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Systematic review of health behavioral risks and cognitive health in older adults

  • Yunhwan Lee (a1) (a2), Joung Hwan Back (a1) (a2), Jinhee Kim (a1) (a2), Si-Heon Kim (a1), Duk L. Na (a3), Hae-Kwan Cheong (a4), Chang Hyung Hong (a5) and Youn Gu Kim (a1)...

Background: An increasing body of evidence suggests that health behaviors may protect against cognitive impairment and dementia. The purpose of this study was to summarize the current evidence on health behavioral factors predicting cognitive health through a systematic review of the published literature.

Methods: PubMed, Embase, and PsycINFO databases were searched for studies on community representative samples aged 65 and older, with prospective cohort design and multivariate analysis. The outcome – cognitive health – was defined as a continuum of cognitive function ranging from cognitive decline to impairment and dementia, and health behaviors included physical activity, smoking, alcohol drinking, body mass index, and diet and nutrition.

Results: Of 12,105 abstracts identified, 690 relevant full-texts were reviewed. The final yield amounted to 115 articles of which 37 studies were chosen that met the highest standards of quality. Leisure time physical activity, even of moderate level, showed protective effects against dementia, whereas smoking elevated the risk of Alzheimer's disease. Moderate alcohol consumption tended to be protective against cognitive decline and dementia, but nondrinkers and frequent drinkers exhibited a higher risk for dementia and cognitive impairment. Midlife obesity had an adverse effect on cognitive function in later life. Analysis showed vegetable and fish consumption to be of benefit, whereas, persons consuming a diet high in saturated fat had an increased dementia risk.

Conclusion: The review demonstrates accumulating evidence supporting health behavioral effects in reducing the risk of cognitive decline and dementia. Results indicate potential benefits of healthy lifestyles in protecting cognitive health in later life.

