Healthy lifestyle and life expectancy with and without Alzheimer's dementia: population based cohort study

Abstract

Objective: To determine the impact of lifestyle factors on life expectancy lived with and without Alzheimer's dementia.

Design: Prospective cohort study.

Setting: The Chicago Health and Aging Project, a population based cohort study in the United States.

Participants: 2449 men and women aged 65 years and older.

Main exposure: A healthy lifestyle score was developed based on five modifiable lifestyle factors: a diet for brain health (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay-MIND diet score in upper 40% of cohort distribution), late life cognitive activities (composite score in upper 40%), moderate or vigorous physical activity (≥150 min/week), no smoking, and light to moderate alcohol consumption (women 1-15 g/day; men 1-30 g/day).

Main outcome: Life expectancy with and without Alzheimer's dementia in women and men.

Results: Women aged 65 with four or five healthy factors had a life expectancy of 24.2 years (95% confidence interval 22.8 to 25.5) and lived 3.1 years longer than women aged 65 with zero or one healthy factor (life expectancy 21.1 years, 19.5 to 22.4). Of the total life expectancy at age 65, women with four or five healthy factors spent 10.8% (2.6 years, 2.0 to 3.3) of their remaining years with Alzheimer's dementia, whereas women with zero or one healthy factor spent 19.3% (4.1 years, 3.2 to 5.1) with the disease. Life expectancy for women aged 65 without Alzheimer's dementia and four or five healthy factors was 21.5 years (20.0 to 22.7), and for those with zero or one healthy factor it was 17.0 years (15.5 to 18.3). Men aged 65 with four or five healthy factors had a total life expectancy of 23.1 years (21.4 to 25.6), which is 5.7 years longer than men aged 65 with zero or one healthy factor (life expectancy 17.4 years, 15.8 to 20.1). Of the total life expectancy at age 65, men with four or five healthy factors spent 6.1% (1.4 years, 0.3 to 2.0) of their remaining years with Alzheimer's dementia, and those with zero or one healthy factor spent 12.0% (2.1 years, 0.2 to 3.0) with the disease. Life expectancy for men aged 65 without Alzheimer's dementia and four or five healthy factors was 21.7 years (19.7 to 24.9), and for those with zero or one healthy factor life expectancy was 15.3 years (13.4 to 19.1).

Conclusion: A healthy lifestyle was associated with a longer life expectancy among men and women, and they lived a larger proportion of their remaining years without Alzheimer's dementia. The life expectancy estimates might help health professionals, policy makers, and stakeholders to plan future healthcare services, costs, and needs.

Fig 1

Overall life expectancy and life expectancy with and without Alzheimer’s dementia according to categories of lifestyle score in women and men. A behavior was classified as low risk or healthy if it met several criteria: Mediterranean-DASH Diet Intervention for Neurodegenerative Delay—MIND score (without alcohol) >7.5, corresponding to upper 40% of cohort distribution; cognitive activity score >3.43, corresponding to upper 40% of cohort distribution; not being a current smoker; moderate or vigorous exercise for ≥150 min/week; and light to moderate alcohol consumption (1-15 g/day for women and 1-30 g/day for men)

Fig 2

Proportion of life expectancy spent with Alzheimer’s dementia according to categories of lifestyle score in women and men. Proportion is computed by dividing life expectancy lived with Alzheimer’s dementia by total life expectancy at a given age (supplementary tables 2 and 3). A behavior was classified as low risk or healthy if it met several criteria: Mediterranean-DASH Diet Intervention for Neurodegenerative Delay—MIND score (without alcohol) >7.5, corresponding to upper 40% of cohort distribution; cognitive activity score >3.43, corresponding to upper 40% of cohort distribution; not being a current smoker; moderate or vigorous exercise for ≥150 min/week; and light to moderate alcohol consumption (1-15 g/day for women and 1-30 g/day for men)