Asociación de obesidad y dislipidemia con el riesgo de progresión a deterioro cognitivo leve y demencia: revisión sistemática

Association between obesity and dislipidemia with the risk of mild cognitive decline and dementia: a systematic review

Objetivo: evaluar si en la literatura científica se describe una relación entre obesidad y dislipidemia con progresión a deterioro cognitivo leve (DCL) y demencia en adultos mayores de 65 años.  Métodos: búsqueda en la literatura científica publicada en PubMed, EbscoHost, ScienceDirect ClinicalKey y Registro Cochrane entre 2009 y 2017, de estudios prospectivos de cohortes, casos y controles de sujetos adultos con diagnóstico de obesidad o dislipidemia y con valoraciones de la función cognitiva a través del tiempo, con el fin de determinar la incidencia de DCL y demencia, y su relación con los factores de riesgo mencionados. Resultados: la revisión sistemática arrojó un total de 13 artículos de alta calidad según SIGN que cumplieron con los criterios de selección. De estos 7 incluyen la obesidad como factor de riesgo y 6 la dislipidemia. En los diferentes artículos relacionados con obesidad en adultos mayores no existió relación directa entre obesidad y deterioro cognitivo, de igual forma en los relacionados con dislipidemia no se reportó relación directa con   deterioro cognitivo. Conclusión: los pacientes adultos mayores con obesidad podrían tener un factor protector frente al desarrollo de deterioro cognoscitivo, lo que no ocurre con adultos jóvenes. Por su parte, la fisiopatología descrita en la dislipidemia sugiere que el colesterol alto o bajo pueden llevar a DCL y a demencia. 

