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BMJ Open. 2018 Nov 25;8(11):e023664. doi: 10.1136/bmjopen-2018-023664.

Associations of lifestyle and vascular risk factors with Alzheimer's brain biomarker changes during middle age: a 3-year longitudinal study in the broader New York City area.

Author information

Department of Neurology, Weill Cornell Medical College, New York, USA.
Department of Psychology, Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, USA.
Department of Psychiatry, New York University School of Medicine, New York, USA.
The Graduate Center, City University of New York, New York, USA.
Hunter-Bellevue School of Nursing, Hunter College, New York, USA.
ADM Diagnostics, Northbrook, Illinois, USA.
Department of Radiology, Weill Cornell Medical College, New York, USA.
Department of Nutrition and Food Studies, New York University Steinhardt School of Culture, Education, and Human Development, New York, USA.



To investigate the associations between lifestyle and vascular risk factors and changes in Alzheimer's disease (AD) biomarkers (beta-amyloid load via 11C-PiB PET, glucose metabolism via 18F-FDG PET and neurodegeneration via structural MRI) and global cognition in middle-aged asymptomatic participants at risk for AD.


Prospective, longitudinal.


The study was conducted at New York University Langone/Weill Cornell Medical Centres in New York City.


Seventy cognitively normal participants from multiple community sources, aged 30-60 years with lifestyle measures (diet, intellectual activity and physical activity), vascular risk measures and two imaging biomarkers visits over at least 2 years, were included in the study.


We examined MRI-based cortical thickness, fluoro-deoxy-glucose (FDG) glucose metabolism and PiB beta-amyloid in AD-vulnerable regions. A global cognitive z-score served as our summary cognition measure. We used regression change models to investigate the associations of clinical, lifestyle and vascular risk measures with changes in AD biomarkers and global cognition.


Diet influenced changes in glucose metabolism, but not amyloid or cortical thickness changes. With and without accounting for demographic measures, vascular risk and baseline FDG measures, lower adherence to a Mediterranean-style diet was associated with faster rates of FDG decline in the posterior cingulate cortex (p≤0.05) and marginally in the frontal cortex (p=0.07). None of the other lifestyle variables or vascular measures showed associations with AD biomarker changes. Higher baseline plasma homocysteine was associated with faster rates of decline in global cognition, with and without accounting for lifestyle and biomarker measures (p=0.048). None of the lifestyle variables were associated with cognition.


Diet influenced brain glucose metabolism in middle-aged participants, while plasma homocysteine explained variability in cognitive performance. These findings suggest that these modifiable risk factors affect AD risk through different pathways and support further investigation of risk reduction strategies in midlife.


alzheimer’s disease; brain imaging; dementia; lifestyle; magnetic resonance imaging

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