Zhong Wen-Fang, Wang Xiao-Meng, Chen Huan, Song Wei-Qi, Gao Jian, Chen Pei-Liang, Shen Qiao-Qiao, You Fang-Fei, Li Chuan, Lv Yue-Bin, Li Zhi-Hao, Shi Xiao-Ming, Mao Chen
Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong, 510515, China.
Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, 510280, China.
Alzheimers Res Ther. 2025 Jul 14;17(1):158. doi: 10.1186/s13195-025-01806-7.
This study aims to evaluate the combination effects of physical activity (PA), cognitive activity (CA), and dietary patterns impacts cognitive impairment among older adults, and whether these associations differ by apolipoprotein E (APOE) genotype.
A total of 18,909 adults aged 65 years or older at baseline were enrolled from 1998 to 2014 years. PA and CA was assessed using scores that reflected participation in various activities, and a total activity (TA) score was calculated as the sum of PA and CA scores. Diet quality was assessed with the SHE-index. Participants were categorized into lifestyle groups based on combinations of activity levels and SHE-index. The APOE genotype was categorized as APOEε4 carriers versus non-carriers. Cognitive function was evaluated using the Mini-Mental State Examination at baseline and follow-up. Adjusted Cox proportional hazards models was used to estimate the association and interaction between lifestyle and APOE genotype on the risk of cognitive impairment.
During a mean follow-up time of 5.27 ± 3.67 years, 5713 participants developed cognitive impairment. Participants with higher levels of TA, PA, or CA, combined with a healthy diet, consistently exhibited the lowest risk of cognitive impairment, with hazard ratios (HR) of 0.65 [95% confidence intervals (CIs): 0.60-0.71] for TA, 0.72 (95% CI: 0.66-0.78) for PA, and 0.73 (95% CI: 0.67-0.79) for CA. This protective effect remained consistent across APOEε4 genotype groups, with HRs ranging from 0.54 to 0.67 in carriers and 0.63 to 0.69 in non-carriers for higher TA, PA, or CA combined with a healthy diet. In addition, participants engaging in high PA, high CA, and a healthy diet simultaneously showed the greatest protection against cognitive impairment, with HRs of 0.46 (95% CI: 0.28-0.76) in APOEε4 carriers and 0.47 (95% CI: 0.37-0.58) in non-carriers.
The greatest decrease in cognitive impairment was observed among older Chinese adults adhering to both high activity levels and healthy diet, The protective effect was even stronger when high physical activity, high cognitive activity, and a healthy diet were maintained simultaneously, and this trend was consistent regardless of APOEε4 status.
本研究旨在评估身体活动（PA）、认知活动（CA）和饮食模式对老年人认知障碍的综合影响，以及这些关联是否因载脂蛋白E（APOE）基因型而异。
1998年至2014年共纳入18909名基线年龄在65岁及以上的成年人。使用反映参与各种活动的分数评估PA和CA，并计算总活动（TA）分数，即PA和CA分数之和。用SHE指数评估饮食质量。根据活动水平和SHE指数的组合将参与者分为生活方式组。APOE基因型分为APOEε4携带者和非携带者。在基线和随访时使用简易精神状态检查表评估认知功能。使用调整后的Cox比例风险模型估计生活方式和APOE基因型与认知障碍风险之间的关联和相互作用。
在平均5.27±3.67年的随访期间，5713名参与者出现认知障碍。TA、PA或CA水平较高且饮食健康的参与者始终表现出最低的认知障碍风险，TA的风险比（HR）为0.65[95%置信区间（CI）：0.60-0.71]，PA为0.72（95%CI：0.66-0.78），CA为0.73（95%CI：0.67-0.79）。在APOEε4基因型组中，这种保护作用保持一致，对于较高的TA、PA或CA与健康饮食相结合的情况，携带者的HR范围为0.54至0.67，非携带者为0.63至0.69。此外，同时进行高PA、高CA和健康饮食的参与者对认知障碍的保护作用最大，APOEε4携带者的HR为0.46（95%CI：0.28-0.76），非携带者为0.47（95%CI：0.37-0.58）。
在坚持高活动水平和健康饮食的中国老年人中，认知障碍的下降最为明显。当同时保持高身体活动、高认知活动和健康饮食时，保护作用更强，且无论APOEε4状态如何，这一趋势都是一致的。
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