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Cited by 164Dementia and Cognitive Impairment ResearchCardiovascular Health and Risk FactorsAging, Health, and Disability

Healthy lifestyle and life expectancy with and without Alzheimer’s dementia: population based cohort study

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Dhana, Klodian, Franco, Oscar H, Ritz, Ethan M, Ford, Christopher N, Desai, Pankaja, Krueger, Kristin R, Holland, Thomas M, Dhana, Anisa +4 more·2022·BMJ
DOI 10.1136/bmj-2021-068390PMC PMC9006322
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Abstract

OBJECTIVE: 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.

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  • Those with a healthy lifestyle have a lower risk of dementia, and dementia onset was pushed back further than life expectancy prolongation.

    “Those with a healthy lifestyle, involving regular exercise, not smoking, avoiding excess alcohol, and late life cognitive activity, not only have a lower risk of dementia, but dementia onset was also pushed back further than life expectancy prolongation. (19)”

    From Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission (2024) · cites this paper as [19]

    The Discussion reports a lower risk of Alzheimer’s dementia with a healthy lifestyle and says dementia onset could be postponed. The Results show that dementia-free life expectancy increased more than total life expectancy, but this does not establish that onset itself was pushed back by more than the gain in life expectancy; time lived with dementia also depends on mortality after onset. No page numbers are available in our copy. (LLM, conf=0.84)

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Research works printed but not linked: 36

