Clustering of midlife lifestyle behaviors and subsequent cognitive function: a longitudinal study

Abstract

Objectives: We examined the association between individual and clustered lifestyle behaviors in middle age and later in cognitive functioning.

Methods: Middle-aged participants (n = 2430) in the Supplémentation en Vitamines et Minéraux Antioxydant study self-reported their low physical activity, sedentary behavior, alcohol use, smoking, low fruit and vegetable consumption, and low fish consumption. We assessed cognition 13 years later via 6 neuropsychological tests. After standardization, we summed the scores for a composite cognitive measure. We estimated executive functioning and verbal memory scores using principal component analysis. We estimated the mean differences (95% confidence intervals [CIs]) in cognitive performance by the number of unhealthy behaviors using analysis of covariance. We identified latent unhealthy behavior factor via structural equation modeling.

Results: Global cognitive function and verbal memory were linearly, negatively associated with the number of unhealthy behaviors: adjusted mean differences = -0.36 (95% CI = -0.69, -0.03) and -0.46 (95% CI = -0.80, -0.11), respectively, per unit increase in the number of unhealthy behaviors. The latent unhealthy behavior factor with low fruit and vegetable consumption and low physical activity as main contributors was associated with reduced verbal memory (RMSEA = 0.02; CFI = 0.96; P = .004). No association was found with executive functioning.

Conclusions: Comprehensive public health strategies promoting healthy lifestyles might help deter cognitive aging.

FIGURE 1—

Association between unhealthy lifestyle behaviors and verbal memory: Midlife Lifestyle Behaviors and Subsequent Cognitive Function, France, 1994–2009. Note. Structural equation modeling was used to specify a measurement model presenting the relationships between the measured (lifestyle behavior indicators) and the latent variable (unhealthy lifestyle), including unidirectional paths from the unhealthy lifestyle to verbal memory. Comparative Fit Index = 0.96; root mean-square error of approximation = 0.02; robust independence model χ² = 490.79; P = .004.