Healthy lifestyle and cognitive decline in people living with stroke in the community

Abstract

AbstractBackgroundA 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.MethodThe 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.ResultThe 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.ConclusionIn 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.