Lifestyles and Cognition


Lifestyles, cognitive decline, smoking, alcohol, physical activity, diet, obesity, Alzheimer’s disease, MCI


How to Cite

Agarwal S. Lifestyles and Cognition. Integr J Med Sci [Internet]. 2021 Aug. 9 [cited 2021 Sep. 28];8. Available from:


Cognitive decline is a growing medical concern. It includes age-related cognitive decline, mild cognitive impairment, and dementia. Dementia results in considerable dysfunction in life and is associated with an increase in mortality. Since there is no cure at this time, attention is being increasingly directed towards prevention. Lifestyle factors, such as smoking, alcoholism, physical inactivity, poor diet, improper sleep, and loneliness are repeatedly being recognized as modifiable factors that can reduce cognitive decline. This manuscript briefly reviews the lifestyle-cognition relationship.


Chaves AS, dos Santos AM, Soares de Britto E Alves MT , Filho NS. Association between cognitive decline and the quality of life of hypertensive elderly individuals. Rev Bras Geriatr Gerontol. 2015;18(3):545–56. doi: 10.1590/1809-9823.2015.14043.
Singh-Manoux, A., Kivimaki, M., Glymour, M. M., Elbaz, A., Berr, C., Ebmeier, K. P., et al. (2012). Timing of onset of cognitive decline: results from Whitehall II prospective cohort study. BMJ 344:d7622. doi: 10.1136/bmj.d7622.
Lin, P.-J.; Zhong, Y.; Fillit, H.M.; Chen, E.; Neumann, P.J. Medicare expenditures of Individuals with Alzheimer’s Disease and related dementias or mild cognitive impairment before and after diagnosis. J. Am. Geriatr. Soc. 2016, 64, 1549–1557.
Roberts, R.O.; Knopman, D.S. Classification and Epidemiology of MCI. Clin. Geriatr. Med. 2013, 29, 753–772.
Petersen RC. Clinical practice. mild cognitive impairment. N Engl J Med 2011;364:2227. 10.1056/NEJMcp0910237.
Draper, B.; Cations, M.; White, F.; Trollor, J.; Loy, C.; Brodaty, H.; Sachdev, P.; Gonski, P.; Demirkol, A.; Cumming, R.G.; et al. Time to diagnosis in young-onset dementia and its determinants: The inspired study. Int. J. Geriatr. Psychiatry 2016, 31, 1217–1224.
Prince M, Ali G-C, Guerchet M, et al. Recent global trends in the prevalence and incidence of dementia, and survival with dementia. Alzheimers Res Ther2016;8:23. 10.1186/s13195-016-0188-8.
World Health Organisation. Global Action Plan on the Public Health Response to Dementia 2017–2020; World Health Organisation: Geneva, Switzerland, 2017.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Washington, DC, USA, 2013.
Galvin JE and Sadowsky CH. Practical guidelines for the recognition and diagnosis of dementia. J Am Board Family Med. 2012;25(3):367-382.
Landeiro F, Mughal S, Walsh K, et al. ROADMAP consortium. Health-related quality of life in people with predementia Alzheimer's disease, mild cognitive impairment or dementia measured with preference-based instruments: a systematic literature review. Alzheimers Res Ther. 2020 Nov 18;12(1):154. doi: 10.1186/s13195-020-00723-1. PMID: 33208190; PMCID: PMC7677851.
Dewey ME, Saz P. Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: A systematic review of the literature. Int J Geriatr Psychiatr. 2001;16:751–761.
Calabrese M, Poretto V, Favaretto A, et al. . Cortical lesion load associates with progression of disability in multiple sclerosis. Brain 2012;135:2952–2961.
Campbell, S.; Manthorpe, J.; Samsi, K.; Abley, C.; Robinson, L.; Watts, S.; Bond, J.; Keady, J. Living with uncertainty: Mapping the transition from pre-diagnosis to a diagnosis of dementia. J. Aging Stud. 2016, 37, 40–47.
Kivipelto, M., Mangialasche, F., and Ngandu, T. (2018). Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat. Rev. Neurol. 14, 653–666. doi: 10.1038/s41582-018-0070-3.
Gluckman TJ, Kovacs RJ, Stone NJ, Damalas D, Mullen JB, Oetgen WJ. The ASCVD risk estimator app: from concept to the current state. J. Am. Coll. Cardiol., 67 (2016), pp. 350-352, 10.1016/j.jacc.2015.10.068.