  1. [2]Lourida I Hannon E Littlejohns TJ. Association of lifestyle and genetic risk with incidence of dementia. JAMA 2019; 322: 430- 7. 10.1001/jama.2019.9879. 31302669 PMC6628594 · DOI · Paper page
  2. [3]Licher S Ahmad S Karamujić-Čomić H. Genetic predisposition, modifiable-risk-factor profile and long-term dementia risk in the general population. Nat Med 2019; 25: 1364- 9. 10.1038/s41591-019-0547-7. 31451782 PMC6739225 · DOI
  3. [4]Dhana K Evans DA Rajan KB Bennett DA Morris MC. Healthy lifestyle and the risk of Alzheimer dementia: findings from 2 longitudinal studies. Neurology 2020; 95: e374- 83. 10.1212/WNL.0000000000009816. 32554763 PMC7455318 · DOI
  4. [5]Dhana K Aggarwal NT Rajan KB Barnes LL Evans DA Morris MC. Impact of the apolipoprotein E4 allele on the relationship between healthy lifestyle and cognitive decline: a population-based study. Am J Epidemiol 2021; 190: 1225- 33. 10.1093/aje/kwab033. 33585904 PMC8484773 · DOI
  5. [6]Dhana K Barnes LL Liu X. Genetic risk, adherence to a healthy lifestyle, and cognitive decline in African Americans and European Americans. Alzheimers Dement 2021. 10.1002/alz.12435. 34310036 PMC8789942 · DOI
  6. [7]Li Y Schoufour J Wang DD. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 2020; 368: l6669. 10.1136/bmj.l6669. 31915124 PMC7190036 · DOI
  7. [9]Ott A Breteler MM van Harskamp F. Prevalence of Alzheimer’s disease and vascular dementia: association with education. The Rotterdam study. BMJ 1995; 310: 970- 3. 10.1136/bmj.310.6985.970. 7728032 PMC2549358 · DOI · Paper page
  8. [10]Rajan KB Weuve J Barnes LL McAninch EA Wilson RS Evans DA. Population estimate of people with clinical Alzheimer’s disease and mild cognitive impairment in the United States (2020-2060). Alzheimers Dement 2021; 17: 1966- 75. 10.1002/alz.12362. 34043283 PMC9013315 · DOI · Paper page
  9. [11]Bienias JL Beckett LA Bennett DA Wilson RS Evans DA. Design of the Chicago health and aging project (CHAP). J Alzheimers Dis 2003; 5: 349- 55. 10.3233/JAD-2003-5501. 14646025 · DOI
  10. [12]Evans DA Bennett DA Wilson RS. Incidence of Alzheimer disease in a biracial urban community: relation to apolipoprotein E allele status. Arch Neurol 2003; 60: 185- 9. 10.1001/archneur.60.2.185. 12580702 · DOI · Paper page
  11. [13]Morris MC Tangney CC Wang Y Sacks FM Bennett DA Aggarwal NT. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement 2015; 11: 1007- 14. 10.1016/j.jalz.2014.11.009. 25681666 PMC4532650 · DOI · Paper page
  12. [14]Wilson RS Scherr PA Schneider JA Tang Y Bennett DA. Relation of cognitive activity to risk of developing Alzheimer disease. Neurology 2007; 69: 1911- 20. 10.1212/01.wnl.0000271087.67782.cb. 17596582 · DOI · Paper page
  13. [15]Blondell SJ Hammersley-Mather R Veerman JL. Does physical activity prevent cognitive decline and dementia? A systematic review and meta-analysis of longitudinal studies. BMC Public Health 2014; 14: 510. 10.1186/1471-2458-14-510. 24885250 PMC4064273 · DOI · Paper page
  14. [16]Aggarwal NT Bienias JL Bennett DA. The relation of cigarette smoking to incident Alzheimer’s disease in a biracial urban community population. Neuroepidemiology 2006; 26: 140- 6. 10.1159/000091654. 16493200 · DOI
  15. [17]Sabia S Fayosse A Dumurgier J. Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study. BMJ 2018; 362: k2927. 10.1136/bmj.k2927. 30068508 PMC6066998 · DOI
  16. [18]Morris MC Tangney CC Bienias JL Evans DA Wilson RS. Validity and reproducibility of a food frequency questionnaire by cognition in an older biracial sample. Am J Epidemiol 2003; 158: 1213- 7. 10.1093/aje/kwg290 14652307 · DOI
  17. [20]McPhillips JB Pellettera KM Barrett-Connor E Wingard DL Criqui MH. Exercise patterns in a population of older adults. Am J Prev Med 1989; 5: 65- 72. 10.1016/S0749-3797(18)31107-3 2730794 · DOI
  18. [23]Wenham PR Price WH Blandell G. Apolipoprotein E genotyping by one-stage PCR. Lancet 1991; 337: 1158- 9. 10.1016/0140-6736(91)92823-K. 1674030 · DOI
  19. [24]Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1977; 1: 385- 401. 10.1177/014662167700100306. · DOI · Paper page
  20. [25]Goldstein LB Bertels C Davis JN. Interrater reliability of the NIH stroke scale. Arch Neurol 1989; 46: 660- 2. 10.1001/archneur.1989.00520420080026 2730378 · DOI
  21. [26]McKhann G Drachman D Folstein M Katzman R Price D Stadlan EM. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer’s disease. Neurology 1984; 34: 939- 44. 10.1212/WNL.34.7.939. 6610841 · DOI · Paper page
  22. [27]Rajan KB Aggarwal NT Wilson RS Everson-Rose SA Evans DA. Association of cognitive functioning, incident stroke, and mortality in older adults. Stroke 2014; 45: 2563- 7. 10.1161/STROKEAHA.114.005143. 25104848 PMC4146653 · DOI
  23. [28]Franco OH de Laet C Peeters A Jonker J Mackenbach J Nusselder W. Effects of physical activity on life expectancy with cardiovascular disease. Arch Intern Med 2005; 165: 2355- 60. 10.1001/archinte.165.20.2355. 16287764 · DOI
  24. [29]Dhana K Nano J Ligthart S. Obesity and life expectancy with and without diabetes in adults aged 55 years and older in the Netherlands: a prospective cohort study. PLoS Med 2016; 13: e1002086. 10.1371/journal.pmed.1002086. 27433939 PMC4951120 · DOI
  25. [30]Dhana K Berghout MA Peeters A. Obesity in older adults and life expectancy with and without cardiovascular disease. Int J Obes (Lond) 2016; 40: 1535- 40. 10.1038/ijo.2016.94. 27163746 · DOI
  26. [31]Dhana K Koolhaas CM Berghout MA. Physical activity types and life expectancy with and without cardiovascular disease: the Rotterdam Study. J Public Health (Oxf) 2017; 39: e209- 18. 10.1093/pubmed/fdw110. 27738126 · DOI
  27. [32]Bano A Dhana K Chaker L. Association of thyroid function with life expectancy with and without cardiovascular disease: the Rotterdam study. JAMA Intern Med 2017; 177: 1650- 7. 10.1001/jamainternmed.2017.4836. 28975207 PMC5710266 · DOI · Paper page
  28. [33]Wolters FJ Tinga LM Dhana K. Life expectancy with and without dementia: a population-based study of dementia burden and preventive potential. Am J Epidemiol 2019; 188: 372- 81. 10.1093/aje/kwy234. 30299452 · DOI
  29. [34]Olshansky SJ Carnes BA. Ever since Gompertz. Demography 1997; 34: 1- 15. 10.2307/2061656 9074828 · DOI
  30. [35]Azur MJ Stuart EA Frangakis C Leaf PJ. Multiple imputation by chained equations: what is it and how does it work? Int J Methods Psychiatr Res 2011; 20: 40- 9. 10.1002/mpr.329. 21499542 PMC3074241 · DOI · Paper page
  31. [38]Ritchie K Robine JM Letenneur L Dartigues JF. Dementia-free life expectancy in France. Am J Public Health 1994; 84: 232- 6. 10.2105/AJPH.84.2.232. 8296946 PMC1614984 · DOI
  32. [39]Ritchie K Mathers C Jorm A. Dementia-free life expectancy in Australia. Aust J Public Health 1994; 18: 149- 52. 10.1111/j.1753-6405.1994.tb00216.x. 7948330 · DOI
  33. [40]Sauvaget C Tsuji I Minami Y. Dementia-free life expectancy among elderly Japanese. Gerontology 1997; 43: 168- 75. 10.1159/000213846. 9142511 · DOI
  34. [43]Chêne G Beiser A Au R. Gender and incidence of dementia in the Framingham Heart Study from mid-adult life. Alzheimers Dement 2015; 11: 310- 20. 10.1016/j.jalz.2013.10.005. 24418058 PMC4092061 · DOI · Paper page
  35. [44]Sindi S Kåreholt I Ngandu T. Sex differences in dementia and response to a lifestyle intervention: evidence from Nordic population-based studies and a prevention trial. Alzheimers Dement 2021; 17: 1166- 78. 10.1002/alz.12279. 34255432 PMC8361986 · DOI
  36. [45]McPhillips JB Pellettera KM Barrett-Connor E Wingard DL Criqui MH. Exercise patterns in a population of older adults. Am J Prev Med 1989; 5: 65- 72. 10.1016/S0749-3797(18)31107-3 2730794 · DOI

