Meta-Analysis

. 2024 Jun;20(6):3972-3986.

doi: 10.1002/alz.13846. Epub 2024 Apr 27.

Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis

[Article in Italian]

Stephanie Van Asbroeck¹, Sebastian Köhler¹, Martin P J van Boxtel¹, Darren M Lipnicki², John D Crawford², Erico Castro-Costa³, Maria Fernanda Lima-Costa³, Sergio Luis Blay⁴, Xiao Shifu⁵, Tao Wang^{5

6

7}, Ling Yue⁵, Richard B Lipton^{8

9

10}, Mindy J Katz⁸, Carol A Derby^{8

9}, Maëlenn Guerchet¹¹, Pierre-Marie Preux¹¹, Pascal Mbelesso¹², Joanna Norton¹³, Karen Ritchie^{13

14}, Ingmar Skoog^{15

16

17}, Jenna Najar^{15

16

17

18}, Therese Rydberg Sterner^{15

16

19}, Nikolaos Scarmeas^{20

21}, Mary Yannakoulia²², Themis Dardiotis²³, Elena Rolandi^{24

25}, Annalisa Davin²⁴, Michele Rossi²⁴, Oye Gureje²⁶, Akin Ojagbemi²⁷, Toyin Bello²⁷, Ki Woong Kim^{28

29

30}, Ji Won Han^{28

29}, Dae Jong Oh³¹, Stella Trompet³², Jacobijn Gussekloo^{32

33}, Steffi G Riedel-Heller³⁴, Susanne Röhr^{34

35

36}, Alexander Pabst³⁴, Suzana Shahar³⁷, Nurul Fatin Malek Rivan³⁷, Devinder Kaur Ajit Singh³⁷, Erin Jacobsen³⁸, Mary Ganguli^{38

39}, Tiffany Hughes⁴⁰, Mary Haan⁴¹, Allison E Aiello⁴², Ding Ding⁴³, Qianhua Zhao⁴³, Zhenxu Xiao⁴³, Kenji Narazaki⁴⁴, Tao Chen⁴⁵, Sanmei Chen⁴⁶, Tze Pin Ng⁴⁷, Xinyi Gwee⁴⁷, Qi Gao⁴⁷, Henry Brodaty², Julian Trollor^{2

48}, Nicole Kochan², Antonio Lobo^{49

50

51}, Javier Santabárbara^{50

51

52}, Patricia Gracia-Garcia^{49

50

51}, Perminder S Sachdev^{2

53}, Kay Deckers¹; for Cohort Studies of Memory in an International Consortium (COSMIC)

Affiliations

¹ Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, The Netherlands.
² Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
³ René Rachou Institute, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil.
⁴ Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
⁵ Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷ Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
⁸ Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.
⁹ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁰ Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
¹¹ Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
¹² Department of Neurology, Amitié Hospital, Bangui, Central African Republic.
¹³ Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France.
¹⁴ Institut du Cerveau Trocadéro, Paris, France.
¹⁵ Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of Gothenburg, Gothenburg, Sweden.
¹⁶ Centre for Ageing and Health (AGECAP), University of Gothenburg, Gothenburg, Sweden.
¹⁷ Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden.
¹⁸ Department of Clinical Genetics, Section Genomics of Neurodegenerative Diseases and Aging, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
¹⁹ Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden.
²⁰ 1st Department of Neurology, Aiginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²¹ Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University, New York, New York, USA.
²² Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
²³ School of Medicine, University of Thessaly, Larissa, Greece.
²⁴ Golgi Cenci Foundation, Milan, Italy.
²⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁶ Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, University of Ibadan, Ibadan, Nigeria.
²⁷ Department of Psychiatry, College of Medicine University of Ibadan, Ibadan, Nigeria.
²⁸ Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
²⁹ Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
³⁰ Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
³¹ Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
³² Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
³³ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
³⁴ Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
³⁵ Health and Ageing Research Team (HART), School of Psychology, Massey University, Palmerston North, Aotearoa New Zealand.
³⁶ Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland.
³⁷ Center for Healthy Ageing & Wellness (H-CARE), Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
³⁸ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
³⁹ Departments of Neurology, and Epidemiology, University of Pittsburgh School of Medicine and School of Public Health, Pittsburgh, Pennsylvania, USA.
⁴⁰ Department of Graduate Studies in Health and Rehabilitation Sciences, Bitonte College of Health and Human Services, Youngstown State University, Youngstown, Ohio, USA.
⁴¹ Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA.
⁴² Columbia Aging Center and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
⁴³ Institute of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
⁴⁴ Center for Liberal Arts, Fukuoka Institute of Technology, Higashi-ku, Fukuoka, Japan.
⁴⁵ Department of Physical Education, Sports and Health Research Center, Tongji University, Shanghai, China.
⁴⁶ Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁴⁷ Department of Psychological Medicine, Gerontology Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁴⁸ Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴⁹ Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain.
⁵⁰ Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
⁵¹ CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.
⁵² Department of Public Health, Universidad de Zaragoza, Zaragoza, Spain.
⁵³ Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, New South Wales, Australia.

