| Background:Dementia is a syndrome in which acquired cognitive impairment is the core and leads to a significant decline in patients’ daily life,social interaction,and work ability.Alzheimer’s disease(AD)accounts for 70%-80%of all types.Nevertheless,the pathogenesis of AD has not yet been fully elucidated,and no effective therapy and interventions are known.Therefore,exploring the pathogenesis of AD,finding effective intervention measures,and seeking early diagnosis indicators to prevent or delay the development of AD are extremely important.The liver is an essential organ of the human body with highly complex functions.The role of the liver in the pathogenesis of AD has drawn more and more attention with an increasing understanding of AD.More evidence suggests that changes in liver function may play an essential role in the pathogenesis of AD.Apart from that,the peripheral immune system is considered an essential factor in AD development.The relationship between changes in routine blood indicators and cognitive impairment has also been a topic of ongoing research concern.However,it is unclear whether there is a relationship between changes in liver function and blood routine parameters and cognitive impairment.Therefore,our study carried out the following two parts to explore based on multicenter research from a clinical perspective.Part1 Association of liver function with cognitive impairment in the Shenzhen aging-related Disorder Cohort in ChinaObjective:There is evidence suggesting that alterations of liver function may play important roles in the pathogenesis of AD.However,it remains unclear whether there is a relationship between alterations in liver function and cognitive impairment among the elderly community of Shenzhen City,China.Methods:From 2017 to 2018,we recruited 9,411 older adults over 60 years old from 51 community health service centers in Luohu District,Shenzhen,and after being screened by inclusion and exclusion criteria,7,201 participants were included in the final analysis.Plasma samples of the participants(collected on an empty stomach in the morning)were collected for laboratory testing,including multiple indicators,such as aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin(ALB),total bilirubin(TB),and blood lipid-related indicators,etc.Grouped according to MMSE score(completed by a professional neurologist)and educational level(educational level is divided into 1.below high school;2.completed high school,vocational school,college,professional school,or graduate school),the participant was considered as cognitive impairment,if MMSE score≤21(applicable to subjects with primary school education and below)or MMSE score ≤24(subjects with middle school and above education),otherwise,the rest were considered as normal cognition.Nonparametric tests,chi-square tests,and binary logistic regression were used to analyze the data.Results:According to the MMSE score and educational level,participants were divided into a cognitive impairment group(n=372)and a normal cognitive function group(n=6,829).Regarding liver function,the cognitive impairment group was characterized by the elder-aged(68[64,75]vs.67[63,71],P=0.001),a higher ratio of lower educational level(less than senior high school)(57.8%vs.43.4%,P<0.001),relatively lower level of albumin and triglyceride.Additionally,the AST to ALT ratio was mainly distributed in the range of 1.17 to 1.3 in the cognitive impairment group and 0.85 to 1.00 in the normal cognitive function group(χ2=10.02,P=0.04).Binary logistic regression showed that cognitive impairment was significantly associated with age(OR=0.934,95%CI:0.886-0.985,P=0.017),a lower education level(less than senior high school)(OR=11.509,95%CI:9.064-14.613,P<0.001)and a lower level of albumin(OR=1.023,95%CI:1.004-1.043,P=0.011).Conclusions:In addition to older age,a higher proportion of living alone and lower educational level,decreased albumin and triglyceride level,and increased AST/ALT ratio were associated with cognitive impairment,and a low level of albumin is viewed as an independent risk factor of cognitive impairment,suggesting that the liver may be involved in the pathological process of cognitive impairment-related diseases,and the function of the liver may be associated with cognitive impairment diseases.Part2 Association of routine-checked blood parameters with cognitive impairment in the Shenzhen aging-related Disorder Cohort in ChinaObjective:Previous literature has demonstrated that peripheral inflammation may be a factor leading to neurological diseases,suggesting that there is a significant relationship between changes in some blood routine parameters and cognitive impairment.For example,some researchers have found that monocytes in AD patients were within the normal range while the levels of lymphocytes and basophils have been low.Therefore,we here aimed to explore the relationship between routine-checked blood parameters and cognitive impairments among the elderly community of Shenzhen City,China.Methods:From 2017 to 2018,we recruited 9,411 older adults over 60 years old from 51 community health service centers in Luohu District,Shenzhen,and after being screened by inclusion and exclusion criteria,8,025 participants were finally included in the final analysis.Plasma samples of the participants(both collected on an empty stomach in the morning)were collected for laboratory testing,including multiple indicators,such as the white blood cell,lymphocyte count,neutrophil count,monocyte count,etc.Grouped according to MMSE score(completed by a professional neurologist)and educational level(educational level is divided into 1.below high school;2.completed high school,vocational school,college,professional school,or graduate school),the participant was considered as cognitive impairment,if MMSE score≤21(applicable to subjects with primary school education and below)or MMSE score ≤24(subjects with middle school and above education),otherwise,the rest were considered as normal cognition.Nonparametric tests,chi-square tests,and binary logistic regression were applied to analyze the data.Results:According to the MMSE score and educational level,participants were divided into a cognitive impairment group(n=385)and a normal cognitive function group(n=7,640).Compared to the normal cognitive function group,the lymphocyte-to-monocyte ratio(LMR),packed-cell volume(PCV),and platelet count(PLT)in the cognitive impairment group were significantly lower(7.26[5.50-8.81]vs.7.45[5.80-9.35];40.1[36.65-42.95]vs.40.5[37.7-43.1];and 216[190-258]vs.228[196-261]×109/L,P<0.05,respectively),while the monocyte count and mean corpuscular hemoglobin concentration(MCHC)were higher(0.31[0.25-0.38]vs.0.3[0.24-0.37]×109/L;and 336[330-343]vs.335[328-342]×g/L,P<0.05,respectively).However,it was shown that the PCV(odds ratio[OR]:0.993,95%confidence interval[CI]:0.987-0.999,P=0.033)and MCHC(OR:1.011,95%CI:1.001-1.021,P=0.033)seem to be independently associated with cognitive impairment.Conclusions:LMR,PCV,and PLT were significantly lower in the cognitive impairment group,while monocyte counts and MCHC were significantly higher.Furthermore,reductions in PCV and increases in MCHC were statistically independently associated with cognitive impairment,suggesting that peripheral inflammatory mechanisms may be associated with cognitive impairment diseases. |
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