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Authors
Dhana, K., Franco, O. H., Ritz, E. M., Ford, C. N., Desai, P., Krueger, K. R., Holland, T. M., Dhana, A., Liu, X., Aggarwal, N. T., Evans, D. A., & Rajan, K. B.
Affiliations
  • Rush University Medical Center (US)
  • University of Bern (CH)
ORCID
Venue
BMJ
Publisher
BMJ
Published
2022-04-13
Volume
377
Pages
e068390
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj-2021-068390
PMC
PMC9006322
OpenAlex
W4224064529
Cited by
164
References
7
Citations by year
2026: 25 · 2025: 36 · 2024: 51 · 2023: 35 · 2022: 17
FWCI
22.81
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • BORIS (University Library Bern) (submittedVersion, cc-by-nc)
  • Open Access CRIS of the University of Bern
Funders
National Institutes of Health
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
Keywords
Alzheimer's dementia, life expectancy, healthy lifestyle, MIND diet, cognitive activity, physical activity, smoking, alcohol consumption, older adults, sex differences, modifiable risk factors, Chicago Health and Aging Project, life expectancy at age 65
MeSH terms
Healthy Lifestyle, Aged, Alzheimer Disease, Female, Humans, Life Expectancy, Life Style, Male, Prospective Studies, Risk Factors, United States, Cohort Studies

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