G. Shiels, S. Buchanan, C. Selman, P. Stenvinkel.Allostatic load and ageing: linking the microbiome and nutrition with age-related health. Biochem. Soc. Trans., 47 (2019), pp. 1165-1172, 10.1042/BST20190110Shiels et al., 2019.
Li Y, Schoufour J, Wang DD, et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020;368:l6669. Published 2020 Jan 8. doi:10.1136/bmj.l6669.
Loef M, Walach H. The combined effects of healthy lifestyle behaviors on all cause mortality: a systematic review and meta-analysis. Prev Med 2012;55:163-70. 10.1016/j.ypmed.2012.06.017.
Mokdad AH, Forouzanfar MH, Daoud F, et al. Global burden of diseases, injuries, and risk factors for young people’s health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2016;387:2383-401. 10.1016/S0140-6736(16)00648-6.
Yanping Li, An Pan, Dong D. Wang, et al. Impact of Healthy Lifestyle Factors on Life Expectancies in the US Population. Circulation. 2018;138:345–355.
O’Doherty MG, Cairns K, O’Neill V, et al. Effect of major lifestyle risk factors, independent and jointly, on life expectancy with and without cardiovascular disease: results from the Consortium on Health and Ageing Network of Cohorts in Europe and the United States (CHANCES). Eur J Epidemiol. 2016; 31:455–468. doi: 10.1007/s10654-015-0112-8. Accessed January 8, 2021.
Huang Zhezhou, Guo Yanfei, Ruan Ye, et al. Associations of Lifestyle Factors With Cognition in Community-Dwelling Adults Aged 50 and Older: A Longitudinal Cohort Study. Aging Neurosci., 09 November 2020. 
Newhouse P., Kellar K., Aisen P., White H., Wesnes K., Coderre E., Pfaff A., Wilkins H., Howard D., Levin E.D. Nicotine treatment of mild cognitive impairment: A 6-month double-blind pilot clinical trial. Neurology. 2012;78:91–101. doi: 10.1212/WNL.0b013e31823efcbb.
Millan M.J., Agid Y., Brüne M., et al. Cognitive dysfunction in psychiatric disorders: characteristics, causes and the quest for improved therapy. Nat. Rev. Drug Discov. 2012;11(2):141–168.  
de Leon J., Diaz F.J. A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors. Schizophr. Res. 2005;76(2-3):135–157. http://dx.
Besson M., Forget B. Cognitive dysfunction, affective states, and vulnerability to nicotine addiction: A multifactorial perspective. Front. Psychiatry. 2016;7:160. 2016.00160.
Newhouse P.A., Potter A., Singh A. Effects of nicotinic stimulation on cognitive performance. Curr. Opin. Pharmacol. 2004;4:36–46. doi: 10.1016/j.coph.2003.11.001.
Hill R.D., Nilsson L.G., Nyberg L., Backman L. Cigarette smoking and cognitive performance in healthy Swedish adults. Age Ageing. 2003;32:548–550. doi: 10.1093/ageing/afg067.
Zhan Y, Fang F. Smoking and amyotrophic lateral sclerosis: a mendelian randomization study. Ann Neurol. 2019;85(4):482-484. doi:10.1002/ana.25443.
Durazzo TC, Mattsson N, Weiner MW; Alzheimer’s Disease Neuroimaging Initiative. Smoking and increased Alzheimer’s disease risk: a review of potential mechanisms. Alzheimers Dement. 2014;10(3)(suppl):S122-S145. doi:10.1016/j.jalz.2014.04.009.
Khan U., Porteous L., Hassan A., Markus H. S. (2007). Risk factor profile of cerebral small vessel disease and its subtypes. J. Neurol. Neurosurg. Psychiatry 78 702–706. 10.1136/jnnp.2006.103549.
Anstey K. J., von Sanden C., Salim A., O’Kearney R. (2007). Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am. J. Epidemiol. 166 367–378. 10.1093/aje/kwm116.
Tyas S. L., White L. R., Petrovitch H., Webster Ross G., Foley D. J., Heimovitz H. K., et al. (2003). Mid-life smoking and late-life dementia: the honolulu-asia aging study. Neurobiol. Aging 24 589–596. 10.1016/s0197-4580(02)00156-2.
Liu Y, Li H, Wang J, et al. Association of Cigarette Smoking With Cerebrospinal Fluid Biomarkers of Neurodegeneration, Neuroinflammation, and Oxidation. JAMA Netw Open. 2020 Oct 1;3(10):e2018777. doi: 10.1001/jamanetworkopen.2020.18777.
