Cardiovascular and lifestyle risk factors of mild cognitive impairment in UK veterans and non-veterans

Abstract

Acknowledgement: We thank all volunteers who participated in the PROTECT study.Key learning points: What is already known about this subject: · Previous evidence in the general population has shown exposure to cardiovascular health, or lifestyle choices, are modifiable risk factors for mild cognitive impairment. · This is concerning as veterans are at an increased risk of cardiovascular health or lifestyle factors. This could potentially have a negative consequence on their cognitive function with age. What this study adds: · This is the first study to quantify the risk of mild cognitive impairment in UK veterans exposed to nine key cardiovascular health and lifestyle risk factors compared to the non-veteran population using longitudinal data. · Obesity, alcohol consumption and physical inactivity reduced the risk of mild cognitive impairment in veterans compared to non-veterans. · Within the veteran sample, diabetes and high cholesterol increased the risk of mild cognitive impairment. What impact this may have on practice or policy: · Early diagnosis and intervention of modifiable risk factors may reduce the risk of mild cognitive impairment and subsequently dementia in both veterans and non-veterans.Background: The link between poor cardiovascular health (CVH), lifestyle and mild cognitive impairment (MCI) has been well established in the general population. However, there is limited research exploring these associations in ageing UK veterans. Aims: This study explored the risk of MCI and its association with nine CVH and lifestyle risk factors (including diabetes, heart disease, high cholesterol, high blood pressure, obesity, stroke, physical inactivity, the frequency of alcohol consumption and smoking) in UK veterans and non-veterans. Methods: This prospective cohort study comprised data from the PROTECT study between 2014 and 2022. Participants comprised of UK military veterans and non-veterans aged ≥50 years at baseline. Veteran status was defined using the Military Service History Questionnaire. CVH and lifestyle risk factors were defined using a combination of self-report measures, medication history or physical measurements. MCI was defined as the presence of subjective and objective cognitive impairment. Results: Based on a sample of 9378 veterans (n = 488) and non-veterans (n = 8890), the findings showed the risk of MCI significantly reduced in veterans with obesity, those who frequently consumed alcohol and were physically inactive compared to non-veterans. The risk of MCI significantly increased in veterans with diabetes (hazards ratio [HR] = 2.22, 95% confidence interval [CI] 1.04–4.75, P ≤ 0.05) or high cholesterol (HR = 3.11, 95% CI 1.64–5.87, P ≤ 0.05) compared to veterans without. Conclusions: This study identified CVH and lifestyle factors of MCI in UK veterans and non-veterans. Further work is needed to understand these associations and the underpinning mechanisms which could determine intervention strategies to reduce the risk of MCI.This study was funded as part of a PhD studentship by Alzheimer’s Society (award no. 475 [AS-PhD-18b-002]). The PROTECT study was externally funded/supported by the National Institute of Health and Care Research Exeter Biomedical Research Centre. The Family History of Neurological Disease Questionnaire was funded in part by the Alzheimer’s Research UK South West Network