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APOE4, lifestyle factors, and cognitive decline: A population‐based cohort study
Author(s) -
Dhana Klodian,
Aggarwal Neelum T,
Rajan Kumar B,
Barnes Lisa L,
Evans Denis A,
Morris Martha Clare
Publication year - 2020
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1002/alz.043228
Subject(s) - medicine , gerontology , cognitive decline , cognition , dementia , cohort , population , demography , cohort study , disease , environmental health , psychiatry , sociology
Background While prevention trials are recruiting individuals at high risk of dementia, including those who are genetically predisposed, it has become uncertain whether these interventions, in particular, lifestyle factors can lessen the increased genetic risk. We investigated whether the association between lifestyle factors and cognitive decline differed as a function of APOE4 status in an elderly population. Method Using data from the Chicago Health and Aging Project, a population‐based cohort study, we defined a healthy lifestyle score based on non‐smoking, >=150 min/week moderate/vigorous physical activity, light‐to‐moderate alcohol consumption, high‐quality MIND diet, and engagement in late‐life cognitive activities, yielding an overall composite score that ranged from 0 to 5. Global cognitive function was assessed using brief tests of episodic memory, executive function, and the MMSE in approximately 3‐year cycles for over 18‐years. We examined the association of adherence to lifestyle factors with cognitive decline separately in those with and without APOE4 using a linear mixed effect model adjusted for age, sex, education, race, cardiovascular disease, time, and their interactions with time. Result Of 3,886 older adults included in the study, 1,269 (33%) were APOE4 carriers. Compared to non‐carriers, APOE4 carriers were younger (71y vs. 72y; p<0.001), mostly African American (68% vs. 57%; p<0.001), and had a lower global cognitive score at baseline (0.37 vs. 0.43; p=0.01). In the multivariable‐adjusted model, a higher healthy lifestyle (4‐5 healthy lifestyle factors versus 0‐1 factor) was associated with a slower rate of cognitive decline in both carriers (beta=0.029; p<0.001) and non‐carriers (beta=0.011; p=0.013). However, when we created a propensity score‐matching sample where groups with and without APOE4 were not different concerning age, gender, race, education, baseline global cognitive score, and sample size, these associations differed by APOE4 status. In the matched sample, adherence to a healthy lifestyle was not associated with a cognitive decline in non‐APOE4 carriers (beta=0.002; p=0.763) but remained significant in APOE4 carriers (beta=0.046; p<0.001). Conclusion A healthy lifestyle should be promoted to everyone, especially to individuals with a genetic predisposition for Alzheimer’s dementia.