ORIGINAL PAPER Cognitive impairment and cancer mortality: a biological or health care explanation? Michail Katsoulis • Andeas Kyrozis • Antonia Trichopoulou • Christina Bamia • Dimitrios Trichopoulos • Pagona Lagiou Received: 7 May 2014 / Accepted: 7 August 2014 / Published online: 22 August 2014 Ó Springer International Publishing Switzerland 2014 Abstract Purpose To examine whether the documented association of suboptimal cognitive function with total and cardio- vascular (CVD) mortality also applies to cancer mortality and probe whether the explanation for this association is biomedical or health care related. Methods In a subsample of 733 participants of the EPIC- Greece cohort from Athens and surrounding area, we assessed cognitive function at age 65 or older in the period 2004–2006, using the Mini-Mental State Examination (MMSE). Incidence of cancer, mortality from cancer and CVD, and overall mortality were ascertained through active follow-up for a median of 4 years after MMSE assessment using Cox proportional hazards models. Results A total of 86 participants died during follow-up. A 2-point decrease in MMSE score was associated with increase in overall (hazard ratio (HR) 1.26, 95 % confi- dence interval (CI) 1.11–1.43), CVD (HR 1.26, 95 % CI 1.02–1.56), and cancer (HR 1.32, 95 % CI 1.02–1.70) mortality. In contrast, there was no noticeable difference in cancer incidence associated with a 2-point decrease in MMSE score (HR 1.07, 95 % CI 0.79–1.45). Conclusions Cognitive function appears to be inversely associated not only with CVD and overall, but also with cancer mortality. Although for CVD mortality there is a biomedical explanation invoking vascular mechanisms, for cancer mortality we may need to focus on socially condi- tioned factors, such as compromised ability to identify early signs and suboptimal compliance to treatment. Our hypothesis-generating results need to be confirmed in lar- ger studies, as the issue is of major importance, since cognitive decline is not uncommon among the elderly. Keywords Cancer mortality Á Cognitive function Á Cognitive decline Á Cardiovascular mortality Introduction Since 1990, several studies, using variable designs, have reported that low cognitive performance or decline in cognition is associated with increased mortality [1–6]. The association is consistent across studies, but the focus has been on cardiovascular diseases (CVD) [3, 4, 6–10]. Frailty [5], biological aging [11, 12], reduced efficiency of pro- cessing information [13], and underlying cardiovascular conditions [7] have been invoked as possible underlying mechanisms. Little work has been done on a possible relation between cognitive function and cancer mortality or M. Katsoulis (&) Á A. Kyrozis Á A. Trichopoulou Á D. Trichopoulos Hellenic Health Foundation, 13 Kaisareias Street, 115 27 Athens, Greece e-mail: mkatsoulis@hhf-greece.gr A. Kyrozis 1st Department of Neurology, Eginition Hospital, University of Athens Medical School, 74 Vas. Sofias Avenue, 11528 Athens, Greece A. Trichopoulou Á D. Trichopoulos Á P. Lagiou Bureau of Epidemiologic Research, Academy of Athens, 23 Alexandroupoleos Street, 115 27 Athens, Greece C. Bamia Á P. Lagiou Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 75 M. Asias Street, Goudi, 115 27 Athens, Greece D. Trichopoulos Á P. Lagiou Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA 123 Cancer Causes Control (2014) 25:1565–1570 DOI 10.1007/s10552-014-0460-9