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  • Liu, Xiaoran  (8)
  • Rajan, Kumar B  (8)
  • 1
    In: BMJ, BMJ
    Abstract: To determine the impact of lifestyle factors on life expectancy lived with and without Alzheimer’s dementia. Design Prospective cohort study. Setting The Chicago Health and Aging Project, a population based cohort study in the United States. Participants 2449 men and women aged 65 years and older. Main exposure A healthy lifestyle score was developed based on five modifiable lifestyle factors: a diet for brain health (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay—MIND diet score in upper 40% of cohort distribution), late life cognitive activities (composite score in upper 40%), moderate or vigorous physical activity (≥150 min/week), no smoking, and light to moderate alcohol consumption (women 1-15 g/day; men 1-30 g/day). Main outcome Life expectancy with and without Alzheimer’s dementia in women and men. Results Women aged 65 with four or five healthy factors had a life expectancy of 24.2 years (95% confidence interval 22.8 to 25.5) and lived 3.1 years longer than women aged 65 with zero or one healthy factor (life expectancy 21.1 years, 19.5 to 22.4). Of the total life expectancy at age 65, women with four or five healthy factors spent 10.8% (2.6 years, 2.0 to 3.3) of their remaining years with Alzheimer’s dementia, whereas women with zero or one healthy factor spent 19.3% (4.1 years, 3.2 to 5.1) with the disease. Life expectancy for women aged 65 without Alzheimer’s dementia and four or five healthy factors was 21.5 years (20.0 to 22.7), and for those with zero or one healthy factor it was 17.0 years (15.5 to 18.3). Men aged 65 with four or five healthy factors had a total life expectancy of 23.1 years (21.4 to 25.6), which is 5.7 years longer than men aged 65 with zero or one healthy factor (life expectancy 17.4 years, 15.8 to 20.1). Of the total life expectancy at age 65, men with four or five healthy factors spent 6.1% (1.4 years, 0.3 to 2.0) of their remaining years with Alzheimer’s dementia, and those with zero or one healthy factor spent 12.0% (2.1 years, 0.2 to 3.0) with the disease. Life expectancy for men aged 65 without Alzheimer’s dementia and four or five healthy factors was 21.7 years (19.7 to 24.9), and for those with zero or one healthy factor life expectancy was 15.3 years (13.4 to 19.1). Conclusion A healthy lifestyle was associated with a longer life expectancy among men and women, and they lived a larger proportion of their remaining years without Alzheimer’s dementia. The life expectancy estimates might help health professionals, policy makers, and stakeholders to plan future healthcare services, costs, and needs.
    Type of Medium: Online Resource
    ISSN: 1756-1833
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 1479799-9
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  • 2
    In: Alzheimer's & Dementia, Wiley, Vol. 19, No. S8 ( 2023-06)
    Abstract: Vitamin D intake and supplementation has received considerable interest in dementia research because the prevalence of vitamin D deficiency is higher among older adults, particularly among older African Americans and cognitively impaired individuals. We prospectively examined the role of vitamin D intake, from both diet and supplements, in association with cognitive decline in African Americans and European Americans. Method Utilizing data from the population‐based Chicago Health and Aging Project, we studied 2,061 African Americans and 1,329 European Americans with dietary vitamin D data and cognitive testing over 18 years of follow‐up. Multivariable linear mixed‐effects models adjusted for age, sex, education, APOE e4, body mass index, late‐life cognitive activities, physical activity, comorbidities, total energy intake, and their respective interactions with follow‐up time were used to determine the association of vitamin D intake with cognitive decline. Result On average, the vitamin D intake was lower in African Americans than European Americans (210.2 IU/d vs. 348.7 IU/d). In African Americans, participants in the highest tertile had a slower cognitive decline of 0.019 units/year (95%CI 0.009, 0.030) compared to those in the lowest tertile of dietary intake. The use of vitamin D supplementation was not associated with cognitive decline in African Americans (β 0.004, 95%CI ‐0.006, 0.013). In European Americans, vitamin D intake was not associated with cognitive decline. Conclusion Dietary vitamin D may help slow the rate of cognitive decline in African Americans as they age.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2023
    detail.hit.zdb_id: 2201940-6
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  • 3
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S10 ( 2021-12)
