Association Between Mild Anemia and Executive Function Impairment in Community‐Dwelling Older Women: The Women's Health and Aging Study II

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Abstract
OBJECTIVES: To evaluate the relationship between mild anemia and executive function in community‐dwelling older women. DESIGN: Cross‐sectional. SETTING: Community‐based. PARTICIPANTS: High‐functioning subjects participating in the baseline assessment of the Women's Health and Aging Study (WHAS) II, Baltimore, Maryland, 1994 to 1996. WHAS II eligibility criteria included aged 70 to 80, a Mini‐Mental State Examination score of 24 or greater, and absence of advanced disability (difficulty in no more than 1 domain of physical function). Included in this study were 364 subjects with a hemoglobin concentration 10 g/dL or greater and known executive function status. MEASUREMENTS: Trail Making Test (TMT) Parts B and A. Tertiles of time to complete each test were used to define best (bottom), intermediate, and worst (top) performance. Tertiles of the difference TMT‐B minus TMT‐A were calculated. Anemia defined as hemoglobin concentration less than 12 g/dL. RESULTS: The percentage of subjects in the worst TMT‐B, TMT‐A, and TMT‐B minus TMT‐A performance tertile was highest for those with anemia. Prevalent anemia substantially increased the likelihood of performing worst (as opposed to best) on the TMT‐B (odds ratio (OR)=5.2, 95% confidence interval (CI)=1.3–20.5), TMT‐A (OR=4.8, 95% CI=1.5–15.6), and TMT‐B minus TMT‐A (OR= 4.2, 95% CI=1.0–17.2), even after controlling for age, education, race, prevalent diseases, and relevant physiological and functional parameters. CONCLUSION: This study provides preliminary evidence in support of the hypothesis that mild anemia might be an independent risk factor for executive function impairment in community‐dwelling older adults. Whether such an association is causal or noncausal remains to be determined.