Association between advanced lung cancer inflammation index and cognitive function among US older adults from a cross-sectional survey of the NHANES 2011 to 2014

As a composite metric integrating body mass index, serum albumin, and neutrophil-to-lymphocyte ratio, the advanced lung cancer inflammation index (ALI) provides unique advantages for assessing systemic inflammation and nutritional status. This study aimed to systematically investigate the association between chronic inflammation/malnutrition and cognitive decline. Utilizing 2011 to 2014 National Health and Nutrition Examination Survey data, we conducted a cross-sectional analysis. Immediate recall tests (IRT), delayed recall tests (DRT), animal fluency tests, digit symbol substitution tests (DSST), and composite Z-scores were used to evaluate cognitive performance. Stratified interaction analyses, weighted multivariable linear regression, and generalized additive models were employed. Multivariate adjusted models revealed positive correlations between ALI and DSST (β = 1.137, 95% confidence intervals [95% CI]: 1.006-1.285, P = .041), DRT (β = 1.201, 95% CI: 1.030-1.400, P = .022), and composite scores (β = 1.664, 95% CI: 1.115-2.484, P = .016), suggesting that higher ALIs are associated with better cognition. The high-ALI groups performed better in DSST (β = 1.126, 95% CI: 1.028-1.233, P = .014), DRT (β = 1.128, 95% CI: 1.003-1.269, P = .046), and composite scores (β = 1.528, 95% CI: 1.148-2.034, P = .006) than the low-ALI groups. Generalized additive models identified nonlinear dose-response relationships in ALI with immediate recall tests/animal fluency test. Through inflammation/nutrition optimization, ALI may be a modifiable target for preserving cognitive health by enhancing information-processing speed, memory, and composite cognition.