Cardiometabolic Risk Factors and Cognitive Impairment Among Community-Dwelling Older Adults in Rural India: A Cross- Sectional Analysis of the Longitudinal Ageing Study in India (LASI) Wave 1

Background India is experiencing a rapid demographic transition with an ageing population increasingly burdened by cardiometabolic disease. Despite growing evidence from high-income countries linking cardiovascular risk factors with late-life cognitive decline, data from rural South Asia remain scarce. We examined the prevalence of cognitive impairment and its association with cardiometabolic and sociodemographic determinants among community-dwelling older adults in India, with a focus on rural residence. Methods We conducted a cross-sectional analysis using Wave 1 data (2017–18) of the Longitudinal Ageing Study in India (LASI), a nationally representative survey of adults aged 45 years and above (analytic sample: 31,464 individuals aged ≥ 60 years). Cognitive impairment was defined using the LASI composite cognitive index encompassing memory, orientation, arithmetic, executive function, and object naming domains. Cardiometabolic risk factors included self-reported hypertension, diabetes mellitus, tobacco use, and physical inactivity. Covariates included age, sex, education, rural–urban residence, and depressive symptoms. Binary logistic regression was used to estimate crude and adjusted odds ratios (aOR) with 95% confidence intervals. Results The overall prevalence of cognitive impairment was 10.8% (rural 12.8% vs. urban 6.0%; p < 0.001). In adjusted models, rural residence (aOR 1.68; 95% CI 1.52–1.87), female sex (aOR 2.18; 95% CI 1.99–2.38), no formal education (aOR 3.87; 95% CI 3.35–4.47), hypertension (aOR 1.19; 95% CI 1.10–1.29), tobacco use (aOR 1.26; 95% CI 1.16–1.37), physical inactivity (aOR 1.28; 95% CI 1.18–1.38), and depression (aOR 1.83; 95% CI 1.68–1.99) were independently associated with cognitive impairment. Diabetes mellitus did not reach statistical significance after adjustment (aOR 1.11; 95% CI 0.99–1.24; p = 0.072). Conclusions Rural older adults in India face a substantially higher cognitive impairment burden driven by compounding cardiometabolic and sociodemographic vulnerabilities. Integrated community-based screening and cardiometabolic risk reduction strategies are urgently needed, particularly in rural settings. These findings have direct implications for the design of geriatric care programmes in primary health care settings.