10 Year Study in China Found Memory Decline Slowed by Healthy Lifestyle


In a population-based cohort study in China, researchers found that a healthy lifestyle contributed to slower declines in memory for older adults.

Jianping Jia, MD, PhD

Jianping Jia, MD, PhD

Older adults with a healthy lifestyle—even with the presence of the APOE ε4 allele—showed slower declines in memory than those without a healthy lifestyle, according to new findings.1

The research was authored by Jianping Jia, MD, PhD, from the Innovation Center for Neurological Disorders and Department of Neurology at Xuanwu Hospital, Capital Medical Center in China.

The study was designed to assess lifestyle factors in the role of memory decline in elderly adults using the World Health Organization/University of California-Los Angeles (UCLA) Auditory Verbal Learning Test and the Mini-Mental State Examination.

“We used data from a large population based cohort (the China Cognition and Ageing Study; COAST) to investigate whether adherence to a combination of healthy lifestyle factors was associated with a slower memory decline in cognitively normal older adults, even those genetically susceptible to memory decline,” Jia and colleagues wrote.


The investigators tested participants who were age 60-or-older who were found to have normal cognition and were given apolipoprotein E (APOE) genotyping at baseline in 2009.

The investigators used a set of 6 healthy lifestyle elements to determine participants’ health, following up with them until death, until their discontinuation, or until December of 2019. The 6 elements including the following:

  • A healthy diet (adherence to at least 7 of 12 eligible food items)
  • Regularly had ≥150 minutes of moderate-intensity exercise or ≥75 min of vigorous intensity exercise, weekly
  • Active social life (≥ twice weekly),
  • Active cognitive activity (≥ twice weekly),
  • Never smoked (or did not anymore)
  • Never drinking alcohol

The investigators categorized the study participants into their ‘favorable’ group if they had at least 4 healthy lifestyle elements. If they had 2 to 3 of these elements, they were in the ‘average’ group, and those with 0 to 1 were in the ‘unfavorable’ group.

The team recruited 29,072 participants, with a mean age of 72.23 years. Of those 29,072,  around 49% (n=14,113) were female and 20.43% (n=5939) were APOE ε4 carriers.

The team determined participants’ memory functioning through the World Health Organization/UCLA Auditory Verbal Learning Test. They determined global cognition through the use of the Mini-Mental State Examination.


The study’s results indicated that a healthy lifestyle was associated with slower declines in cognitive function, with those in the favorable group reporting slower memory declines than the members of the unfavorable group (declines by 0.028 points/year, 95% confidence interval [CI] 0.023 to 0.032, P<0.001).

The investigators reported that APOE ε4 carriers in the favorable group (0.027, 95% CI, 0.023 - 0.031) and the average group (0.014, 0.010 - 0.019) lifestyles were also found to have decreased rates of memory decline than participants in the unfavorable group.

Similar data was reported for those who were not APOE ε4 carriers and observed among participants in the favorable and average lifestyles.

The team added that participants’ APOE ε4 status and lifestyle profiles did not demonstrate substantial interaction effects on the subjects’ memories  (P=0.52).

“The results of this study provide strong evidence that adherence to a healthy lifestyle with a combination of positive behaviours, such as never or former smoking, never drinking, a healthy diet, regular physical exercise, and active cognitive activity and social contact, is associated with a slower rate of memory decline,” they wrote. “Importantly, our study provides evidence that these effects also include individuals with the APOE ε4 allele.”


  1. Jia J, Zhao T, Liu Z, Liang Y, Li F, Li Y et al. Association between healthy lifestyle and memory decline in older adults: 10 year, population based, prospective cohort study BMJ 2023; 380 :e072691 doi:10.1136/bmj-2022-072691.
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