PMID: 38676366
PMCID: PMC11180928
DOI: 10.1002/alz.13846

Meta-Analysis

Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis

[Article in Italian]

Stephanie Van Asbroeck et al. Alzheimers Dement. 2024 Jun.

. 2024 Jun;20(6):3972-3986.

doi: 10.1002/alz.13846. Epub 2024 Apr 27.

Authors

Affiliations

¹ Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, Mental Health and Neuroscience (MHeNs) Research Institute, Maastricht University, Maastricht, The Netherlands.
² Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
³ René Rachou Institute, Fiocruz Minas, Belo Horizonte, Minas Gerais, Brazil.
⁴ Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil.
⁵ Department of Geriatric Psychiatry, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁶ Department of Psychiatry & Affective Disorders Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
⁷ Alzheimer's Disease and Related Disorders Center, Shanghai Jiao Tong University, Shanghai, China.
⁸ Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, Bronx, New York, USA.
⁹ Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁰ Department of Psychiatry and Behavioral Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
¹¹ Inserm U1094, IRD UMR270, University Limoges, CHU Limoges, EpiMaCT - Epidemiology of chronic diseases in tropical zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
¹² Department of Neurology, Amitié Hospital, Bangui, Central African Republic.
¹³ Institute for Neurosciences of Montpellier (INM), University of Montpellier, Inserm, Montpellier, France.
¹⁴ Institut du Cerveau Trocadéro, Paris, France.
¹⁵ Department of Psychiatry and Neurochemistry, Neuropsychiatric Epidemiology Unit, Institute of Neuroscience and Physiology, Sahlgrenska Academy, at the University of Gothenburg, Gothenburg, Sweden.
¹⁶ Centre for Ageing and Health (AGECAP), University of Gothenburg, Gothenburg, Sweden.
¹⁷ Region Västra Götaland, Sahlgrenska University Hospital, Psychiatry, Cognition and Old Age Psychiatry Clinic, Gothenburg, Sweden.
¹⁸ Department of Clinical Genetics, Section Genomics of Neurodegenerative Diseases and Aging, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.
¹⁹ Department of Neurobiology, Aging Research Center, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden.
²⁰ 1st Department of Neurology, Aiginition Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
²¹ Department of Neurology, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Gertrude H. Sergievsky Center, Columbia University, New York, New York, USA.
²² Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
²³ School of Medicine, University of Thessaly, Larissa, Greece.
²⁴ Golgi Cenci Foundation, Milan, Italy.
²⁵ Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
²⁶ Department of Psychiatry, WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience and Substance Abuse, University of Ibadan, Ibadan, Nigeria.
²⁷ Department of Psychiatry, College of Medicine University of Ibadan, Ibadan, Nigeria.
²⁸ Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
²⁹ Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea.
³⁰ Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
³¹ Workplace Mental Health Institute, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
³² Department of Internal Medicine, section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
³³ Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
³⁴ Institute of Social Medicine, Occupational Health and Public Health, Medical Faculty, University of Leipzig, Leipzig, Germany.
³⁵ Health and Ageing Research Team (HART), School of Psychology, Massey University, Palmerston North, Aotearoa New Zealand.
³⁶ Global Brain Health Institute (GBHI), Trinity College Dublin, Dublin, Ireland.
³⁷ Center for Healthy Ageing & Wellness (H-CARE), Faculty of Health Sciences, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
³⁸ Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
³⁹ Departments of Neurology, and Epidemiology, University of Pittsburgh School of Medicine and School of Public Health, Pittsburgh, Pennsylvania, USA.
⁴⁰ Department of Graduate Studies in Health and Rehabilitation Sciences, Bitonte College of Health and Human Services, Youngstown State University, Youngstown, Ohio, USA.
⁴¹ Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, California, USA.
⁴² Columbia Aging Center and the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA.
⁴³ Institute of Neurology, National Center for Neurological Disorders, National Clinical Research Center for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China.
⁴⁴ Center for Liberal Arts, Fukuoka Institute of Technology, Higashi-ku, Fukuoka, Japan.
⁴⁵ Department of Physical Education, Sports and Health Research Center, Tongji University, Shanghai, China.
⁴⁶ Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
⁴⁷ Department of Psychological Medicine, Gerontology Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
⁴⁸ Department of Developmental Disability Neuropsychiatry, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia.
⁴⁹ Department of Medicine and Psychiatry, Universidad de Zaragoza, Zaragoza, Spain.
⁵⁰ Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain.
⁵¹ CIBERSAM, Instituto de Salud Carlos III, Madrid, Spain.
⁵² Department of Public Health, Universidad de Zaragoza, Zaragoza, Spain.
⁵³ Neuropsychiatric Institute, The Prince of Wales Hospital, Sydney, New South Wales, Australia.

