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  • 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
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2021
    In:  American Journal of Epidemiology Vol. 190, No. 7 ( 2021-07-01), p. 1225-1233
    In: American Journal of Epidemiology, Oxford University Press (OUP), Vol. 190, No. 7 ( 2021-07-01), p. 1225-1233
    Abstract: 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 ε4 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 (β = −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 (β = 0.008 units/year (95% CI: 0.002, 0.014) and β = 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 (β = 0.029, 95% CI: 0.013, 0.045) and noncarriers (β = 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.
    Type of Medium: Online Resource
    ISSN: 0002-9262 , 1476-6256
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2030043-8
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  • 3
    In: Alzheimer's & Dementia, Wiley, Vol. 16, No. S10 ( 2020-12)
    Abstract: Few older adults are able to achieve recommended levels of moderate‐vigorous physical activity despite known cognitive benefits. Alternatively, small movements, such as increasing movement while standing during usual tasks, can easily be integrated into daily routines by older adults. However, standing activity is best assessed with specific devices (i.e., seismic accelerometers). No existing study of older adults has examined the impact of device‐measured standing activity on cognition. Therefore, the purpose of this secondary analysis is to examine the association between standing activity (as measured by a seismic accelerometer) and cognition in cognitively healthy older adults. Method Participants were 98 cognitively healthy adult participants aged 65 years or older with family history of dementia from the ongoing MIND trial (NCT02817074), which tests the effects of a 3‐year diet intervention on cognitive decline. Exclusion criteria included diagnosis or symptoms of mild cognitive impairment or dementia. Linear regression analyses tested cross‐sectional associations between standing intensity and cognition. Standing activities were mean intensity of standing and static activities (sum of standing and shuffling) assessed by the MoveMonitor+ accelerometer/gyroscope. Cognition was composed of 4 cognitive domains constructed from 12 cognitive performance tests. Result Participants were on average 69.7 years old ( SD =3.7), 69.4% women, and 73.5% had a college degree or higher. Both higher mean intensity of standing activity and static activity were significantly associated with higher levels of executive functioning and perceptual speed in models adjusted for age, gender, and education. Each log unit increase in standing activity intensity was associated with 0.77 units higher of executive function ( p =.041), and 0.85 units higher of perceptual speed ( p =.032). For static activities, significant log unit increases were 0.86 ( p =.009) for executive function and 0.96 ( p =.006) for perceptual speed. When we additionally adjusted for time spent in moderate‐vigorous physical activity and cognitive activity, the positive associations between higher intensity of standing and static activity and perceptual speed remained. Conclusion These findings suggest the importance of considering intensity of standing activity in cognition. The relationships should be further explored in longitudinal analyses and interventions that incorporate small changes to daily routines in addition to promoting moderate‐vigorous physical activity.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2201940-6
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  • 4
    In: Alzheimer's & Dementia, Wiley, Vol. 16, No. S10 ( 2020-12)
    Abstract: While prevention trials are recruiting individuals at high risk of dementia, including those who are genetically predisposed, it has become uncertain whether these interventions, in particular, lifestyle factors can lessen the increased genetic risk. We investigated whether the association between lifestyle factors and cognitive decline differed as a function of APOE4 status in an elderly population. Method Using data from the Chicago Health and Aging Project, a population‐based cohort study, we defined a healthy lifestyle score based on non‐smoking, 〉 =150 min/week moderate/vigorous physical activity, light‐to‐moderate alcohol consumption, high‐quality MIND diet, and engagement in late‐life cognitive activities, yielding an overall composite score that ranged from 0 to 5. Global cognitive function was assessed using brief tests of episodic memory, executive function, and the MMSE in approximately 3‐year cycles for over 18‐years. We examined the association of adherence to lifestyle factors with cognitive decline separately in those with and without APOE4 using a linear mixed effect model adjusted for age, sex, education, race, cardiovascular disease, time, and their interactions with time. Result Of 3,886 older adults included in the study, 1,269 (33%) were APOE4 carriers. Compared to non‐carriers, APOE4 carriers were younger (71y vs. 72y; p 〈 0.001), mostly African American (68% vs. 57%; p 〈 0.001), and had a lower global cognitive score at baseline (0.37 vs. 0.43; p=0.01). In the multivariable‐adjusted model, a higher healthy lifestyle (4‐5 healthy lifestyle factors versus 0‐1 factor) was associated with a slower rate of cognitive decline in both carriers (beta=0.029; p 〈 0.001) and non‐carriers (beta=0.011; p=0.013). However, when we created a propensity score‐matching sample where groups with and without APOE4 were not different concerning age, gender, race, education, baseline global cognitive score, and sample size, these associations differed by APOE4 status. In the matched sample, adherence to a healthy lifestyle was not associated with a cognitive decline in non‐APOE4 carriers (beta=0.002; p=0.763) but remained significant in APOE4 carriers (beta=0.046; p 〈 0.001). Conclusion A healthy lifestyle should be promoted to everyone, especially to individuals with a genetic predisposition for Alzheimer’s dementia.