    Abstract: A healthy lifestyle is associated with a slower cognitive decline and reduced risk of Alzheimer’s dementia in the general population. Whether such a healthy lifestyle exerts cognitive benefits among people living with stroke in the community deserves examination. Method The analyses used 5,324 older individuals without dementia participating in the Chicago Health and Aging Project, a population‐based cohort study. Of 5,324 participants, 1,030 individuals had a stroke at the baseline or developed it over study period. We followed up 1,030 participants with stroke and 1,030 stroke‐free individuals matched by age, sex, race, and examination cycle, for changes in cognitive functioning. The primary exposure was healthy lifestyle score that included five factors, non‐smoking, moderate exercise, being cognitively active, having a high‐quality diet, and limiting alcohol use – giving an overall score ranging from 0 to 5. Global cognitive function was evaluated every 3‐years using a short‐battery tests consisting of two tests of episodic memory, one test of executive function, and the MMSE. Multivariable adjusted linear mixed effect models were used to estimate the role of a healthy lifestyle score on cognitive decline. Result The average age of participants with stroke was 76 years, 62% were women, and 64% were African Americans. These characteristics were similar to the overall study population (n=5,324). Compared to people without stroke, participants with stroke had 22.3% (beta ‐0.019 unit/year; 95%CI ‐0.03, ‐0.008) faster cognitive decline during follow‐up. The healthy lifestyle score was associated with a slower cognitive decline in participants with and without stroke. Each unit increase in healthy lifestyle was associated with 8.7% (beta 0.010 unit/year; 95% 0.001, 0.018) slower annual cognitive decline in people with stroke and 7.3% in people without stroke. The annual cognitive decline rate in individuals with 4‐5 healthy lifestyle factors compared with those with 0‐1 factor was 32.7% (beta 0.033 unit/year; 95%CI 0.002, 0.064) slower in participants with stroke and 34.0% (beta 0.030 unit/year; 95%CI 0.006, 0.053) slower in participants without stroke. Conclusion In community‐dwelling stroke survivors, a higher healthy lifestyle score was associated with better cognitive functioning, suggesting that these lifestyle factors may exert cognitive benefits after stroke.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2201940-6
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  • 4
    In: Alzheimer's & Dementia, Wiley, Vol. 18, No. S11 ( 2022-12)
    Abstract: Different forms of vitamin E may have a different association with cognitive function, which might vary by the APOE E4 allele status. We aim to examine vitamin E from different sources and in varying forms and their relation to cognitive decline among those with and without the APOE E4 allele. Methods We included 2,014 participants from the Chicago Health and Aging Project (62% African Americans, 63% female). Global cognition was assessed using a composite score of episodic memory, perceptual speed, and the MMSE. Diet was assessed by a 139‐item FFQ. APOE genotype was assessed by hME Sequenom mass‐array platform. Mixed models were adjusted for age, sex, education, smoking status, calorie intake, alcohol consumption, use of supplements, time since baseline, and the interaction term of time with each covariate. Results A higher dietary vitamin E was associated with slower cognitive decline. Those in the highest quintile of dietary vitamin E intake had 28% slower cognitive decline than the lowest quintile (β = 0.014, p = 0.02). A higher intake of dietary αlpha‐tocopherol was associated with slower cognitive decline in participants with APOE E4 allele, but not among those without. In participants with APOE E4 allele and in the highest quintile of alpha‐tocopherol intake had a 16.4% slower rate of global cognitive decline than those in the lowest quintile (β = 0.015, p = 0.0015). A higher intake of delta‐tocopherol was associated with a slower decline in individuals without the APOE E4 allele only. Among those without the APOE E4 allele and in the highest quintile, the rate of global cognitive decline was slower by 22% than the lowest quintile (β = 0.012, p = 0.0014). We found no significant associations between beta‐ and gamma‐ tocopherol intakes and cognitive decline among those with and without the APOE E4 allele. Conclusion Our study found a positive association of alpha‐tocopherol with cognitive decline among those with the APOE E4 allele and delta‐tocopherol with the decline in those without the APOE E4 allele. Our findings suggest that different forms of vitamin E might have a different association with cognitive decline in older adults depending on their APOE E4 allele status.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2201940-6
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  • 5
    In: The Journal of nutrition, health and aging, Elsevier BV, Vol. 28, No. 5 ( 2024-05), p. 100211-
    Type of Medium: Online Resource
    ISSN: 1279-7707
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2024
    detail.hit.zdb_id: 2082520-1
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  • 6
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S10 ( 2021-12)