Corresponding author
Correspondence should be addressed to: Dr. Yunhwan Lee, Department of Preventive Medicine and Public Health, Ajou University School of Medicine, San 5, Wonchun-dong, Youngtong-gu, Suwon 443-721, Republic of Korea. Phone: +82-31-219-5085; Fax: +82-31-219-5084. Email:
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Abbott R. D., White L. R., Ross G. W., Masaki K. H., Curb J. D. and Petrovitch H. (2004). Walking and dementia in physically capable elderly men. JAMA, 292, 14471453.
Alzheimer's Disease International (2008). The Prevalence of Dementia Worldwide. Available at:
Anstey K. J., von Sanden C., Salim A. and O'Kearney R. (2007). Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. American Journal of Epidemiology, 166, 367378.
Anttila T. et al. (2004). Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population based study. BMJ, 329, 539.
Beydoun M. A., Beydoun H. A. and Wang Y. (2008). Obesity and central obesity as risk factors for incident dementia and its subtypes: a systematic review and meta-analysis. Obesity Reviews, 9, 204218.
Brookmeyer R., Gray S. and Kawas C. (1998). Projections of Alzheimer's disease in the United States and the public health impact of delaying disease onset. American Journal of Public Health, 88, 13371342.
Calon F. and Cole G. (2007). Neuroprotective action of omega-3 polyunsaturated fatty acids against neurodegenerative diseases: evidence from animal studies. Prostaglandins, Leukotrienes and Essential Fatty Acids, 77, 287293.
Dai Q., Borenstein A. R., Wu Y., Jackson J. C. and Larson E. B. (2006). Fruit and vegetable juices and Alzheimer's disease: the Kame Project. American Journal of Medicine, 119, 751759.
Elias M. F., Elias P. K., Sullivan L. M., Wolf P. A. and D'Agostino R. B. (2005). Obesity, diabetes and cognitive deficit: the Framingham Heart Study. Neurobiology of Aging, 26 (Suppl. 1), 1116.
Elias P. K., Elias M. F., D'Agostino R. B., Silbershatz H. and Wolf P. A. (1999). Alcohol consumption and cognitive performance in the Framingham Heart Study. American Journal of Epidemiology, 150, 580589.
Engelhart M. J. et al. (2002). Dietary intake of antioxidants and risk of Alzheimer disease. JAMA, 287, 32233229.
Eskelinen M. H. et al. (2008). Fat intake at midlife and cognitive impairment later in life: a population-based CAIDE study. International Journal of Geriatric Psychiatry, 23, 741747.
Ferri C. P. et al. (2005). Global prevalence of dementia: a Delphi consensus study. Lancet, 366, 21122117.
Ganguli M., Bilt J. V., Saxton J. A., Shen C. and Dodge H. H. (2005). Alcohol consumption and cognitive function in late life: a longitudinal community study. Neurology, 65, 12101217.
Gorospe E. C. and Dave J. K. (2007). The risk of dementia with increased body mass index. Age and Ageing, 36, 2329.
Grodstein F., Chen J. and Willett W. C. (2003). High-dose antioxidant supplements and cognitive function in community-dwelling elderly women. American Journal of Clinical Nutrition, 77, 975984.
Gustafson D., Rothenberg E., Blennow K., Steen B. and Skoog I. (2003). An 18-year follow-up of overweight and risk of Alzheimer disease. Annals of Internal Medicine, 163, 15241528.
Haynes R. B., Kastner M., Wilczynski N. L. and Hedges Team (2005). Developing optimal search strategies for detecting clinically sound and relevant causation studies in EMBASE. BMC Medical Informatics and Decision Making, 5, 8.
Hendrie H. C. et al. (2006). The NIH Cognitive and Emotional Health Project: report of the Critical Evaluation Study Committee. Alzheimer's and Dementia, 2, 1232.
Huang T. L. et al. (2005). Benefits of fatty fish on dementia risk are stronger for those without APOE epsilon4. Neurology, 65, 14091414.
Institute of Medicine (2001). Health and Behavior: The Interplay of Biological, Behavioral, and Societal Influences. Washington, DC: National Academy Press.
Kang J. H., Ascherio A. and Grodstein F. (2005). Fruit and vegetable consumption and cognitive decline in aging women. Annals of Neurology, 57, 713720.
Kivipelto M. et al. (2005). Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Archives of Neurology, 62, 15561560.
Kivipelto M. et al. (2008). Apolipoprotein E epsilon4 magnifies lifestyle risks for dementia: a population-based study. Journal of Cellular and Molecular Medicine, 12, 27622771.
Laitinen M. H. et al. (2006). Fat intake at midlife and risk of dementia and Alzheimer's disease: a population-based study. Dementia and Geriatric Cognitive Disorders, 22, 99107.
Larson E. B. et al. (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine, 144, 7381.
Laurin D., Masaki K. H., Foley D. J., White L. R. and Launer L. J. (2004). Midlife dietary intake of antioxidants and risk of late-life incident dementia: the Honolulu-Asia Aging Study. American Journal of Epidemiology, 159, 959967.
Lautenschlager N. T., Almeida O. P. and Flicker L. (2003). Preventing dementia: why we should focus on health promotion now. International Psychogeriatrics, 15, 111119.
Lee Y., Kim J. and Back J. H. (2009). The influence of multiple lifestyle behaviors on cognitive function in older persons living in the community. Preventive Medicine, 48, 8690.
