Association of Combined Healthy Lifestyle Factors With Incident Dementia in Patients With Type 2 Diabetes

Background and Objectives Type 2 diabetes and lifestyle factors have been associated with dementia risk, but the effect of a healthy lifestyle on diabetes-related dementia remains largely unknown. We aimed to investigate whether the increased risk of dementia among individuals with diabetes can be offset by a broad combination of healthy lifestyle factors. Methods This prospective study used data from the UK Biobank cohort. An overall lifestyle score ranging from 0 to 7 was created, with 1 point for each of the 7 healthy lifestyle factors: no current smoking, moderate alcohol consumption, regular physical activity, healthy diet, adequate sleep duration, less sedentary behavior, and frequent social contact. Incident dementia was ascertained using linkage with electronic health records. Cox proportional hazards models were used to examine the associations between diabetes, healthy lifestyle score, and dementia incidence. Results We included 167,946 participants aged 60 years or older without dementia at baseline (mean age 64.1 [SD 2.8] years, 51.7% female). During a median follow-up of 12.3 years, 4,351 developed all-cause dementia. Participants with diabetes, but not those with prediabetes, showed a higher risk of dementia than those with normoglycemia. Compared with diabetes-free participants who had a lifestyle score of 7, the hazard ratios (HRs) for dementia were 4.01 (95% CI 3.06–5.25) and 1.74 (95% CI 1.11–2.72) for those with diabetes who had a lifestyle score of 0–2 and 7, respectively. Among participants with diabetes, the HR for dementia comparing a lifestyle score of 7 vs 0–2 was 0.46 (95% CI 0.28–0.75). This finding corresponded to a reduction in the 10-year absolute risk of dementia from 5.22% (95% CI 3.94%–6.73%) to 1.72% (95% CI 0.92%–2.97%). The association between higher lifestyle score and lower dementia risk was independent of glycemic control and diabetes medication. Discussion Adherence to a broad range of healthy lifestyle factors was associated with a significantly lower risk of dementia among participants with diabetes. Behavioral lifestyle modification through multifactorial approaches should be a priority for prevention and delayed onset of dementia in patients with diabetes.

[1]  M. Lythgoe,et al.  Regulatory decisions diverge over aducanumab for Alzheimer’s disease , 2022, BMJ.

[2]  K. Dhana,et al.  Association of a Healthy Lifestyle With All-Cause and Cause-Specific Mortality Among Individuals With Type 2 Diabetes: A Prospective Study in UK Biobank. , 2021, Diabetes care.

[3]  M. Kivimäki,et al.  Association Between Age at Diabetes Onset and Subsequent Risk of Dementia. , 2021, JAMA.

[4]  O. Franco,et al.  Associations of healthy lifestyle and socioeconomic status with mortality and incident cardiovascular disease: two prospective cohort studies , 2021, BMJ.

[5]  C. Sudlow,et al.  Midlife vascular risk factors and risk of incident dementia: Longitudinal cohort and Mendelian randomization analyses in the UK Biobank , 2021, Alzheimer's & dementia : the journal of the Alzheimer's Association.

[6]  V. Beral,et al.  Social isolation and risk of heart disease and stroke: analysis of two large UK prospective studies , 2021, The Lancet. Public health.

[7]  Naaheed Mukadam,et al.  Dementia prevention, intervention, and care: 2020 report of the Lancet Commission , 2020, The Lancet.

[8]  L. Fratiglioni,et al.  Can active life mitigate the impact of diabetes on dementia and brain aging? , 2020, Alzheimer's & dementia : the journal of the Alzheimer's Association.

[9]  2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2020 , 2019, Diabetes Care.

[10]  T. Littlejohns,et al.  Association of Lifestyle and Genetic Risk With Incidence of Dementia. , 2019, JAMA.

[11]  G. Livingston,et al.  Association of social contact with dementia and cognition: 28-year follow-up of the Whitehall II cohort study , 2019, PLoS medicine.

[12]  Hui-Xin Wang,et al.  Participating in Mental, Social, and Physical Leisure Activities and Having a Rich Social Network Reduce the Incidence of Diabetes-Related Dementia in a Cohort of Swedish Older Adults , 2018, Diabetes Care.

[13]  J. Pell,et al.  The effect of socioeconomic deprivation on the association between an extended measurement of unhealthy lifestyle factors and health outcomes: a prospective analysis of the UK Biobank cohort. , 2018, The Lancet. Public health.

[14]  Miia Kivipelto,et al.  Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease , 2018, Nature Reviews Neurology.

[15]  Cécile Proust-Lima,et al.  Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia , 2018, JAMA.

[16]  M. Kivimäki,et al.  Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study , 2018, British Medical Journal.

[17]  S. Kanba,et al.  Association Between Daily Sleep Duration and Risk of Dementia and Mortality in a Japanese Community , 2018, Journal of the American Geriatrics Society.

[18]  J. Manson,et al.  Influence of Lifestyle on Incident Cardiovascular Disease and Mortality in Patients With Diabetes Mellitus. , 2018, Journal of the American College of Cardiology.

[19]  D. Knopman,et al.  Sleep characteristics and risk of dementia and Alzheimer's disease: The Atherosclerosis Risk in Communities Study , 2018, Alzheimer's & Dementia.

[20]  Classi fi cation and Diagnosis of Diabetes : Standards of Medical Care in Diabetes d 2019 , 2018 .

[21]  C. Wan,et al.  The Effect of Social Support on Glycemic Control in Patients with Type 2 Diabetes Mellitus: The Mediating Roles of Self-Efficacy and Adherence , 2017, Journal of diabetes research.

[22]  Cathie Sudlow,et al.  Algorithms for the Capture and Adjudication of Prevalent and Incident Diabetes in UK Biobank , 2016, PloS one.

[23]  Edo Richard,et al.  Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial , 2016, The Lancet.

[24]  D. Mozaffarian.  Dietary and Policy Priorities for Cardiovascular Disease, Diabetes, and Obesity: A Comprehensive Review , 2016, Circulation.

[25]  Valentin E. Brimkov,et al.  Digital , 2015, Bankmagazin.

[26]  D. Jacobs,et al.  Effect of Early Adult Patterns of Physical Activity and Television Viewing on Midlife Cognitive Function. , 2016, JAMA psychiatry.

[27]  M. Woodward,et al.  Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia , 2015, Diabetes Care.

[28]  Lars Bäckman,et al.  A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial , 2015, The Lancet.

[29]  P. Elliott,et al.  UK Biobank: An Open Access Resource for Identifying the Causes of a Wide Range of Complex Diseases of Middle and Old Age , 2015, PLoS medicine.

[30]  Kristine Yaffe,et al.  Potential for primary prevention of Alzheimer's disease: an analysis of population-based data , 2014, The Lancet Neurology.

[31]  J. Manson,et al.  Body-mass index and mortality among adults with incident type 2 diabetes. , 2014, The New England journal of medicine.

[32]  Riccardo E. Marioni,et al.  Cognitive function, dementia and type 2 diabetes mellitus in the elderly , 2011, Nature Reviews Endocrinology.

[33]  K. Anstey,et al.  Alcohol consumption as a risk factor for dementia and cognitive decline: meta-analysis of prospective studies. , 2009, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[34]  B. Winblad,et al.  The Effect of Borderline Diabetes on the Risk of Dementia and Alzheimer’s Disease , 2007, Diabetes.

[35]  H. Brodaty,et al.  ALZHEIMER'S DISEASE INTERNATIONAL , 1997, International journal of geriatric psychiatry.