Malnutrition in Females and Anxiety in Males Predicts Mild Neurocognitive Disorder: Insights from LASI-DAD

BACKGROUND AND OBJECTIVES: Dementia is a debilitating neurological disorder and a major public health priority. Age is the strongest known non-modifiable risk factor for dementia, followed by sex. The objective of this study was to examine sex-specific prevalence and the effects of risk factors associated with cognitive impairment. METHODS: Data from Wave 1 of the nationally representative Harmonized Diagnostic Assessment of Dementia for the Longitudinal Aging Study in India (2017-2019; n = 4,096) were used for this analysis. Neurocognitive disorder (NCD) was classified according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Editioncriteria, with participants categorized as cognitively normal, mild NCD, or major NCD. In the multinomial logistic regression analysis, two separate models were implemented: an age-adjusted model and a fully adjusted model that incorporated all variables found to be statistically significant in the first model, in addition to age. RESULTS: Of the 4,096 participants, 46.1% were male and 53.9% were female. The distribution of mild or major NCD diagnoses did not differ significantly by sex ( P = 0.077). In the multiple risk factor model, among men, only anxiety remained significantly associated with mild NCD [odds ratio (OR), 3.30; 95% confidence interval (CI), 1.25-8.74; P = 0.016], whereas among women, being underweight was independently associated with mild NCD (OR, 2.93; 95% CI, 1.13-7.58; P = 0.027). CONCLUSIONS: These findings suggest that the determinants of late-life cognitive impairment are sex-dependent and multifactorial, with psychological factors appearing more salient in men, whereas nutritional vulnerability may be more relevant in women. Interventions aimed at reducing cognitive decline may therefore need to be sex-specific.