A32-35 Worse Asthma Control Is Associated With Greater Odds of Cognitive Impairment

Abstract Rationale Cognitive impairment is increasingly recognized among people with asthma and may be influenced by disease control and psychosocial factors such as depression. However, limited data exist on this association in younger adults with less severe asthma, and the potential mediating role of depression remains unclear. We aimed to evaluate the association between asthma control and cognitive impairment, with a sub-analysis exploring depression as a potential mediator. Methods We conducted a secondary cross-sectional analysis of a prospective cohort study of adults (≥21 years) with asthma from Denver and New York City. Primary outcome was cognitive impairment, dichotomized as a Montreal Cognitive Assessment (MoCA) score 23; 1-point was added for ≤12 years education. Primary exposure was Asthma Control Questionnaire (ACQ) score with a clinically meaningful difference of 0.5 points with higher scores indicating worse control. Depression was dichotomized as Patient Health Questionnaire-9 at ≥ 10. We used multivariable logistic regression models adjusted for age, sex, and education. Causal mediation analysis was performed in R using the mediation package with Quasi-Bayesian approximation (5000 simulations). A sensitivity analysis was conducted excluding participants who had their survey completed in Spanish. Results Of 321 adults with asthma, we identified 216 (67%) without cognitive impairment and 105 (33%) with any cognitive impairment (mean MoCA score 26.8 (SD 2.3) vs 19.4 (SD 2.5), respectively). Medication adherence was slightly lower in the group without cognitive impairment (32.4% vs 36.2% with cognitive impairment). There was a higher proportion of Hispanic/Latino participants in those with cognitive impairment (45.7% vs 23.7% without cognitive impairment). In the adjusted analysis, higher ACQ scores were associated with higher odds of cognitive impairment (OR 1.17 per 0.5-point ACQ increase; 95% CI 1.04-1.32; p = 0.009) (Fig 1). Mediation analysis showed that depression did not significantly mediate the relationship between asthma control and cognitive impairment (average causal mediated effect = 0.003; 95% CI -0.003-0.013; p = 0.36). The direct effect of asthma control on cognitive impairment, independent of depression, remained significant (average direct effect = 0.020; p = 0.048), indicating that for every 0.5-point increase in ACQ score, the probability of cognitive impairment increased by 2 percentage-points. In sensitivity analyses excluding Spanish-language respondents, findings were unchanged. Conclusion Worse asthma control was associated with increased probability of cognitive impairment, and this relationship was not mediated by depression. These findings underscore the importance of better understanding the relationship between asthma and cognitive impairment. This abstract is funded by: R01 HL129198-01A1