PMID: 38676366
PMCID: PMC11180928
DOI: 10.1002/alz.13846

Abstract

Introduction: The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics.

Methods: We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort-specific Cox proportional hazard regression analyses in a two-step individual participant data meta-analysis.

Results: A one-standard-deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow-up. No interactions with sex, education, or socioeconomic position were observed.

Discussion: Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups.

Highlights: A two-step individual participant data meta-analysis was conducted. This was done at a global scale using data from 21 ethno-regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.

Keywords: age; dementia; dementia risk reduction; education; effect modification; ethnicity; individual participant data meta‐analysis; interaction; lifestyle; primary prevention; region; risk factor; risk personalization; sex; socioeconomic.

PubMed Disclaimer

Conflict of interest statement

AL has received financial support to attend scientific meetings from Janssen. PG has received financial support to attend scientific meetings from Lundbeck, Esteve, Nutrición Médica, Angelini, and Neuraxpharm. DD reports grants from Shanghai Municipal Science and Technology Major Project (2018SHZDZX01) and ZJ LAB, National Natural Science Foundation of China (82173599, 81773513), Scientific Research Plan Project of Shanghai Science and Technology Committee (17411950701, 17411950106), and National Project of Chronic Disease (2016YFC1306402); all payments were made to the institution. QZ reports grants from the National Chronic Disease Project (2016YFC1306402), Shanghai Science and Technology Municipality (17411950106, 2018SHZDZX03, 17411950701), National Natural Science Foundation of China (82071200, 81773513), Shanghai Hospital Development Center (SHDC2020CR4007), and MOE Frontiers Center for Brain Science (JIH2642001/028); all payments were made to the institution. NS declares personal fees from NIH, grants from Novo Nordisk (not related to current manuscript). All other authors do not have any conflicts of interest to declare. Author disclosures are available in the supporting information.

Figures

**FIGURE 1**
Flow chart of sample selection. LIBRA, LIfestyle for BRAin Health (index).

**FIGURE 2**
Mean LIBRA score by cohort and continent. Expansions of cohort name abbreviations are presented in Table 1. CI, confidence interval; LIBRA, LIfestyle for BRAin Health.

**FIGURE 3**
Hazard ratio for incident dementia per one‐point increase in LIBRA score. Model 2 (main model), controlled for age (time scale), sex, and years of formal education. Expansions of cohort name abbreviations are presented in Table 1. CI, confidence interval; HR, hazard ratio; LIBRA, LIfestyle for BRAin Health.

**FIGURE 4**
Hazard ratio for incident dementia per one‐point increase in LIBRA score per sociodemographic group. Model 2 (main model), controlled for age (time scale), sex, and years of formal education. CI, confidence interval; HR, hazard ratio; LIBRA, LIfestyle for BRAin Health; SEP, socioeconomic position.

See this image and copyright information in PMC

References

1. World Health Organisation (WHO) . Global status report on the public health response to dementia. 2021.
1. Kivipelto M, Mangialasche F, Ngandu T. Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat Rev Neurol. 2018;14(11):653‐666. doi:10.1038/s41582-018-0070-3 - DOI - PubMed
1. Rolandi E, Zaccaria D, Vaccaro R, et al. Estimating the potential for dementia prevention through modifiable risk factors elimination in the real‐world setting: a population‐based study. Alzheimers Res Ther. 2020;12(1):94. doi:10.1186/s13195-020-00661-y - DOI - PMC - PubMed
1. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413‐446. doi:10.1016/S0140-6736(20)30367-6 - DOI - PMC - PubMed
1. World Health Organization (WHO) . Risk reduction of cognitive decline and dementia: WHO guidelines. 2019. - PubMed

Publication types

Actions
Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Grants and funding

LinkOut - more resources

Full Text Sources
Medical
- MedlinePlus Health Information

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis

Affiliations

Lifestyle and incident dementia: A COSMIC individual participant data meta‐analysis

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical