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Longitudinal Associations of Plasma TMAO and Related Metabolites with Cognitive Impairment and Dementia in Older Adults: The Cardiovascular Health Study.

TitleLongitudinal Associations of Plasma TMAO and Related Metabolites with Cognitive Impairment and Dementia in Older Adults: The Cardiovascular Health Study.
Publication TypeJournal Article
Year of Publication2022
AuthorsOtto, MC de Olive, Li, XS, Wang, Z, Siscovick, D, Newman, AB, Lai, HTsz Mung, Nemet, I, Lee, Y, Wang, M, Fretts, A, Lemaitre, RN, Tang, WHWilson, Lopez, O, Hazen, SL, Mozaffarian, D
JournalJ Alzheimers Dis
Date Published2022 Sep 02
ISSN1875-8908
Abstract<p><b>BACKGROUND: </b>Animal studies suggest that gut microbiome metabolites such as trimethylamine N-oxide (TMAO) may influence cognitive function and dementia risk. However potential health effects of TMAO and related metabolites remain unclear.</p><p><b>OBJECTIVE: </b>We examined prospective associations of TMAO, γ-butyrobetaine, crotonobetaine, carnitine, choline, and betaine with risk of cognitive impairment and dementia among older adults aged 65 years and older in the Cardiovascular Health Study (CHS).</p><p><b>METHODS: </b>TMAO and metabolites were measured in stored plasma specimens collected at baseline. Incident cognitive impairment was assessed using the 100-point Modified Mini-Mental State Examination administered serially up to 7 times. Clinical dementia was identified using neuropsychological tests adjudicated by CHS Cognition Study investigators, and by ICD-9 codes from linked Medicare data. Associations of each metabolite with cognitive outcomes were assessed using Cox proportional hazards models.</p><p><b>RESULTS: </b>Over a median of 13 years of follow-up, 529 cases of cognitive impairment, and 522 of dementia were identified. After multivariable adjustment for relevant risk factors, no associations were seen with TMAO, carnitine, choline, or betaine. In contrast, higher crotonobetaine was associated with 20-32% higher risk of cognitive impairment and dementia per interquintile range (IQR), while γ-butyrobetaine was associated with ∼25% lower risk of the same cognitive outcomes per IQR.∥Conclusion:These findings suggest that γ-butyrobetaine, crotonobetaine, two gut microbe and host metabolites, are associated with risk of cognitive impairment and dementia. Our results indicate a need for mechanistic studies evaluating potential effects of these metabolites, and their interconversion on brain health, especially later in life.</p>
DOI10.3233/JAD-220477
Alternate JournalJ Alzheimers Dis
PubMed ID36057823
ePub date: 
22/09