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. 2024 May 21;16(4):2373-2382.
doi: 10.14336/AD.2024.0380.

COVID-19 and Cognitive Decline in Older Adults with High-Cardiovascular Risk: A Post Hoc Analysis

Sangeetha Shyam  1   2   3 , Carlos Gómez-Martínez  1   2   3 , Jiaqi Ni  1   2   3 , José J Gaforio  4   5 , Miguel Ángel Martínez-González  3   6   7 , Dolores Corella  3   8 , J Alfredo Martínez  9   3   10 , Ángel M Alonso-Gómez  11   3 , Julia Wärnberg  12   3 , Jesús Vioque  13   4 , Dora Romaguera  14   3 , José López-Miranda  15   3 , Ramon Estruch  16   3 , Francisco J Tinahones  17   3 , José Lapetra  18   3 , Lluís Serra-Majem  19   3 , Aurora Bueno-Cavanillas  20   21   4 , Josep A Tur  14   22   3 , Vicente Martín-Sánchez  23   4 , Xavier Pintó  24   3 , Miguel Delgado-Rodríguez  9 , Pilar Matía-Martín  25 , Josep Vidal  26   27 , Clotilde Vázquez  28   3 , Lidia Daimiel  3   29   30 , Emilio Ros  31 , Fernando Fernandez-Aranda  3   32 , Adrián Hernández-Cacho  1   2   3 , Pilar Buil-Cosiales  3   33   6 , Jose V Sorli  3   8 , Olga Castañer  34   4 , Antonio Garcia-Rios  15   3 , Alejandro Oncina-Canovas  13   4 , Napoleón Pérez-Farinós  12 , Mar Nafria  14 , Rosa Casas  16   3 , Silvia Martínez-Diz  20   21   35   4 , Lucas Tojal-Sierra  11 , Gómez-Pérez Am  17   3 , Estefania Toledo  3   6 , Rebeca Fernández-Carrión  3   8 , Álvaro Morán Bayón  9   23 , Jose David Torres-Peña  15   3 , Laura Compañ-Gabucio  13   4 , Zenaida Vázquez-Ruiz  3   6 , Nancy Babio  1   2   3 , Montserrat Fitó  3   34 , Jordi Salas-Salvadó  1   2   3
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COVID-19 and Cognitive Decline in Older Adults with High-Cardiovascular Risk: A Post Hoc Analysis

Sangeetha Shyam et al. Aging Dis. .

Abstract

Cognitive decline has been reported as a short-term sequela in patients hospitalized for coronavirus disease-19 (COVID-19). Whether COVID-19 is associated with late cognitive impairment in older free-living individuals with high cardiovascular risk, a group at greater risk of cognitive decline, is unknown. We determined this association of COVID-19 through a longitudinal evaluation of post-COVID-19 cognitive performance and impairment as post hoc analysis in 5,179 older adults (48% female) with mean (SD) age 68.5 (5.0) years, body mass index 31.7 (3.7) kg/m2, harboring ≥ 3 criteria for metabolic syndrome (e.g., hypertension, hyperlipidemia, hyperglycemia etc.) enrolled in PREDIMED-Plus trial. Pre- and post-COVID-19 cognitive performance was ascertained from scheduled assessments conducted using a battery of neuropsychological tests, including 5 domains: Global Cognitive Function, General Cognitive Function, Execution Function, Verbal Fluency and Attention domains, which were standardized for the cohort. Cognitive impairment was defined as the bottom 10 percentile of the sample. Multivariable linear and logistic regression models assessed the association of COVID-19 with cognitive decline and impairment, respectively. After a mean 50-week follow-up, no significant associations were observed between COVID-19 status and post-COVID-19 scores of all tapped neuropsychological domains, except Global Cognitive Function (GCF). When fully adjusted, COVID-19 was marginally associated with higher (better) post-pandemic GCF score (βadj (95% CI): 0.06 (0.00, 0.13) p=.05). However, the odds for post-COVID-19 cognitive impairment in GCF domain were not associated with the disease (ORadj (95% CI): 0.90 (0.53, 1.51) p=.68). In the PREDIMED-Plus cohort, COVID-19 status and cognitive impairment determined 50 weeks post-infection showed no association in older adults at high cardiovascular risk. This suggests that cognitive changes observed shortly after COVID-19 revert over time. However, cautious interpretation is warranted as these data were obtained within the framework of a clinical trial encouraging a healthy lifestyle.

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Conflict of interest statement

The funders had no role in the “design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.”

Data and materials availability: The study protocol of PREDIMDED-Plus including its statistical analysis plan has been published earlier and can be downloaded from https://www.predimedplus.com/. Data and variables collected in PREDIMED-Plus and the procedure for request of data or samples are outlined here. The datasets generated and analyzed during the current study are not publicly available due to data regulations and for ethical reasons, considering that this information might compromise research participants’ consent because our participants only gave their consent for the use of their data by the original team of investigators. However, collaboration for data analyses can be requested by sending a letter to the PREDIMED-Plus Steering Committee (predimed_plus_scommittee@googlegroups.com). The request will then be passed to all the members of the PREDIMED-Plus Steering Committee for deliberation.

FFA acknowledges consulting fees from Novo Nordisk and Wiley as EIC for the European Eat Dis Rev. He has also received honoraria for lectures and support for travel/meetings from Novo Nordisk. He discloses his honorary participation in the Data Safety Monitoring Board or Advisory Board of Sustain-Consortium-Germany. ER has received honoraria for presentations and support for attending meetings/travel from the California Walnut Commission, Alexion and the Spanish Atherosclerosis Society. He has also received consulting fees from Alexion. He participates in the Data Safety Monitoring Board or Advisory Board of the PREDIMED-Plus Clinical Trial. RE has received research grants from Instituto de Salud Carlos III, Madrid, Spain. He has received honoraria for presentations from Fundacion Cerveza y Salud, Spain; Instituto Cervantes, Albuquerque, USA; Instituto Cervantes, Milan, Italy; Instituto Cervantes, Tokyo, Japan; Fundacion Bosch i Gimpera, Spain; Wine and Culinary International Forum; Pernaud Richart; Mexico; Fundacion Dieta Mediterranea, Barcelona, Spain. He has received support for travel or meetings or conference organizations from ERAB, Belgium, Brewers of Europe, Belgium, and Sociedad Española de Nutrición (SEN). He has served on the Advisory Board of Cerveza y Salud, Spain. JSS reported receiving consulting fees from the Eroski Foundation. He has also received grants and support for attending meetings/travel from the Nut and Dried Fruit Foundation. He is an honorary Member of the International Advisory Board of the Project “Effect of cashew nut supplementation on glycemic status and lipid profile in type 2 diabetes subjects”, Member of the Scientific Advisory Committee of the European PEGASO project (Personalized Guidance Services for Optimizing lifestyle management in teenagers through awareness, motivation and engagement) and Member of the Scientific Committee of Danone Institute International. He received personal fees for serving as a Member of the Institute Danone Advisory Board. SS has received consulting fees from Abbott Sdn Bhd. Other authors declare no potential conflict of interest.

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