CoChat
Sign Up
Cited by 252Dementia and Cognitive Impairment ResearchCardiovascular Health and Risk FactorsAging, Health, and Disability

Association between healthy lifestyle and memory decline in older adults: 10 year, population based, prospective cohort study

Open access
Jia, Jianping, Zhao, Tan, Liu, Zhaojun, Liang, Yumei, Li, Fangyu, Li, Yan, Liu, Wenying, Li, Fang +21 more·2023·BMJ
DOI 10.1136/bmj-2022-072691PMC PMC9872850
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective: To identify an optimal lifestyle profile to protect against memory loss in older individuals. Design: Population based, prospective cohort study. Setting: Participants from areas representative of the north, south, and west of China. Participants: Individuals aged 60 years or older who had normal cognition and underwent apolipoprotein E (APOE) genotyping at baseline in 2009. Main outcome measures: Participants were followed up until death, discontinuation, or 26 December 2019. Six healthy lifestyle factors were assessed: a healthy diet (adherence to the recommended intake of at least 7 of 12 eligible food items), regular physical exercise (≥150 min of moderate intensity or ≥75 min of vigorous intensity, per week), active social contact (≥twice per week), active cognitive activity (≥twice per week), never or previously smoked, and never drinking alcohol. Participants were categorised into the favourable group if they had four to six healthy lifestyle factors, into the average group for two to three factors, and into the unfavourable group for zero to one factor. Memory function was assessed using the World Health Organization/University of California-Los Angeles Auditory Verbal Learning Test, and global cognition was assessed via the Mini-Mental State Examination. Linear mixed models were used to explore the impact of lifestyle factors on memory in the study sample. Results: 29 072 participants were included (mean age of 72.23 years; 48.54% (n=14 113) were women; and 20.43% (n=5939) were APOE ε4 carriers). Over the 10 year follow-up period (2009-19), participants in the favourable group had slower memory decline than those in the unfavourable group (by 0.028 points/year, 95% confidence interval 0.023 to 0.032, P<0.001). APOE ε4 carriers with favourable (0.027, 95% confidence interval 0.023 to 0.031) and average (0.014, 0.010 to 0.019) lifestyles exhibited a slower memory decline than those with unfavourable lifestyles. Among people who were not carriers of APOE ε4, similar results were observed among participants in the favourable (0.029 points/year, 95% confidence interval 0.019 to 0.039) and average (0.019, 0.011 to 0.027) groups compared with those in the unfavourable group. APOE ε4 status and lifestyle profiles did not show a significant interaction effect on memory decline (P=0.52). Conclusion: A healthy lifestyle is associated with slower memory decline, even in the presence of the APOE ε4 allele. This study might offer important information to protect older adults against memory decline. Trial registration: ClinicalTrials.gov NCT03653156 .

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/bmj-2022-072691

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Not all epidemiological studies have detected interactions between APOE genotype and modifiable risk factors.

    “However, not all epidemiological studies have detected these interactions33.”

    From Multifaceted roles of APOE in Alzheimer disease (2024) · cites this paper as [33]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 39

