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Association of Healthy Lifestyles With Risk of Alzheimer Disease and Related Dementias in Low-Income Black and White Americans
Open accessAbstract
Background and Objectives Although the importance of healthy lifestyles for preventing Alzheimer disease and related dementias (ADRD) has been recognized, epidemiologic evidence remains limited for non-White or low-income individuals who bear disproportionate burdens of ADRD. This population-based cohort study aims to investigate associations of lifestyle factors, individually and together, with the risk of ADRD among socioeconomically disadvantaged Americans. Methods In the Southern Community Cohort Study, comprising two-thirds self-reported Black and primarily low-income Americans, we identified incident ADRD using claims data among participants enrolled in Medicare for at least 12 consecutive months after age 65 years. Five lifestyle factors—tobacco smoking, alcohol consumption, leisure-time physical activity (LTPA), sleep hours, and diet quality—were each scored 0 (unhealthy), 1 (intermediate), or 2 (healthy) based on the health guidelines. A composite lifestyle score was created by summing all scores. Cox regression was used to estimate hazard ratios (HRs, 95% CIs) for incident ADRD, treating death as a competing risk. Results We identified 1,694 patients with newly diagnosed ADRD among 17,209 participants during a median follow-up of 4.0 years in claims data; the mean age at ADRD diagnosis was 74.0 years. Healthy lifestyles were individually associated with an 11%–25% reduced risk of ADRD: multivariable-adjusted HR (95% CI) was 0.87 (0.76–0.99) for never vs current smoking, 0.81 (0.72–0.92) for low-to-moderate vs no alcohol consumption, 0.89 (0.77–1.03) for ≥150 minutes of moderate or ≥75 minutes of vigorous LTPA each week vs none, 0.75 (0.64–0.87) for 7–9 hours vs >9 hours of sleep, and 0.85 (0.75–0.96) for the highest vs lowest tertiles of the Healthy Eating Index. The composite lifestyle score showed a dose-response association with up to 36% reduced risk of ADRD: multivariable-adjusted HRs (95% CIs) across quartiles were 1 (ref), 0.88 (0.77–0.99), 0.79 (0.70–0.90), and 0.64 (0.55–0.74); p trend <0.001. The beneficial associations were observed regardless of participants9 sociodemographics (e.g., race, education, and income) and health conditions (e.g., history of cardiometabolic diseases and depression). Discussion Our findings support significant benefits of healthy lifestyles for ADRD prevention among socioeconomically disadvantaged Americans, suggesting that promoting healthy lifestyles and reducing barriers to lifestyle changes are crucial to tackling the growing burden and disparities posed by ADRD.
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“AD risk factors include obesity, diabetes, high blood pressure, and high cholesterol [51,52,53].”
From Recent Advances in Therapeutics for the Treatment of Alzheimer’s Disease (2024) · cites this paper as [51]
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Recent Advances in Therapeutics for the Treatment of Alzheimer’s Disease
Thawabteh, A. M., Ghanem, A. W., AbuMadi, S., Thaher, D., Jaghama, W., Karaman, D., & Karaman, R. (2024) · Molecules · doi:10.3390/molecules29215131 · Cited by 56
“AD risk factors include obesity, diabetes, high blood pressure, and high cholesterol [51–53].”
Background
Metadata
- Authors
- Yang, J. J., Keohane, L. M., Pan, X.-F., Qu, R., Shu, X.-O., Lipworth, L., Braun, K., Steinwandel, M. D., Dai, Q., Shrubsole, M., Zheng, W., Blot, W. J., & Yu, D.
- Affiliations
- Vanderbilt University (US)
- ORCID
- Venue
- Neurology
- Published
- 2022-08-30
- Volume
- 99
- Issue
- 9
- Pages
- e944-e953
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC9502739
- OpenAlex
- W4282838583
- Cited by
- 39
- References
- 45
- Citations by year
- 2026: 6 · 2025: 12 · 2024: 11 · 2023: 8 · 2022: 2
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (R01CA092447, U01CA202979)
- 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
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Alzheimer's disease research and treatments
- Keywords
- Alzheimer's disease and related dementias, healthy lifestyle, lifestyle risk factors, smoking, alcohol consumption, leisure-time physical activity, sleep duration, diet quality, Healthy Eating Index, socioeconomic deprivation, low-income populations, African Americans, racial disparities, Southern Community Cohort Study, dementia prevention, dose-response relationship, competing risk of death, older adults, Medicare claims data
- MeSH terms
- Healthy Lifestyle, Aged, Alzheimer Disease, Black or African American, Medicare, Humans, United States, Cohort Studies
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