Luchsinger J. A., Tang M. X., Shea S. and Mayeux R. (2003). Antioxidant vitamin intake and risk of Alzheimer disease. Archives of Neurology, 60, 203208.
Luchsinger J. A., Tang M. X., Siddiqui M., Shea S. and Mayeux R. (2004). Alcohol intake and risk of dementia. Journal of the American Geriatrics Society, 52, 540546.
Maxwell C. J., Hogan D. B. and Ebly E. M. (2002). Serum folate levels and subsequent adverse cerebrovascular outcomes in elderly persons. Dementia and Geriatric Cognitive Disorders, 13, 225234.
Morris M. C. et al. (2004). Dietary niacin and the risk of incident Alzheimer's disease and of cognitive decline. Journal of Neurology, Neurosurgery, and Psychiatry, 75, 10931099.
Morris M. C., Evans D. A., Tangney C. C., Bienias J. L. and Wilson R. S. (2005). Fish consumption and cognitive decline with age in a large community study. Archives of Neurology, 62, 18491853.
Morris M. C., Evans D. A., Tangney C. C., Bienias J. L. and Wilson R. S. (2006). Associations of vegetable and fruit consumption with age-related cognitive change. Neurology, 67, 13701376.
Ngandu T. et al. (2007). Alcohol drinking and cognitive functions: findings from the Cardiovascular Risk Factors Aging and Dementia (CAIDE) Study. Dementia and Geriatric Cognitive Disorders, 23, 140149.
Ott A. et al. (1998). Smoking and risk of dementia and Alzheimer's disease in a population-based cohort study: the Rotterdam Study. Lancet, 351, 18401843.
Patterson C., Feightner J., Garcia A. and MacKnight C. (2007). General risk factors for dementia: a systematic evidence review. Alzheimer's and Dementia, 3, 341347.
Peters R., Peters J., Warner J., Beckett N. and Bulpitt C. (2008). Alcohol, dementia and cognitive decline in the elderly: a systematic review. Age and Ageing, 37, 505512.
Podewils L. J. et al. (2005). Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. American Journal of Epidemiology, 161, 639651.
Qiu C., De Ronchi D. and Fratiglioni L. (2007). The epidemiology of the dementias: an update. Current Opinion in Psychiatry, 20, 380385.
Ravaglia G. et al. (2005). Homocysteine and folate as risk factors for dementia and Alzheimer disease. American Journal of Clinical Nutrition, 82, 636643.
Ravaglia G. et al. (2008). Plasma tocopherols and risk of cognitive impairment in an elderly Italian cohort. American Journal of Clinical Nutrition, 87, 13061313.
Reitz C., den Heijer T., van Duijn C., Hofman A. and Breteler M. M. (2007). Relation between smoking and risk of dementia and Alzheimer disease: the Rotterdam Study. Neurology, 69, 9981005.
Rosengren A., Skoog I., Gustafson D. and Wilhelmsen L. (2005). Body mass index, other cardiovascular risk factors, and hospitalization for dementia. Archives of Internal Medicine, 165, 321326.
Rovio S. et al. (2007). Work-related physical activity and the risk of dementia and Alzheimer's disease. International Journal of Geriatric Psychiatry, 22, 874882.
Simons L. A., Simons J., McCallum J. and Friedlander Y. (2006). Lifestyle factors and risk of dementia: Dubbo Study of the elderly. Medical Journal of Australia, 184, 6870.
Singh-Manoux A., Hillsdon M., Brunner E. and Marmot M. (2005). Effects of physical activity on cognitive functioning in middle age: evidence from the Whitehall II prospective cohort study. American Journal of Public Health, 95, 22522258.
Sloane P. D. et al. (2002). The public health impact of Alzheimer's disease, 2000–2050: potential implication of treatment advances. Annual Review of Public Health, 23, 213231.
Swan G. E. and Lessov-Schlaggar C. N. (2007). The effects of tobacco smoke and nicotine on cognition and the brain. Neuropsychology Review, 17, 259273.
Taaffe D. R. et al. (2008). Physical activity, physical function, and incident dementia in elderly men: the Honolulu-Asia Aging Study. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 63, 529535.
Tyas S. L. et al. (2003). Mid-life smoking and late-life dementia: the Honolulu-Asia Aging Study. Neurobiology of Aging, 24, 589596.
U.S. Centers for Disease Control and Prevention (1999). The Community Guide. Data Abstraction Form. Available at:
Weuve J., Kang J. H., Manson J. E., Breteler M. M. B., Ware J. H. and Grodstein F. (2004). Physical activity, including walking, and cognitive function in older women. JAMA, 292, 14541461.
Whitmer R. A., Gunderson E. P., Quesenberry C. P. Jr, Zhou J. and Yaffe K. (2007). Body mass index in midlife and risk of Alzheimer disease and vascular dementia. Current Alzheimer Research, 4, 103109.
Wilczynski N. L., Haynes R. B. and Hedges Team (2003). Developing optimal search strategies for detecting clinically sound causation studies in MEDLINE. American Medical Informatics Association Annual Symposium Proceedings, 719–723.
Yamada M., Kasagi F., Sasaki H., Masunari N., Mimori Y. and Suzuki G. (2003). Association between dementia and midlife risk factors: the Radiation Effects Research Foundation Adult Health Study. Journal of the American Geriatrics Society, 51, 410414.
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International Psychogeriatrics
  • ISSN: 1041-6102
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