Abstract
This study aimed to identify lifestyle factors associated with cognitive change and to explore whether the effect of lifestyle varies by socioeconomic status (SES). Participants aged 65 years and older were recruited from elderly health checkup programs from 2011 to 2013 in Taiwan. Neuropsychological tests, including tests of global cognition, logical memory, executive function, verbal fluency and attention, were administered at baseline (N = 603) and 2 years later (N = 509). After literature review, 9 lifestyle factors and 3 SES indicators were chosen and their effects on cognitive change were evaluated using linear regression adjusting for age, sex, education, APOE ε4 status, and baseline cognitive score. Five lifestyle factors (high vegetable and fish intake, regular exercise, not smoking, and light to moderate alcohol consumption) and 3 SES indicators [annual household income (> 33,333 USD vs. less), occupational complexity (high vs. low mental demanding job), and years of education (> 12 years vs. less)] were found to be protective against cognitive decline (P < 0.1 in any cognitive domains, ß ranging from 0.06 to 0.38). After further adjusting for all the lifestyle and SES factors, fish intake, higher income and occupational complexity remained protective. Significant interactions were found between a healthful lifestyle (defined as having ≥ 3 healthful lifestyle factors) and income on changes of global cognition and verbal fluency (Pinteraction = 0.02 and 0.04). The protective effect of a healthful lifestyle was observed only among participants with lower income in global cognition and logical memory [ß = 0.17, 95% confidence interval (CI) = 0.07–0.26; ß = 0.30, 95% CI = 0.14–0.46]. To the best of our knowledge, this study for the first time explored how the interactions of lifestyle and SES affect cognitive change. Our findings will aid in developing dementia prevention programs and reduce health inequalities.
Highlights
Dementia is one of the most common debilitating disorders in the elderly, with an estimated lifetime risk of 1 in 5 for women and 1 in 6 for men over 65 years of age [1]
This study aimed to identify lifestyle factors associated with cognitive change and to explore whether the effect of lifestyle varies by socioeconomic status (SES)
Frequent social activity and cognition-enhancing activity [9, 10], light to moderate alcohol consumption [11], and coffee or tea intake [12] have been associated with decreased risk for dementia or cognitive decline, the results are less consistent for these factors
Summary
Dementia is one of the most common debilitating disorders in the elderly, with an estimated lifetime risk of 1 in 5 for women and 1 in 6 for men over 65 years of age [1]. Identifying modifiable risk factors for cognitive decline is critical for the development of dementia prevention programs. Well-known modifiable risk factors for dementia include vascular risk factors, depression, unhealthful lifestyle, and low socioeconomic status (SES) [3]. Previous meta-analyses have shown that the choices of healthful lifestyles, which include an increased intake of vegetables and fish, regular exercise and not smoking, are associated with decreased risk of dementia [3,4,5,6,7,8]. Frequent social activity and cognition-enhancing activity [9, 10], light to moderate alcohol consumption [11], and coffee or tea intake [12] have been associated with decreased risk for dementia or cognitive decline, the results are less consistent for these factors
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