1. Alzheimer's Disease International. World Alzheimer Report 2015. The Global Impact of Dementia, an analysis of prevalence, incidence, cost and trends. London, UK: Alzheimer's Disease International; 2015. p. 24.
2. Mayeux R, Stern Y. Epidemiology of Alzheimer disease. Cold Spring Harb Perspect Med. 2012;2(8):a006239.
3. Pradilla A, Vesga A, Boris E, León-Sarmiento FE, GENECO. National neuroepidemiological study in Colombia (EPINEURO). Rev Panam Salud Pública. 2003;14(2):104-11.
4. Pedraza OL, Perilla HJ, Cruz A, Botero JA, Montalvo MC, Salazar AM, et al. Deterioro cognitivo y factores de riesgo cardiovascular y metabólico en una muestra de adultos de Bogotá. Acta Neurol Colomb. 2016;32(2):91-9.
5. Pedraza OL, Salazar Montes AM, Sierra FA, Motalvo MC, Muñoz Y, Díaz JM, et al. Mild cognitive impairment (MCI) and dementia in a sample of adults in the city of Bogotá. Dement Neuropsychol. 2017;11(3):262-9.
6. Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri C. La prevalencia global de la demencia: una revisión sistemática y metaanálisis. Alzheimers Dement. 2013; 9(1):63-75.e2.
7. Niu H, Álvarez-Álvarez I, Guillén-Grima F, Aguinaga-Ontoso I. Prevalence and incidence of Alzheimer's disease in Europe: A meta-analysis Neurologia. 2016;32(8):523-32.
8. Tinetti M, McAvay G, Murphy T, Gross C, Lin H, Allore H. Contribution of individual diseases to death in older adults with multiple diseases. J Am Geriatr Soc 2012;60(8):1448-56.
9. James B, Leurgans S, Hebert L. Contribución de la enfermedad de Alzheimer a la mortalidad en los Estados Unidos. Neurología 2014;82:1045.
10. Neergaard JS, Dragsbæk K, Hansen HB, Henriksen K, Christiansen C, Karsdal MA. Late-Life Risk Factors for All-Cause Dementia and Differential Dementia Diagnoses in Women: A Prospective Cohort Study. Medicine (Baltimore). 2016;95(11):e3112.
11. Prickett C, Brennan L, Stolwyk R. Examining the relationship between obesity and cognitive function: a systematic literature review. Obes Res Clin Pract. 2015;9(2):93-113
12. Power BD, Alfonso H, Flicker L, Hankey GJ, Yeap BB, Almeida OP. Body adiposity in later life and the incidence of dementia: the health in men study. PloS one. 2011;6(3):e17902.
13. Fitzpatrick A, Kuller L, Lopez O, Diehr P, O'Meara E, Longstreth WJ, et al. Midlife and late-life obesity and the risk of dementia: cardiovascular health study. Arch Neurol. 2009;66(3):336-42.
14. Luchsinger J, Gustafson D. Adiposity and Alzheimer’s disease. Curr Opin Clin Nutr Metab Care. 2009;12(1):15–21.
15. Yaffe K. Metabolic syndrome and cognitive disorders: is the sum greater than its parts? . Alzheimer Dis Assoc Disord. 2007; 21(2):167–71.
16. Marchesi V. Alzheimer's dementia begins as a disease of small blood vessels, damaged by oxidative-induced inflammation and dysregulated amyloid metabolism: implications for early detection and therapy. FASEB J. 2011;25(1):5-13.
17. Jonee L, Bray GA. The thermic effect of food and obesity: a critical review. Obes Res. 1997;5(6):622-31.
18. Castellano JM, Kim J, Stewart F, Jiang H, DeMattos RB, Patterson BW, et al. Human apoE isoforms differentially regulate brain amyloid-beta peptide clearance. Sci Transl Med. 2011;3(89):89ra57. Epub 2011/07/01.
19. Villanueva-Castillo CA, Galván EJ. Plasticidad sináptica de los circuitos senescentes. Residente. 2011;6(2):85-8.
20. Kosicek M, Hecimovic S. Phospholipids and Alzheimer’s Disease: Alterations, Mechanisms and Potential Biomarkers. J Mol Sci. 2013;14(1):1310-22.
21. Baumgart M, Snyder H, Carrillo M, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dement 2015;11(1):718-26.
22. Dahl Aslan AK, Starr JM, Pattie A, Deary I. Cognitive consequences of overweight and obesity in the ninth decade of life? Age Ageing. 2014;44(1):59-65.
23. Wotton CJ, Goldacre MJ. Age at obesity and association with subsequent dementia: record linkage study. Postgrad Med J. 2014;90(1068):547-51.
24. Qizilbash N, Gregson J, Johnson ME, Pearce N, Douglas I, Wing K, et al. BMI and risk of dementia in two million people over two decades: a retrospective cohort study. Lancet Diabetes Endocrinol. 2015;3(6):431-6.
25. Hu G, Horswell R, Wang Y, Li W, Besse J, Xiao K, et al. Body mass index and the risk of dementia among Louisiana low income diabetic patients. PLoS One. 2012;7(9):e44537.
26. Feng L, Chong MS, Lim WS, Lee TS, Collinson SL, Yap P, et al. Metabolic syndrome and amnestic mild cognitive impairment: Singapore Longitudinal Ageing Study-2 findings. J Alzheimers Dis. 2013;34(3):649-57.
27. Virta JJ, Heikkilä K, Perola M, Koskenvuo M, Räihä I, Rinne JO, et al. Midlife cardiovascular risk factors and late cognitive impairment. Eur J Epidemiol. 2013;28(5):405-16.
28. Zeki Al Hazzouri A, Stone KL, Haan MN, Yaffe K. Leptin, mild cognitive impairment, and dementia among elderly women. J Gerontol A Biol Sci Med Sci. 2012;68(2):175-80.
29. Ancelin ML, Ripoche E, Dupuy AM, Barberger-Gateau P, Auriacombe S, Rouaud O, et al. Sex differences in the associations between lipid levels and incident dementia. J Alzheimers Dis. 2013;34(2):519-28.
30. Ancelin M-L, Carrière I, Barberger-Gateau P, Auriacombe S, Rouaud O, Fourlanos S, et al. Lipid lowering agents, cognitive decline, and dementia: the three-city study. J Alzheimers Dis. 2012;30(3):629-37.
31. Okusaga O, Stewart MCW, Butcher I, Deary I, Fowkes FGR, Price JF. Smoking, hypercholesterolaemia and hypertension as risk factors for cognitive impairment in older adults. Age Ageing. 2013;42(3):306-11.
32. Schneider L. Reduce vascular risk to prevent dementia? . Lancet. 2016;388(10046):738–40.
33. Trompet S, van Vliet P, de Craen A, Jolles J, Buckley B, Murphy M, et al. Pravastatin and cognitive function in the elderly. Results of the PROSPER study. J Neurol. 2010;257(1):85-90.
34. Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D2, de la Torre R, Martínez-González M, et al. Mediterranean diet and age-related cognitive decline: a randomized clinical trial. JAMA Intern Med. 2015;175(7):1094–103.
35. Erickson K, Voss M, Prakash R, Basak C, Szabo A, Chaddock L, et al. Exercise training increases size of hippocampus and improves memory. Proc Natl Acad Sci USA. 2011;108(7):3017–22.
36. Global Council on Brain Health. The brain–body connection: GCBH recommendations on physical activity and brain health. Global Council on Brain Health; 2016. p. 20.
37. Kivipelto M, Solomon A, Ahtiluoto S, Ngandu T, Lehtisalo J, Antikainen R, et al. The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER): study design and progress. Alzheimers Dement. 2013; 9(6):657–65.
38. Richard E, Van den Heuvel E, Moll van Charante E, Achthoven L, Vermeulen M, Bindels P, et al. Prevention of dementia by intensive vascular care (PreDIVA): a cluster-randomized trial in progress. Alzheimer Dis Assoc Disord. 2009;23(3):198–204.
39. Steenland K, Zhao L, Goldstein F, Levey A. Statins and cognitive decline in older adults with normal cognition or mild cognitive impairment. J Am Geriatr Soc. 2013;61 (9):1449–55.
40. Sheehan B. Assessment scales in dementia Bart Sheehan. Ther Adv Neurol Disord. 2012;5(6):349–58.