Firstly, the cross-sectional design of this study does not allow examination of the temporal association between GDF-15 and the progression of cognitive impairment, and as cases and majority of the controls were derived from the memory clinic, who may have had a higher burden of CeVD (due to increased prevalence of vascular risk factors), our findings may also be less generalizable to the elderly population at large. This evidence concerns the gene GDF15 and Cognitive impairment.