Journal
AMERICAN JOURNAL OF EPIDEMIOLOGY
Volume 190, Issue 7, Pages 1225-1233Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/aje/kwab033
Keywords
Alzheimer dementia; APOE epsilon 4 allele; apolipoprotein E; apolipoprotein E gene; cognitive dysfunction; diet; exercise; health behavior
Categories
Funding
- National Institute on Aging [R21AG070287, RF1AG057532, R01AG051635, R01AG058679, R01AG11101]
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Adherence to a healthy lifestyle is associated with slower cognitive decline in older adults, even for those with a genetic predisposition such as carriers of the APOE*E4 allele. On the other hand, individuals carrying the APOE*E4 gene experience faster cognitive decline. However, following a healthy lifestyle can help to mitigate this decline.
Adherence to a healthy lifestyle-characterized by abstaining from smoking, being physically and cognitively active, having a high-quality diet, and limiting alcohol use-is associated with slower cognitive decline in older adults, but whether this relationship extends to persons with a genetic predisposition (e.g., carriers of the epsilon 4 allele of the apolipoprotein E gene (APOE*E4)) remains uncertain. Using data from a population-based study, the Chicago Health and Aging Project (Chicago, Illinois), we followed 3,886 individuals who underwent regular clinical and cognitive assessments from 1993 to 2012. Of 3,886 older adults, 1,269 (32.7%) were APOE*E4 carriers. Compared with noncarriers, APOE*E4 carriers had faster cognitive decline (beta = -0.027 units/year, 95% confidence interval (CI): -0.032, -0.023). In contrast, persons with 2-3 and 4-5 healthy lifestyle factors had slower cognitive decline (beta = 0.008 units/year (95% CI: 0.002, 0.014) and beta = 0.019 units/year (95% CI: 0.011, 0.026), respectively) compared with those with 0-1 factor. In analyses stratified by APOE*E4 status, adherence to a healthy lifestyle (e.g., 4-5 factors vs. 0-1 factors) was associated with a slower rate of cognitive decline in both APOE* E4 carriers (beta = 0.029, 95% CI: 0.013, 0.045) and noncarriers = 0.013, 95% CI: 0.005, 0.022). These results underscore the impact of a healthy lifestyle on cognition, particularly among persons with a genetic predisposition, who are more vulnerable to cognitive decline as they age.
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