  1. [1]Caselli RJ Dueck AC Osborne D. Longitudinal modeling of age-related memory decline and the APOE epsilon4 effect. N Engl J Med 2009; 361: 255- 63. 10.1056/NEJMoa0809437. 19605830 PMC2928998 · DOI · Paper page
  2. [2]Jonker C Geerlings MI Schmand B. Are memory complaints predictive for dementia? A review of clinical and population-based studies. Int J Geriatr Psychiatry 2000; 15: 983- 91. 10.1002/1099-1166(200011)15:11<983::AID-GPS238>3.0.CO;2-5. 11113976 · DOI
  3. [3]Mitchell AJ Beaumont H Ferguson D Yadegarfar M Stubbs B. Risk of dementia and mild cognitive impairment in older people with subjective memory complaints: meta-analysis. Acta Psychiatr Scand 2014; 130: 439- 51. 10.1111/acps.12336. 25219393 · DOI
  4. [4]Comijs HC Deeg DJ Dik MG Twisk JW Jonker C. Memory complaints; the association with psycho-affective and health problems and the role of personality characteristics. A 6-year follow-up study. J Affect Disord 2002; 72: 157- 65. 10.1016/S0165-0327(01)00453-0. 12200206 · DOI
  5. [5]Zahodne LB Wall MM Schupf N. Late-life memory trajectories in relation to incident dementia and regional brain atrophy. J Neurol 2015; 262: 2484- 90. 10.1007/s00415-015-7871-8. 26259562 PMC4819990 · DOI
  6. [6]Rosenich E Bransby L Yassi N. Differential effects of APOE and modifiable risk factors on hippocampal volume loss and memory decline in Aβ- and Aβ+ older adults. Neurology 2022; 98: e1704- 15. 10.1212/WNL.0000000000200118. 35169009 PMC9071368 · DOI
  7. [7]Steffl M Jandova T Dadova K. Demographic and Lifestyle Factors and Memory in European Older People. Int J Environ Res Public Health 2019; 16: 4727. 10.3390/ijerph16234727. 31783491 PMC6926502 · DOI
  8. [8]Sabia S Nabi H Kivimaki M Shipley MJ Marmot MG Singh-Manoux A. Health behaviors from early to late midlife as predictors of cognitive function: The Whitehall II study. Am J Epidemiol 2009; 170: 428- 37. 10.1093/aje/kwp161. 19574344 PMC2727179 · DOI · Paper page
  9. [9]Kesse-Guyot E Andreeva VA Lassale C Hercberg S Galan P. Clustering of midlife lifestyle behaviors and subsequent cognitive function: a longitudinal study. Am J Public Health 2014; 104: e170- 7. 10.2105/AJPH.2014.302121. 25211733 PMC4202965 · DOI
  10. [10]Mueller KD Norton D Koscik RL. Self-reported health behaviors and longitudinal cognitive performance in late middle age: Results from the Wisconsin Registry for Alzheimer’s Prevention. PLoS One 2020; 15: e0221985. 10.1371/journal.pone.0221985. 32324741 PMC7179879 · DOI
  11. [11]Lee Y Kim J Back JH. The influence of multiple lifestyle behaviors on cognitive function in older persons living in the community. Prev Med 2009; 48: 86- 90. 10.1016/j.ypmed.2008.10.021. 19026677 · DOI
  12. [12]Visser M Wijnhoven HAH Comijs HC Thomése FGCF Twisk JWR Deeg DJH. A Healthy Lifestyle in Old Age and Prospective Change in Four Domains of Functioning. J Aging Health 2019; 31: 1297- 314. 10.1177/0898264318774430. 29809092 PMC7322976 · DOI
  13. [13]Flöel A Witte AV Lohmann H. Lifestyle and memory in the elderly. Neuroepidemiology 2008; 31: 39- 47. 10.1159/000137378. 18535399 · DOI
  14. [15]American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. American Psychiatric Association Press, 2000.
  15. [16]Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004; 256: 183- 94. 10.1111/j.1365-2796.2004.01388.x 15324362 · DOI · Paper page
  16. [17]Jia J Wang F Wei C. The prevalence of dementia in urban and rural areas of China. Alzheimers Dement 2014; 10: 1- 9. 10.1016/j.jalz.2013.01.012. 23871765 · DOI
  17. [20]Liu Z Song C Suo C Fan H Zhang T Jin L Chen X. Alcohol consumption and hepatocellular carcinoma: novel insights from a prospective cohort study and nonlinear Mendelian randomization analysis. BMC Med 2022; 28; 413. 10.1186/s12916-022-02622-8 PMC9615332 36303185 · DOI
  18. [21]GBD 2016 Alcohol Collaborators. Alcohol use and burden for 195 countries and territories, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018; 392: 1015- 35. 10.1016/S0140-6736(18)31310-2 30146330 PMC6148333 · DOI · Paper page
  19. [22]van Dam RM Li T Spiegelman D Franco OH Hu FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. BMJ 2008; 337: a1440. 10.1136/bmj.a1440. 18796495 PMC2658866 · DOI · Paper page