    Type of Medium: Online Resource
    ISSN: 1552-5260 , 1552-5279
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2020
    detail.hit.zdb_id: 2201940-6
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  • 5
    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
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  • 6
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S10 ( 2021-12)
    Abstract: Healthy dietary patterns, primarily Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND), and Mediterranean diet (MedDiet) are related to slower cognitive decline and reduced risk for Alzheimer’s dementia. However, it is unknown if these diets and its primary food groups are associated with Alzheimer’s disease (AD) pathology in postmortem brains. Method The study was conducted in 459 deceased participants (age at death (91.0±6.3 years), 73% female, 20% with APO‐ε4 allele) of the Rush Memory and Aging Project (a clinicopathologic longitudinal cohort) with completed neuropathological evaluations, dietary data, and without mild cognitive impairment or dementia at first dietary assessments. Mean diet scores were obtained from a validated food frequency questionnaire administered annually over follow‐up years (6.8 ± 3.9 years). Multiple brain regions were assessed for percent cortical area occupied by amyloid‐beta and density of cortical phosphorylated tau (p‐tau) tangles. A global AD pathology score was computed, summarizing three pathologies (neuritic and diffuse plaques and neurofibrillary tangles) based on modified Bielschowsky silver‐staining. Linear regression models adjusted for age, sex, education, APO‐ε4 status, and total calories were used. We also assessed diet interaction with age, sex, education, and APO‐ε4 status. Diet was evaluated as continuous and in tertiles. Result Healthy diet scores were associated with lower global AD pathology (MIND:β=‐0.028,p=0.02; MedDiet:β=‐0.011,p=0.006) and less amyloid load (MIND:β=‐0.077,p=0.04; MedDiet:β=‐0.040,p=0.001). However, when stratified by APO‐ε4 status, this association was significant only in non‐carriers, and diet was also associated with lower p‐tau tangles. Overall, higher fish (p trend=0.007) and green leafy vegetable (p trend=0.014) intakes were associated with less global AD pathology. Sweets and pastries intake was related to higher amyloid load (β=0.021,p=0.009). Those in the highest tertile of legumes/beans (β=‐0.032,p=0.03), and surprisingly, butter intake had fewer p‐tau tangles (β=‐0.030,p=0.04) compared to the lowest tertile group. Conclusion Both the MIND and Mediterranean diets are associated with less AD pathology, primarily amyloid plaques. Dietary components, including green leafy vegetables, fish, legumes, butter, and sweets, were also related to AD pathology. These relationships were more significant in those without an APOE‐ε4 allele. Further studies with larger numbers should be explored in those with and without APOE‐ ε4 genotypes.
