Abstract
BACKGROUND AND AIM: The relationship between the TG/HDL-C ratio and cognitive impairment in the general US elderly population aged 60 years and older is not well understood. This study aimed to investigate the association between TG/HDL-C ratio and cognitive function in older adults in the US. METHODS: In this cross-sectional study (NHANES 2011-2014), 1340 participants underwent cognitive assessments: CERAD (memory), Animal Fluency (verbal fluency), and DSST (processing speed). Global cognition was derived from standardized Z-scores. Survey-weighted multivariate linear regression evaluated associations between TG/HDL-C (continuous/quartiles) and cognitive scores, adjusted for demographics, lifestyle, and comorbidities. Nonlinearity was tested via restricted cubic splines. RESULTS: Higher TG/HDL-C correlated with poorer cognitive performance. Compared to Q1 (lowest), Q4 (highest) had significantly lower DSST (β = -2.1, 95% CI: -3.4 to -0.8) and global Z-scores (β = -0.09, 95% CI: -0.15 to -0.03; p-trend < 0.001). Each unit increase in TG/HDL-C reduced DSST (β = -1.34, 95% CI: -2.09 to -0.59) and global scores (β = -0.06, 95% CI: -0.09 to -0.02). Nonlinear patterns were observed (p-nonlinearity< 0.05). Subgroup analyses identified significant effect modifications by race (DSST: p-interaction = 0.004) and age (global cognition: p-interaction = 0.024). CONCLUSION: Elevated TG/HDL-C is independently associated with worse cognitive function in older US adults, particularly impacting processing speed and executive function. These findings underscore lipid dysregulation's role in cognitive aging, supporting targeted interventions for metabolic health.