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<p>The red blood cell distribution width-to-albumin ratio (RAR) is an index reflecting inflammatory and nutritional status. While prior studies reported cross-sectional associations between RAR and cognitive performance, its link to future cognitive outcomes has yet to be determined. Our research assessed the longitudinal associations of baseline RAR with subsequent incidence of cognitive impairment and with multi-year trajectories of cognitive change. This longitudinal cohort study included 5896 participants aged over 60 years from the Health and Retirement Study. During a 6-year follow-up, baseline RAR was examined in relation to incident cognitive impairment and membership in distinct cognitive trajectories identified with group-based trajectory modeling. Associations were assessed using multivariable Cox and logistic regression after adjustment. Restricted cubic splines (RCS) were also used to examine dose-response relationships, and we conducted sensitivity analyses to evaluate the stability of findings. During Follow-up, we identified 1586 incident cases of cognitive impairment and three distinct cognitive trajectories: High-stable (40.47%), Middle-slow decline (43.14%), and Low-rapid decline (16.39%). After full adjustment, one unit increase in baseline RAR was linked to a 18% higher incidence of cognitive impairment (HR = 1.18; 95% CI 1.06–1.31), and RCS analysis indicated the association to be linear (<i>P</i> for non-linearity = 0.851). An elevated baseline RAR was also associated with a greater likelihood of membership in the Middle-slow decline (OR = 1.22; 95% CI 1.06–1.40) and Low-rapid decline (OR = 1.27; 95% CI 1.05–1.52) groups, relative to the High-stable group. In addition, these associations were consistent across all examined subgroups (all <i>P</i> &gt; 0.05) and remained robust in sensitivity analyses. Within this study population, a higher RAR was associated with increased risk of cognitive impairment and membership in unfavorable cognitive trajectories. RAR therefore warrants further investigation as a potential indicator of susceptibility to long-term cognitive decline.</p>

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Association of the red blood cell distribution width-to-albumin ratio with subsequent cognitive impairment and adverse cognitive trajectories in older adults

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • Xiangyan Yang,
  • Xiaodong Zhang,
  • Xin Cai,
  • Zuqiao Zhao,
  • Ying Qu

摘要

The red blood cell distribution width-to-albumin ratio (RAR) is an index reflecting inflammatory and nutritional status. While prior studies reported cross-sectional associations between RAR and cognitive performance, its link to future cognitive outcomes has yet to be determined. Our research assessed the longitudinal associations of baseline RAR with subsequent incidence of cognitive impairment and with multi-year trajectories of cognitive change. This longitudinal cohort study included 5896 participants aged over 60 years from the Health and Retirement Study. During a 6-year follow-up, baseline RAR was examined in relation to incident cognitive impairment and membership in distinct cognitive trajectories identified with group-based trajectory modeling. Associations were assessed using multivariable Cox and logistic regression after adjustment. Restricted cubic splines (RCS) were also used to examine dose-response relationships, and we conducted sensitivity analyses to evaluate the stability of findings. During Follow-up, we identified 1586 incident cases of cognitive impairment and three distinct cognitive trajectories: High-stable (40.47%), Middle-slow decline (43.14%), and Low-rapid decline (16.39%). After full adjustment, one unit increase in baseline RAR was linked to a 18% higher incidence of cognitive impairment (HR = 1.18; 95% CI 1.06–1.31), and RCS analysis indicated the association to be linear (P for non-linearity = 0.851). An elevated baseline RAR was also associated with a greater likelihood of membership in the Middle-slow decline (OR = 1.22; 95% CI 1.06–1.40) and Low-rapid decline (OR = 1.27; 95% CI 1.05–1.52) groups, relative to the High-stable group. In addition, these associations were consistent across all examined subgroups (all P > 0.05) and remained robust in sensitivity analyses. Within this study population, a higher RAR was associated with increased risk of cognitive impairment and membership in unfavorable cognitive trajectories. RAR therefore warrants further investigation as a potential indicator of susceptibility to long-term cognitive decline.