  20. [23]Hu FB Manson JE Stampfer MJ. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 2001; 345: 790- 7. 10.1056/NEJMoa010492. 11556298 · DOI · Paper page
  21. [24]Stampfer MJ Hu FB Manson JE Rimm EB Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med 2000; 343: 16- 22. 10.1056/NEJM200007063430103. 10882764 · DOI · Paper page
  22. [25]Dhana K Franco OH Ritz EM. Healthy lifestyle and life expectancy with and without Alzheimer’s dementia: population based cohort study. BMJ 2022; 377: e068390. 10.1136/bmj-2021-068390. 35418416 PMC9006322 · DOI · Paper page
  23. [28]Jiao L Mitrou PN Reedy J. A combined healthy lifestyle score and risk of pancreatic cancer in a large cohort study. Arch Intern Med 2009; 169: 764- 70. 10.1001/archinternmed.2009.46. 19398688 PMC3498842 · DOI
  24. [29]Arvanitakis Z Leurgans SE Fleischman DA. Memory complaints, dementia, and neuropathology in older blacks and whites. Ann Neurol 2018; 83: 718- 29. 10.1002/ana.25189. 29466839 PMC5912967 · DOI
  25. [30]Lewis CR Talboom JS De Both MD. Smoking is associated with impaired verbal learning and memory performance in women more than men. Sci Rep 2021; 11: 10248. 10.1038/s41598-021-88923-z. 33986309 PMC8119711 · DOI
  26. [31]Rao R Creese B Aarsland D. Risky drinking and cognitive impairment in community residents aged 50 and over. Aging Ment Health 2022; 26: 2432- 9. 10.1080/13607863.2021.2000938. 34766529 · DOI · Paper page
  27. [32]Woods AJ Porges EC Bryant VE. Current Heavy Alcohol Consumption is Associated with Greater Cognitive Impairment in Older Adults. Alcohol Clin Exp Res 2016; 40: 2435- 44. 10.1111/acer.13211. 27658235 PMC5113749 · DOI
  28. [33]Zhu N Jacobs DR Meyer KA. Cognitive function in a middle aged cohort is related to higher quality dietary pattern 5 and 25 years earlier: the CARDIA study. J Nutr Health Aging 2015; 19: 33- 8. 10.1007/s12603-014-0491-7. 25560814 PMC5466430 · DOI
  29. [34]Folley S Zhou A Llewellyn DJ Hyppönen E. Physical activity, APOE genotype, and cognitive decline: exploring gene-environment interactions in the UK Biobank. J Alzheimers Dis 2019; 71: 741- 50. 10.3233/JAD-181132. 31450492 · DOI
  30. [35]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
  31. [37]Lim YY Williamson R Laws SM AIBL Research Group. Effect of APOE Genotype on Amyloid Deposition, Brain Volume, and Memory in Cognitively Normal Older Individuals. J Alzheimers Dis 2017; 58: 1293- 302. 10.3233/JAD-170072. 28550258 · DOI
  32. [39]Llibre-Guerra JJ Li J Qian Y. Apolipoprotein E (APOE) genotype, dementia, and memory performance among Caribbean Hispanic versus US populations. Alzheimers Dement 2022; 10.1002/alz.12699. 35661582 PMC9719569 · DOI
  33. [40]Hostage CA Choudhury KR Murali Doraiswamy P Petrella JR Alzheimer’s Disease Neuroimaging Initiative. Mapping the effect of the apolipoprotein E genotype on 4-year atrophy rates in an Alzheimer disease-related brain network. Radiology 2014; 271: 211- 9. 10.1148/radiol.13131041. 24475827 PMC4263636 · DOI
  34. [41]Chiang GC Insel PS Tosun D Alzheimer’s Disease Neuroimaging Initiative. Impact of apolipoprotein E4-cerebrospinal fluid β-amyloid interaction on hippocampal volume loss over 1 year in mild cognitive impairment. Alzheimers Dement 2011; 7: 514- 20. 10.1016/j.jalz.2010.12.010. 21889115 PMC3177162 · DOI
  35. [42]Ossenkoppele R Jansen WJ Rabinovici GD Amyloid PET Study Group. Prevalence of amyloid PET positivity in dementia syndromes: a meta-analysis. JAMA 2015; 313: 1939- 49. 10.1001/jama.2015.4669. 25988463 PMC4517678 · DOI · Paper page
  36. [43]Kivipelto M Mangialasche F Ngandu T. Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat Rev Neurol 2018; 14: 653- 66. 10.1038/s41582-018-0070-3. 30291317 · DOI · Paper page
  37. [44]Dhana K Barnes LL Liu X. Genetic risk, adherence to a healthy lifestyle, and cognitive decline in African Americans and European Americans. Alzheimers Dement 2022; 18: 572- 80. 10.1002/alz.12435. 34310036 PMC8789942 · DOI
  38. [45]Jin X He W Zhang Y. Association of APOE ε4 genotype and lifestyle with cognitive function among Chinese adults aged 80 years and older: a cross-sectional study. PLoS Med 2021; 18: e1003597. 10.1371/journal.pmed.1003597. 34061824 PMC8168868 · DOI
  39. [46]Dhana K Aggarwal NT Rajan KB Barnes LL Evans DA Morris MC. Impact of the apolipoprotein E ε4 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