Karama S., Ducharme S., Corley J., Chouinard-Decorte F., Starr J. M., Wardlaw J. M., et al. (2015). Cigarette smoking and thinning of the brain’s cortex. Mol. Psychiatry 20 778–785. 10.1038/mp.2014.187.
He F, Li T, Lin J, Li F, Zhai Y, Zhang T, Gu X, Zhao G. Passive Smoking Exposure in Living Environments Reduces Cognitive Function: A Prospective Cohort Study in Older Adults. Int J Environ Res Public Health. 2020 Feb 21;17(4):1402. doi: 10.3390/ijerph17041402.
Velusami D, Venkatesh S, Soundariya K. Effect of smoking on neurocognitive function. June 2020. Int. J Basic Appl. Physiol.,5(1),2016.  
Mons U, Schöttker B, Müller H, Kliegel M, Brenner H. History of lifetime smoking, smoking cessation and cognitive function in the elderly population. Eur J Epidemiol. 2013 Oct;28(10):823-31. doi: 10.1007/s10654-013-9840-9.
United States Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (2012). National survey on drug use and health, 2012 [Data set]. National survey on drug use and health (NSDUH) series. ICPSR—Interuniversity Consortium for Political and Social Research. 10.3886/ICPSR34933.v3.
Wood AM, Kaptoge S, Butterworth AS, et al. ; Emerging Risk Factors Collaboration/EPIC-CVD/UK Biobank Alcohol Study Group . Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513-1523. doi:10.1016/S0140-6736(18)30134-X.
Xu W, Wang H, Wan Y, et al. Alcohol consumption and dementia risk: A dose-response meta-analysis of prospective studies. Eur J Epidemiol. 2017;32(1):31–42. doi: 10.1007/s10654-017-0225-3.
Cheng C, Huang CL, Tsai CJ, Chou PH, Lin CC, Chang CK. Alcohol-Related Dementia: A Systemic Review of Epidemiological Studies. Psychosomatics. 2017 Jul-Aug;58(4):331-342. doi: 10.1016/j.psym.2017.02.012. Epub 2017 Mar 1. PMID: 28501289.
Clark D.B., Thatcher D.L., Tapert S.F. Alcohol, psychological dysregulation, and adolescent brain development. Alcohol. Clin. Exp. Res. 2008;32:375–385. doi: 10.1111/j.1530-0277.2007.00601.x.
Oscar-Berman M., Marinkovic K. Alcohol: Effects on neurobehavioral functions and the brain. Neuropsychol. Rev. 2007;17:239–257. doi: 10.1007/s11065-007-9038-6.
Römer, P.; Mathes, B.; Reinelt, T.; Stoyanova, P.; Petermann, F.; Zierul, C. Systematic review showed that low and moderate prenatal alcohol and nicotine exposure affected early child development. Acta Paediatr. 2020, 109, 2491–2501.
Cai H, Li G, Hua S, Liu Y, Chen L. Effect of exercise on cognitive function in chronic disease patients: a meta-analysis and systematic review of randomized controlled trials. Clin Interv Aging. 2017;12:773-783. Published 2017 May 11. doi:10.2147/CIA.S135700.
Yu JT, Xu W, Tan CC, et al. Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials. J Neurol Neurosurg Psychiatry. 2020;91(11):1201-1209. doi:10.1136/jnnp-2019-321913.
Zhezhou Huang, Yanfei Guo, Ye Ruan, et al. Associations of Lifestyle Factors With Cognition in Community-Dwelling Adults Aged 50 and Older: A Longitudinal Cohort Study. Front. Aging Neurosci., 09 November 2020.
Sofi, F., Valecchi, D., Bacci, D., Abbate, R., Gensini, G. F., Casini, A., et al. (2011). Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. J. Intern. Med. 269, 107–117. doi: 10.1111/j.1365-2796.2010.02281.x.
Gehlich, K. H., Beller, J., Lange-Asschenfeldt, B., Köcher, W., Meinke, M. C., and Lademann, J. (2019). Fruit and vegetable consumption is associated with improved mental and cognitive health in older adults from non-Western developing countries. Public Health Nutr. 22, 689–696.
Fieldhouse JLP, Doorduijn AS, de Leeuw FA, et al. A Suboptimal Diet is Associated with Poorer Cognition: The NUDAD Project. Nutrients. 2020;12(3):703. Published 2020 Mar 6. doi:10.3390/nu12030703.