    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. 17, No. S10 ( 2021-12)
    Abstract: Lifestyle interventions for primary prevention of Alzheimer’s dementia recruit people at advanced ages who are at high risk of cognitive decline in the timeline of the trial. Given that Alzheimer’s disease and other dementia‐causing pathologies may accumulate in the brain years or even decades before older adults begin to show cognitive deficits, it is important to determine the association of lifestyle factors, cognition, and the role of dementia‐related brain pathologies. Method Utilizing data from the Rush Memory and Aging Project, a longitudinal clinical‐pathologic study, we studied 566 decedents with lifestyle, cognitive testing proximate to death, and complete autopsy data at the time of these analyses. A healthy lifestyle score included being a non‐smoker, ≥150 min/week moderate/vigorous‐intensity physical activity, light‐to‐moderate alcohol consumption, MIND diet score 〉 7.5, and late‐life cognitive activity score 〉 3.2. Brain pathology included measures of beta‐amyloid, neuronal neurofibrillary tangles, Lewy body disease, hippocampal sclerosis, TDP‐43, cerebral infarcts, cerebral amyloid angiopathy, and arteriolosclerosis and atherosclerotic disease. The global cognitive score was derived from a comprehensive battery of nineteen standardized tests. Result A higher healthy lifestyle score was associated with better global cognitive functioning proximate to death (beta=0.149, SE=0.036, p 〈 0.001) and slower annual cognitive decline (beta=0.014 units/year, SE=0.004, p 〈 0.001). A higher healthy lifestyle score was associated with less beta‐amyloid accumulation (beta=‐0.087, SE=0.041, p=0.034), but not with tangles, other neurodegenerative pathology, or indices of vascular pathology. Pathway analysis using structural equation modeling examined whether beta‐amyloid mediated the relationships between healthy lifestyle score and global cognition. Lifestyle score had a significant positive direct effect (beta=0.130, SE=0.035, p 〈 0.001) on global cognition. The indirect effect of lifestyle score on cognition through the pathway of beta‐amyloid load was also significant but had a relatively small effect size (beta=0.019, SE=0.009, p=0.045) Conclusion A healthy lifestyle was associated with better cognitive functioning even after accounting for dementia‐related brain pathologies, suggesting that lifestyle intervention may have cognitive benefits. Moreover, given that beta‐amyloid accumulates years to decades prior to the onset of cognitive decline, the indirect effect of lifestyle on cognition through beta‐amyloid may indicate that a healthy lifestyle could additionally provide primary prevention of Alzheimer’s disease and 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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  • 8
    In: The Journal of Nutrition, Elsevier BV, Vol. 151, No. 9 ( 2021-09), p. 2760-2767
    Type of Medium: Online Resource
    ISSN: 0022-3166
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 1469429-3
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  • 9
    In: Alzheimer's & Dementia, Wiley, Vol. 17, No. S10 ( 2021-12)
    Abstract: Diet and physical activity (PA) are important for cognitive health, but few studies have examined whether there is a synergistic relationship with cognitive decline in older adults. In this study, we investigated whether the combination of a high MIND diet score and high, device‐measured, PA has a stronger relationship with global cognitive decline and specific cognitive domains when compared to other combinations of MIND diet score and PA levels, Method We examined the association of MIND diet and PA interactions on global cognition and five cognitive domains in 264 participants without cognitive impairment from the Rush Memory and Aging Project. Diet was assessed using a validated 144‐item food frequency questionnaire with objective physical activity measured by Actical. Cognition was assessed using a 19‐test cognitive battery from which a global composite score and 5 domains were derived. Participants (mean age = 79± SD 7.7 years; 75% female) were followed for an average of 6.3 ± SD 2.7 years and separated into 9 categorical combinations of MIND diet score and PA (high, moderate, low for MIND diet x high, moderate, low for PA), with low MIND diet and low PA serving as the reference. Linear mixed models adjusted for age sex, education, ApoE‐4, late life cognitive activity, self‐reported physical activity, smoking, and caloric intake. Result Adherence to a high MIND/high PA regimen over time versus low MIND/low PA was associated with a 62.5% slower rate of decline in global cognition (β=0.12, p=0.0001). We also found similar associations for episodic memory (β=0.13, p=0.0006), semantic memory (β=0.1, p=0.005), perceptual speed (β=0.05, p=0.03), and working memory (β=0.08, p=0.006) but not visuospatial ability (β=0.05, p=0.15.). Further, it was determined that the high MIND/high PA combination improved a broader range of cognitive domains over time, than either the high MIND/low PA, or low MIND/high PA, versus low MIND/low PA. (Figure 1) Conclusion Adherence to a high MIND diet/high PA regimen has a greater impact on cognitive decline and specific cognitive domains versus alternate combinations of MIND diet and Physical Activity.
    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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  • 10
    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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