Am J Epidemiol. 2021 Jul 1;190(7):1225-1233. doi: 10.1093/aje/kwab033.
Adherence to a healthy lifestyle-characterized by abstaining from smoking, being physically and cognitively active, having a high-quality diet, and limiting alcohol use-is associated with slower cognitive decline in older adults, but whether this relationship extends to persons with a genetic predisposition (e.g., carriers of the ε4 allele of the apolipoprotein E gene (APOEE4)) remains uncertain. Using data from a population-based study, the Chicago Health and Aging Project (Chicago, Illinois), we followed 3,886 individuals who underwent regular clinical and cognitive assessments from 1993 to 2012. Of 3,886 older adults, 1,269 (32.7%) were APOEE4 carriers. Compared with noncarriers, APOEE4 carriers had faster cognitive decline (β = -0.027 units/year, 95% confidence interval (CI): -0.032, -0.023). In contrast, persons with 2-3 and 4-5 healthy lifestyle factors had slower cognitive decline (β = 0.008 units/year (95% CI: 0.002, 0.014) and β = 0.019 units/year (95% CI: 0.011, 0.026), respectively) compared with those with 0-1 factor. In analyses stratified by APOEE4 status, adherence to a healthy lifestyle (e.g., 4-5 factors vs. 0-1 factors) was associated with a slower rate of cognitive decline in both APOE*E4 carriers (β = 0.029, 95% CI: 0.013, 0.045) and noncarriers (β = 0.013, 95% CI: 0.005, 0.022). These results underscore the impact of a healthy lifestyle on cognition, particularly among persons with a genetic predisposition, who are more vulnerable to cognitive decline as they age.
坚持健康的生活方式——包括不吸烟、身体和认知活跃、饮食质量高、限制饮酒——与老年人认知能力下降速度较慢有关，但这种关系是否扩展到具有遗传易感性的人（例如，载脂蛋白 E 基因（APOEE4）的 ε4 等位基因（APOEE4）的携带者）仍然不确定。我们使用基于人群的研究——芝加哥健康与老龄化项目（伊利诺伊州芝加哥）的数据，对 1993 年至 2012 年期间接受定期临床和认知评估的 3886 名个体进行了随访。在 3886 名老年人中，有 1269 名（32.7%）是 APOEE4 携带者。与非携带者相比，APOEE4 携带者的认知能力下降更快（β=-0.027 个单位/年，95%置信区间（CI）：-0.032，-0.023）。相比之下，有 2-3 个和 4-5 个健康生活方式因素的人认知能力下降较慢（β=0.008 个单位/年（95%CI：0.002，0.014）和β=0.019 个单位/年（95%CI：0.011，0.026））与有 0-1 个因素的人相比。在按 APOEE4 状态分层的分析中，坚持健康的生活方式（例如，4-5 个因素与 0-1 个因素）与 APOEE4 携带者（β=0.029，95%CI：0.013，0.045）和非携带者（β=0.013，95%CI：0.005，0.022）认知能力下降速度较慢有关。这些结果强调了健康生活方式对认知的影响，尤其是在具有遗传易感性的人群中，随着年龄的增长，他们更容易出现认知能力下降。