Morris, M. C., Evans, D. A., Tangney, C. C., Bienias, J. L., and Wilson, R. S. (2006). Associations of vegetable and fruit consumption with age-related cognitive change. Neurology 67, 1370–1376. doi: 10.1212/01.wnl.0000240224.38978.d8.
van den Brink A.C., Brouwer-Brolsma E.M., Berendsen A.A., van de Rest O. The Mediterranean, Dietary Approaches to Stop Hypertension (DASH), and Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) Diets Are Associated with Less Cognitive Decline and a Lower Risk of Alzheimer’s Disease—A Review. Adv. Nutr. 2019;10:1010–1065. doi: 10.1093/advances/nmz054.
Fieldhouse JLP, Doorduijn AS, de Leeuw FA, et al. A Suboptimal Diet is Associated with Poorer Cognition: The NUDAD Project. Nutrients. 2020;12(3):703. Published 2020 Mar 6. doi:10.3390/nu12030703.
Fotuhi, M., Mohassel, P., Yaffe, K. Fish consumption, long-chain omega-3 fatty acids and risk of cognitive decline or Alzheimer disease: A complex association. Nat. Rev. Neurol. 2009, 5, 140–152.
Gehlich, K. H., Beller, J., Lange-Asschenfeldt, B., Köcher, W., Meinke, M. C., and Lademann, J. (2019). Fruit and vegetable consumption is associated with improved mental and cognitive health in older adults from non-Western developing countries. Public Health Nutr. 22, 689–696. doi: 10.1017/S1368980018002525.
Pistollato, F., Sumalla Cano, S., Elio, I., Masias Vergara, M., Giampieri, F., and Battino, M. (2016). Role of gut microbiota and nutrients in amyloid formation and pathogenesis of Alzheimer disease. Nutr. Rev. 74, 624–634. doi: 10.1093/nutrit/nuw023.
van der Wurff ISM, Meyer BJ, de Groot RHM. Effect of Omega-3 Long Chain Polyunsaturated Fatty Acids (n-3 LCPUFA) Supplementation on Cognition in Children and Adolescents: A Systematic Literature Review with a Focus on n-3 LCPUFA Blood Values and Dose of DHA and EPA. Nutrients. 2020 Oct 12;12(10):3115. doi: 10.3390/nu12103115. PMID: 33053843; PMCID: PMC7599612.
Bischof, G. N., and Park, D. C. (2015). Obesity and aging: consequences for cognition, brain structure, and brain function. Psychosom. Med. 77, 697–709. doi: 10.1097/PSY.0000000000000212.
Monda, V., La Marra, M., Perrella, R., Caviglia, G., Iavarone, A., Chieffi, S., et al. (2017). Obesity and brain illness: from cognitive and psychological evidences to obesity paradox. Diabetes Metab. Syndr. Obes. 10, 473–479. doi: 10.2147/DMSO.S148392.
Gottschling S, Ayonrinde O, Bhaskar A, Blockman M, D'Agnone O, Schecter D, Suárez Rodríguez LD, Yafai S, Cyr C. Safety Considerations in Cannabinoid-Based Medicine. Int J Gen Med. 2020 Dec 1;13:1317-1333. doi: 10.2147/IJGM.S275049.
Bubu OM, Brannick M, Mortimer J, et al. Sleep, cognitive impairment, and Alzheimer’s disease: a systematic review and meta-analysis. Sleep. 2017;40(1):zsw032. doi:10.1093/sleep/zsw032.
Lara E, Caballero FF, Rico-Uribe LA, Olaya B, Haro JM, Ayuso-Mateos JL, Miret M. Are loneliness and social isolation associated with cognitive decline? Int J Geriatr Psychiatry. 2019 Nov;34(11):1613-1622. doi: 10.1002/gps.5174. Epub 2019 Jul 25. PMID: 31304639.
Baumeister R.F., DeWall C.N., Ciarocco N.J., Twenge .JM. (2005). Social exclusion impairs self-regulation. Journal of Personality and Social Psychology, 88(4), 589–604.
Jaremka LM, Andridge RR, Fagundes CP, Alfano CM, Povoski SP, Lipari AM, Agnese DM, Arnold MW, Farrar WB, Yee LD, Carson WE 3rd, Bekaii-Saab T, Martin EW Jr, Schmidt CR, Kiecolt-Glaser JK. Pain, depression, and fatigue: loneliness as a longitudinal risk factor. Health Psychol. 2014 Sep;33(9):948-57. doi: 10.1037/a0034012.
Cacioppo J.T., Ernst J.M., Burleson M.H., et al. (2000). Lonely traits and concomitant physiological processes: the MacArthur social neuroscience studies. Int J Psychophysiol, 35(2-3), 143-154. doi:10.1016/s0167-8760(99)00049-5.
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