Cited by

Sorted by citations

Authors
Jia, J., Zhao, T., Liu, Z., Liang, Y., Li, F., Li, Y., Liu, W., Li, F., Shi, S., Zhou, C., Yang, H., Liao, Z., Li, Y., Zhao, H., Zhang, J., Zhang, K., Kan, M., Yang, S., Li, H., Liu, Z., Ma, R., Lv, J., Wang, Y., Yan, X., Liang, F., Yuan, X., Zhang, J., Gauthier, S., & Cummings, J.
Affiliations
  • Capital Medical University (CN)
  • Shanxi Medical University (CN)
  • Guangxi Medical University (CN)
  • Jilin University (CN)
  • The First Hospital of Kunming (CN)
  • Zhejiang Provincial People's Hospital (CN)
  • Department of Neurology, Shijiazhuang City Hospital, Hebei, China
  • Shandong University (CN)
  • Jiangxi Provincial People's Hospital (CN)
  • Department of Neurology, Handan Central Hospital, Hebei, China
  • Daqing Oilfield General Hospital (CN)
  • Department of Neurology, The First People’s Hospital of Yibin, Sichuan, China
  • Dongguan People’s Hospital (CN)
  • Beijing Geriatric Hospital (CN)
  • Beijing Jishuitan Hospital (CN)
  • Baotou Central Hospital (CN)
  • Liaocheng People's Hospital (CN)
  • McGill University Research Centre for Studies in Aging (CA)
  • Cleveland Clinic (US)
Corresponding author
Jia, Jianping
ORCID
Venue
BMJ
Publisher
BMJ
Published
2023-01-25
Volume
380
Pages
e072691
ISSN
1756-1833 (ISSN-L)
DOI
10.1136/bmj-2022-072691
PMC
PMC9872850
OpenAlex
W4318028328
Cited by
252
References
4
Citations by year
2026: 46 · 2025: 78 · 2024: 89 · 2023: 39
FWCI
50.72
Type
journal article
Language
en
Open access
Licence
Locations
  • BMJ (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
Funders
National Natural Science Foundation of China
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
healthy lifestyle, memory decline, older adults, APOE ε4, healthy eating, physical activity, social contact, cognitive activity, smoking, alcohol consumption, dementia risk, cognitive aging, lifestyle profile
MeSH terms
Healthy Lifestyle, Aged, Cognition Disorders, Female, Humans, Male, Memory Disorders, Neuropsychological Tests, Prospective Studies, Apolipoprotein E4

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review