INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY Int J Geriatr Psychiatry 2006; 21: 529–534. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/gps.1520 Anemia and cognitive performance in hospitalized older patients: results from the GIFA study Valentina Zamboni 1 *, Matteo Cesari 1,2 , Giuseppe Zuccala ` 1 , Graziano Onder 1 , Richard C Woodman 3 , Cinzia Maraldi 2,4 , Monica Ranzini 4 , Stefano Volpato 4 , Marco Pahor 2 and Roberto Bernabei 1 1 Department of Gerontology, Geriatrics and Physiatry, Catholic University of Sacred Heart, Rome, Italy 2 Department of Aging and Geriatric Research, College of Medicine, Institute on Aging, University of Florida, Gainesville, FL, USA 3 Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ, USA 4 Department of Clinical and Experimental Medicine, University of Ferrara, Ferrara, Italy SUMMARY Background Anemia represents a major risk factor for adverse health-related events in older persons. The aim of this study was to evaluate the association between hemoglobin levels/anemia and cognitive function in hospitalized older persons. Methods Data are from the Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) study. Hemoglobin levels (in g/dL) were measured upon admission to hospital; anemia was defined according to the WHO criteria. Cognitive performance was assessed by the Abbreviated Mental Test (AMT) on admission; an AMT score < 7 defined cognitive impairment. Logistic regressions and analyses of covariance were performed to evaluate the relationship between cognitive status and hemoglobin levels/anemia. Results Mean age of the sample (n ¼ 13,301) was 72.0 years. Participants with cognitive impairment presented a higher prevalence of anemia (47%) compared to those without cognitive impairment (35%, p < 0.001). Adjusted logistic regres- sions showed that hemoglobin levels/anemia were significantly associated with cognitive impairment (OR ¼ 0.96, 95%CI ¼ 0.94–0.99, p ¼ 0.004, and OR ¼ 1.32, 95%CI ¼ 1.18–1.48, p < 0.001, respectively). Patients with anemia and cog- nitive impairment at the hospital admission presented a higher number of impaired Activities of Daily Living compared to those with only one or none of the studied conditions ( p for trend < 0.001). Conclusions Low hemoglobin levels and anemia are independently associated with cognitive performance in older persons admitted to acute care units. Copyright # 2006 John Wiley & Sons, Ltd. key words — hemoglobin; anemia; cognitive function; elderly; hospitalized patients; epidemiology INTRODUCTION In these last years, the hypothesis of an age-related cognitive decline has been rethought, considering the cognitive function loss occurring with age as the result of unrecognised pathologies (Lindeboom and Weinstein, 2004). In this context, the early identifica- tion and treatment of modifiable risk factors for cog- nitive impairment is crucial given the relevant impact of this condition on patients, carers, society and the National Health System. Anemia, a common condition in elders, is associa- ted with several major adverse events in elders (e.g. mortality, disability, loss of physical performance, worse quality of life) (Lipschitz, 2003). Moreover, anemia has been associated with body composition changes (Cesari et al., 2004a), potentially responsible for the physical decline occurring with aging. Limited studies have explored the relationship between anemia and cognitive status, which repre- sents a key determinant of functional ability (Graham et al., 1997; Zhu et al., 1998). The anemia-related Received 1 August 2005 Copyright # 2006 John Wiley & Sons, Ltd. Accepted 9 November 2005 *Correspondence to: V. Zamboni, Department of Gerontology, Geriatrics and Psychiatry, Catholic University of the Sacred Heart, Largo Agostino Gemelli, 8, 00168 Rome, Italy. Tel: þ 39 06 3015- 4341. Fax: þ 39 06 3015-1911. E-mail: valentina_zamboni@rm.unicatt.it Contract/grant sponsor: Ortho Biotech Clinical Affairs, LLC, Bridgewater, NJ, USA.