Effects of self-managed lifestyle behavioral changes on cognitive impairment control in Chinese older adults: a population-based prospective study.

Few studies have examined the effects of self-managed lifestyle behavioral adjustment on cognitive status. This study aimed to explore the association between self-managed behavioral changes and transitions in cognitive status. The Hubei Memory and Aging Cohort Study was a prospective cohort study conducted from 2018-2023 in rural and urban areas. Home-dwelling adults aged ≥65 years completed neuropsychological, lifestyle, clinical, and cognitive assessments. The Cox regressions and cubic splines were used to assess the risk of incident cognitive impairment, and latent class analysis was used to group participants based on behavioral patterns and assess transitions in cognitive status. Among 2477 participants with a mean of 2.02 (SD, 1.25) years of follow-up were included in the study. Participants with low and intermediate compared with high baseline behavioral risk exhibited a reduced risk of incident cognitive impairment. At follow-up, those who maintained stable healthy behaviors or positively adjusted them had a 54% (HR, 0.46 [95% CI, 0.34-0.62]) and 84% (0.16 [0.07-0.35]) lower risk of developing cognitive impairment, respectively, compared with those who maintained unhealthy behaviors. The standard and reinforced behavioral adjustment patterns exhibited a 37% (0.63 [0.22-1.79]) and 77% (0.23 [0.05-0.97]) reduction in the risk of incident cognitive impairment, respectively, compared with the basic pattern. Optimal cognitive gains were attributed to positive adjustments in social networks, physical exercise, cognitive activity, and sleep health. Older adults who maintained healthy behaviors or positively adjusted their unhealthy behaviors exhibited a reduced risk of incident cognitive impairment. Positive behavior modification brought greater cognitive improvement to all participants and more pronounced effects for those with dementia.