New research reveals that leading a healthy lifestyle, which includes regular exercise, consumption of fruits and vegetables, and limited alcohol intake, is linked to enhanced cognitive function among older individuals.
Combining longitudinal and cohort data with postmortem brain pathology reports, the study highlights that this association remains robust even in individuals with Alzheimer's disease (AD) pathology. This suggests that lifestyle choices may contribute to cognitive reserve and bolster cognitive abilities as people age.
Published online on February 5 in JAMA Neurology, the study, led by Klodian Dhana, MD, of the Rush University Medical Center in Chicago, Illinois, underscores the crucial role of lifestyle in maintaining cognitive function despite the presence of common dementia-related brain pathologies.
The research, part of the Rush Memory and Aging Project longitudinal cohort study, involved 586 participants (71% female) followed from 1997 to 2022. Lifestyle and demographic data were collected regularly, alongside details on diet, alcohol consumption, and engagement in moderate to vigorous physical activities such as gardening, walking, and biking. Participants also underwent annual cognitive assessments.
In later years, participants reported engaging in cognitively stimulating activities like playing card games, reading, or visiting museums. Postmortem examinations allowed researchers to evaluate brain pathology, with participants having an average age at death of 91 years.
Participants were deemed to lead a healthy lifestyle if they scored positively in five areas: regular moderate to vigorous exercise for at least 150 minutes per week, non-smoking, moderate alcohol consumption (one to two drinks per week), regular engagement in cognitive activities like playing card games or solving puzzles, and adherence to the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay diet.
For each additional point in the healthy lifestyle score, there was a significant reduction in beta-amyloid load in the brain and a higher cognitive performance score (P < .001).
Even after accounting for factors like beta-amyloid load and other dementia-related brain pathologies, the healthy lifestyle score remained independently associated with cognitive function (P < .001).
The authors noted that more than 88% of the variation in a person's global cognition score could be attributed directly to lifestyle factors, with less than 12% influenced by the presence of beta-amyloid.
They suggested that the link between lifestyle and cognition might be partly explained by the antioxidant and anti-inflammatory properties of lifestyle factors, such as nutrition and physical activity, as well as cognitive reserve from engaging in cognitive activities.
However, further research is needed, particularly studies exploring the relationship between lifestyle factors and markers of inflammation, to elucidate the mechanisms underlying the association between lifestyle and cognitive health in later life.
The study has limitations, including reliance on self-reported data, which may be affected by cognitive impairment, and the potential impact of cognitive abilities on adherence to lifestyle factors.
In an accompanying editorial, Yue Leng, MD, and Kristine Yaffe, MD, of the University of San Francisco in California, hailed the study as providing "important evidence" regarding modifiable risk factors and Alzheimer's disease risk reduction. They emphasized the need for more randomized controlled trials to better understand the mechanisms linking modifiable risk factors and cognitive aging, advocating for a comprehensive approach that combines lifestyle interventions with medication, akin to strategies in cardiovascular disease prevention and treatment.
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