Metabolic Syndrome and Cognitive Decline in Elderly Latinos: Findings from the Sacramento Area Latino Study of Aging Study Kristine Yaffe, MD, à wzk Mary Haan, DrPH, MPH, z Terri Blackwell, MA, # Elena Cherkasova, BA, § Rachel A. Whitmer, PhD, Ãà and Nancy West, MS z OBJECTIVES: To investigate the effect of metabolic syn- drome on cognitive function in an elderly Latino population and to determine whether inflammation modifies this asso- ciation. DESIGN: A longitudinal cohort study. SETTING: Sacramento area and the surrounding Califor- nia counties from 1998 to 1999. PARTICIPANTS: One thousand six hundred twenty-four Latinos aged 60 and older who participated in the Sacra- mento Area Latino Study of Aging. MEASUREMENTS: Baseline metabolic syndrome was calculated using the Third Adult Treatment Panel of the National Cholesterol Education Program. Cognitive func- tion was measured using the Modified Mini-Mental State Examination (3MS) and the Delayed Word-List Recall (DelRec), a verbal memory test. The effect of metabolic syndrome on cognitive change scores was examined using random effects models; in addition, the effect of the indi- vidual components of the syndrome on cognitive change was examined. RESULTS: Of the 1,624 participants, 718 (44%) had met- abolic syndrome at baseline. Those with metabolic syn- drome had worse 3-year change scores on 3MS (P 5.04) and DelRec (P 5.03). Multivariate adjustment attenuated the results for DelRec but not for 3MS. This association was especially pronounced in participants with a high serum level of inflammation, resulting in an average 3MS score 0.64 points lower per year (P 5.03) for those with meta- bolic syndrome. Individual components of metabolic syn- drome were not associated with cognitive decline except for elevated glucose on the DelRec (P 5.02) and high blood pressure on 3MS (P 5.05). CONCLUSION: Metabolic syndrome and inflammation may both contribute to cognitive decline in older people of diverse backgrounds. The results also suggest that, in elder- ly Latinos, the composite measure of metabolic syndrome is a greater risk for cognitive decline than its individual components. J Am Geriatr Soc 55:758–762, 2007. Key words: metabolic syndrome; cognition; dementia; diabetes mellitus; elderly M etabolic syndrome is a constellation of cardiovascu- lar risk factors that include abdominal obesity, hy- pertriglyceridemia, low high-density lipoprotein (HDL) levels, hypertension, and hyperglycemia 1 and is associated with greater risk of developing diabetes mellitus and cardiovascular disease. Although several of these cardio- vascular and metabolic risk factors have been independ- ently associated with a greater risk of developing dementia or cognitive decline, the effect of metabolic syndrome on cognitive function has not been extensively studied. It was recently demonstrated that metabolic syndrome contributes to cognitive impairment in older black and white people, particularly in those with high levels of inflammation. 2 By 2005, Hispanic Americans are estimated to become the largest ethnic minority group in the United States. 3 This is especially significant because older Hispanic people have a high prevalence of diabetes mellitus and metabolic syn- drome, 4 although few studies have examined the effects of this higher prevalence on cognitive outcomes. The present study was conducted to investigate the effect of metabolic syndrome on cognitive function in an elderly Hispanic population and to determine whether inflammation mod- ified this association. As part of an ongoing prospective study, whether metabolic syndrome was associated with cognitive decline in older people without dementia was determined. The Sacramento Area Latino Study of Aging (SALSA) study was an ideal cohort in which to address this question, because the participants were all older community-dwelling Latinos who had careful characterization of metabolic Address correspondence to Kristine Yaffe, MD, c/o University of California, San Francisco, Box 181, 4150 Clement Street, San Francisco, CA 94121. E-mail: Kristine.yaffe@ucsf.edu DOI: 10.1111/j.1532-5415.2007.01139.x From the Departments of à Psychiatry, w Neurology, z Epidemiology and Biostatistics, and § Geriatrics, University of California at San Francisco, San Francisco, California; k San Francisco VA Medical Center, San Francisco, California; z School of Public Health, University of Michigan, Ann Arbor, Michigan; # California Pacific Medical Center, San Francisco, California; and Ãà Division of Research, Kaiser Permanente, Oakland, California. JAGS 55:758–762, 2007 r 2007, Copyright the Authors Journal compilation r 2007 by the American Geriatrics Society 0002-8614/07/$15.00