Association between Healthy Lifestyle Index and Cognitive decline In Community- Dwelling Lebanese Older Adults

Abstract

Objective: Normal aging is often associated with cognitive deterioration in older adults, but the prevalence of cognitive decline like cognitive impairment, Alzheimer’s disease and dementia has been increasing lately. Pharmacological treatments have been previously critiqued, so researchers are focusing now on studying the nonpharmacological strategies against cognitive decline. Adopting a healthy lifestyle that constitute of following a healthy diet, consuming moderate alcohol amount, being physically active, maintaining a healthy BMI and never smoking is an important protective factor against cognitive decline. Since Lebanon ranks the highest percentage of dementia among the Arab countries and studies assessing this effect are still scarce, the aim of this study was to establish the association between a healthy lifestyle and cognitive decline. Methods: This is a secondary cross-sectional data analysis conducted on 502 community dwelling Lebanese older adults aged ≥ 65 years old and their informants recruited from two main governorates in Lebanon: Beirut and Mount Lebanon. Cognitive decline was assessed using three measurement tools: RUDAS, IQCODE and 10/66 DRG and the healthy lifestyle index (HLI) was based on 5 components: diet, BMI, alcohol, physical activity and smoking with a score ranging from 0 to 20. Three categories were created based on statistical quartiles and lowest (Q1), intermediate (Q2-Q3) and highest adherence to HLI were compared. Logistic regressions were performed to assess the relationship between HLI and prevalence of cognitive decline while adjusting for: age, gender, marital status, education, number of chronic diseases, medications, depression, and social activity. Results: The final sample size included 432 participants with an average age of 72.4 years and constituted of 56.7% females. One third were cognitively declined and they were more likely to be females (p=0.002), older in age (p=0.002), had lower levels of education (p=0.008), took more medications (p=0.027), were less socially active (p=0.02) and in general they followed a less healthy lifestyle. Participants in the highest HLI category had a significantly lower prevalence of cognitive decline as demonstrated by RUDAS (p<0.0001) and IQCODE (p<0.0001), but not by 10/66DRG (p=0.069). Lastly, participants with the highest adherence to HLI had a 77% lower prevalence of cognitive decline when assessed by RUDAS (OR: 0.23, 95%CI: 0.12-0.45, p<0.0001), but this association was not significant when assessed by IQCODE and 10/66 DRG. Conclusion: The results showed that a healthy lifestyle might contribute to a lower prevalence of cognitive decline in older adults. Longitudinal prospective studies should be performed to assess the effect of adherence to a healthy lifestyle on cognition at early and late-life stages.