    Abstract: We used a life‐course approach to investigate the relationship between trajectories of cognitive activity from early to late‐life with the risk of Alzheimer’s dementia and elucidate a critical age window during which cognitive activities may exert most of their favorable effects. Method The investigation was based on 1,817 older persons without dementia participating in the Rush Memory and Aging Project, a community‐based clinical‐pathologic study. Participants underwent annual clinical evaluations including questions about cognitive activity over the life‐course. Latent class trajectory analyses were used to develop trajectories of cognitive activity from childhood (6‐12y), young adult (18y), middle‐adult‐life (30‐40y), to late‐life ( 〉 65y). Clinical diagnosis of Alzheimer’s dementia was determined using standard criteria. Multivariable adjusted Cox proportional hazard models were used to estimate the hazard ratio(HR) and 95% confidence interval (CI) of trajectories of cognitive activity and Alzheimer’s dementia. Result The average age of study participants was 80 years, 75% were women, and the mean education was 15 years. We identified three groups of participants with distinct trajectories of cognitive activity from early to late‐life. The largest group of individuals (n=1,614, 88.8%) showed steady cognitive activity levels over time – we named this group “stable‐high.” The second group comprised 131 (7.2%) individuals who experienced an increase in cognitive activities after the age of 40 years –‐ the “moderate‐progressive‐increase.” The third group included 72 (4%) individuals who initially engaged in high cognitive activities in early life but then experienced a substantial decrease during middle‐age – the “marked‐decrease” group. During 10 years of follow‐up, 358 (19.7%) of the participants were clinically diagnosed with Alzheimer’s dementia. Compared to individuals in the marked‐decrease group, the risk of Alzheimer’s dementia was 44% lower (HR 0.56, 95%CI 0.37‐0.86) among individuals in the stable‐high group and 53% lower (HR 0.47, 95%CI 0.27‐0.83) in those in the moderate‐progressive‐increase group. Conclusion Using the latent trajectory approach, we identified three distinct cognitive activity trajectories from early to late‐life. These trajectories were differently associated with the risk of Alzheimer’s dementia, suggesting that high cognitive activity starting in middle adult life is protective against Alzheimer’s dementia.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 2201940-6
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  • 7
    In: Alzheimer's & Dementia, Wiley, Vol. 18, No. S11 ( 2022-12)
    Abstract: Diet and physical activity (PA) are important factors associated with improved cognition. Few studies have investigated the synergistic association with cognitive decline and further, whether the association differs by race. In this study, we investigate whether the observed association of high MIND diet score/high self‐reported PA and cognitive decline is different between African Americans (AA’s) and European Americans (EA’s). Method We examined the association of baseline MIND diet and PA combinations on cognition in 3,657 participants (2206 AAs and 1451 EAs; mean age = 73.2±SD5.8 years) from the Chicago Health and Aging Project. Diet was assessed using a validated 144‐item food frequency questionnaire; self‐reported PA was measured by frequency of engagement in six activities. Cognition was evaluated using a four‐test cognitive battery from which a global composite score and two domains were derived. Participants were followed on average 8.5±SD4.8 years and separated into 9 combinations of MIND diet score and PA (high, moderate, low for MIND diet and high, moderate, low, for PA). Using linear mixed models we examined the rate of cognitive decline; adjusting for age, sex, education, race, ApoE‐4, smoking, and caloric intake. Subsequent models were stratified by race to investigate potential differences in the association of diet and PA combinations with cognitive decline. Result Participants who reported high MIND/high PA had a slower rate of decline in global cognition (β = 0.015, 24.87% slower, p = 0.007), memory score (β = 0.014, 31.86% slower, p = 0.042) and improved MMSE (β = 0.023, 33.62% improvement, p 〈 0.001) when compared to participants with low MIND/low PA. In race stratified models, we found that in European Americans, high MIND/high PA was associated with slower rates of decline in global cognition (β = 0.028, 37.1% slower, p = 0.007), memory score (β = 0.026, 48.59% slower, p = 0.033) and improved MMSE (β = 0.050, 50.0% improvement, p 〈 0.0001) versus low MIND diet/low PA. However, only an improved MMSE (β = 0.017, 27.11% improvement, p = 0.033) was observed to be associated in African Americans. Conclusion High adherence to MIND diet/physical activity is associated with slower cognitive decline, regardless of race. However, the breadth of these associations may differ by race. Additional studies are required to elucidate the potential racial differences observed and determine which interventions are most impactful.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2201940-6
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  • 8
    In: The American Journal of Clinical Nutrition, Elsevier BV, Vol. 116, No. 4 ( 2022-10), p. 875-886
    Type of Medium: Online Resource
    ISSN: 0002-9165
    RVK:
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 1496439-9
    SSG: 12
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