The influence of multiple lifestyle behaviors on cognitive function in older persons living in the community Yunhwan Lee a,b, ⁎, Jinhee Kim a,b , Joung Hwan Back a a Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Republic of Korea b Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea abstract article info Available online 5 November 2008 Keywords: Aged Cognition Health behavior Lifestyle Longitudinal studies Objective. This study aimed to examine the influence of multiple lifestyle behaviors on cognitive function in older persons living in an urban community. Method. A representative sample of 977 persons aged 65 and older in Suwon, Korea were interviewed in 2001, with follow-up interviews completed on 645 (2002) and 537 (2003). Lifestyle behaviors included physical activity, non-smoking, vegetable consumption, and social activity. Individual, as well as, the number and combination of health behavioral profiles were considered. Cognitive function was assessed by the Korean version of the Mini-Mental State Examination. Linear regression with generalized estimating equations was used in the analysis, controlling for sociodemographics and chronic conditions. Results. All lifestyle behaviors showed independent association with cognitive ability, even after adjusting for the covariates. An incremental benefit of multiple lifestyle behaviors was evident, with those engaging in more positive behaviors exhibiting a tendency to have a higher cognitive score. A two- or three-factor combination of non-smoking, vegetable consumption, and social activity showed the strongest association with cognitive function. Conclusion. Participation in healthy lifestyles may contribute to the maintenance of cognitive function in later life. It underlines the potential benefit of multiple behaviors in promoting cognitive health of older persons. © 2008 Elsevier Inc. All rights reserved. Introduction With the rapid rise in the number of older persons suffering from dementia and the associated care burden, there is an increasing interest in maintaining cognitive health in later life. The public health impact is obvious. A delay in the onset of dementia would lead to its reduced prevalence (Sloane et al., 2002). Even a modest postponement would amount to huge savings in health and long-term care costs (Brookmeyer et al., 1998). Considering cognitive impairment and dementia as a con- tinuum, it would be important to examine factors influencing change in cognitive function over time (Gallo, 1995). This would help to initiate effective preventive measures before a threshold of dementia has been crossed. Recently, there has been a growing emphasis on the iden- tification of risk factors and development of primary prevention strategies for promoting cognitive health (Centers for Disease Control and Prevention and Alzheimer's Association, 2007; Hendrie et al., 2006). There is accumulating evidence that health or lifestyle behaviors contribute to cognitive function (Fig. 1). Studies suggest that posi- tive health behaviors, such as higher levels of physical activity (Anstey and Christensen, 2000; Rockwood and Middleton, 2007), healthy diet, especially vegetable consumption (Kang et al., 2005; Morris et al., 2006), non-smoking (Anstey et al., 2007; Reitz et al., 2007), and moderate alcohol drinking (Lang et al., 2007) are associated with a decreased risk of cognitive decline, cognitive impairment, and dementia. Moreover, social activity, an increasingly recognized type of leisure activity, contributes to better cognitive function (Karp, 2006; Hsu, 2007; Scarmeas and Stern, 2003). Lifestyle factors are thought to act to decrease cardiovascular risks and increase cognitive reserves in producing the beneficial effect (detailed descriptions are given in the Discussion). Given that multiple lifestyle behaviors may affect cogni- tive ability in older adults, it is important to examine these potentially modifiable factors together. Moreover, different lifestyle factors may share common pathways in engendering protection against cognitive decline and dementia (Fratiglioni et al., 2004). Most studies, however, have focused on examining individual effects. Multiple effects of modifiable lifestyle behaviors are not well understood or quantified. Considering that health behaviors tend to cluster (Fine et al., 2004), it is important to examine the combined effects of multiple behavioral factors. Patterns of clustering of beha- vioral factors are, however, still unclear. Early evidence of significant interactions between lifestyle factors, such as exercise, diet, and social engagement, in predicting cognitive function using animal models has underscored the need for more research (Kramer and Erickson, Preventive Medicine 48 (2009) 86–90 ⁎ Corresponding author. Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Institute on Aging, Ajou University Medical Center, San 5, Wonchun-dong, Youngtong-gu, Suwon 443-721, Republic of Korea. Fax: +82 31 219 5084. E-mail address: yhlee@ajou.ac.kr (Y. Lee). 0091-7435/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.ypmed.2008.10.021 Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed