R., Patel, M. D., Alonso, Á., Coresh, J., Mosley, T. H., Selnes, O. A., Selvin, E., & Gottesman, R. F. (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.04164.x · Cited by 45 · see citing works
Self-citationNeglect Is More Common and Severe at Extreme Hemoglobin Levels in Right Hemispheric Stroke
Gottesman, R. F., Bahrainwala, Z. S., Wityk, R. J., & Hillis, A. E. (2010) · Stroke · doi:10.1161/strokeaha.110.585265 · Cited by 24 · see citing works
Self-citationTamura, M. K., Wadley, V. G., Newsome, B. B., Zakai, N. A., McClure, L. A., Howard, G., Warnock, D. G., & McClellan, W. (2010) · The Journals of Gerontology Series A · doi:10.1093/gerona/glq126 · Cited by 22 · see citing works
Flagged first, then by citations
Research works printed but not linked: 3
- [1]1. World Health Organization. Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva: World Health Organization; 2011. [Google Scholar]
- [13]13. Spreen O, Benton A. Neurosensory Center Comprehensive Examination for Aphasia (NCCEA) Manual of Instructions. Melbourne, Australia: University of Victoria; 1969. [Google Scholar]
- [14]14. Benton AL, Hamsher K. Multilingual Aphasia Examination. 2nd ed Iowa City, IA: AJA Associates; 1989. [Google Scholar]
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Tardy, A.-L., Pouteau, E., Marquez, D., Yilmaz, C., & Scholey, A. (2020) · Nutrients · doi:10.3390/nu12010228 · Cited by 541 · see citing works
- Authors
- Schneider, A. L. C., Jonassaint, C., Sharrett, A. R., Mosley, T. H., Astor, B. C., Selvin, E., Coresh, J., & Gottesman, R. F.
- Affiliations
- Johns Hopkins University (US)
- University of Pittsburgh (US)
- University of Mississippi Medical Center (US)
- University of Wisconsin–Madison (US)
- ORCID
- Venue
- The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
- Publisher
- Oxford University Press (OUP)
- Published
- 2015-09-11
- Volume
- 71
- Issue
- 6
- Pages
- 772-779
- ISSN
- 1079-5006 (ISSN-L)
- 1758-535X
- PMC
- PMC4888383
- OpenAlex
- W2313057638
- Cited by
- 67
- References
- 31
- Citations by year
- 2026: 4 · 2025: 11 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 10 · 2020: 9 · 2019: 8 · 2018: 5 · 2017: 1 · 2016: 2
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- The Journals of Gerontology Series A (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Heart, Lung, and Blood Institute (HHSN268201 100012C, HHSN268201100007C, HHSN2682 01100008C, HH-SN-268201100006C, HHSN268201100011C, HHSN268201100005C, HHSN268201100010C, HHSN26820 1100009C, T32HL007024, U01HL096812)
- National Institute of Diabetes and Digestive and Kidney Diseases (K24DK106414)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Rheumatology › Folate and B Vitamins Research
- Keywords
- hemoglobin, anemia, cognitive function, normocytic anemia, microcytic anemia, macrocytic anemia, mean corpuscular volume, elevated hemoglobin, nonlinear relationship, cognitive decline, middle-aged and older adults, Atherosclerosis Risk in Communities Study
- MeSH terms
- Anemia, Cognition, Cross-Sectional Studies, Dementia, Female, Hemoglobins, Humans, Male, Middle Aged, Neuropsychological Tests, Prospective Studies, Risk Factors, United States, Prevalence
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