Association of mid-age Life′s Essential 8 score with digital cognitive performance and incident Alzheimer′s disease: the Framingham Heart Study

Background Emerging studies indicate that cardiovascular health (CVH) is a modifiable risk factor for AD. However, studies on how mid-life Life’s Essential 8 (LE8) scores affect the AD risk and digital cognitive performance are limited. Objective To examine the associations between CVH in middle age, as defined by LE8 scores, and subsequent digital cognitive performance and incident AD. Methods Linear regression and Cox proportional-hazard models were used to examine the associations of mid-age CVH with dCDT performance and incident AD, respectively. Prediction performance of mid-age LE8 scores for incident AD were assessed using ROC curve analysis. Results Every one-SD increase in mid-age LE8 total score was associated with a 0.16-SD increase in dCDT total score (p < 0.001). Ideal CVH in middle age was associated with higher dCDT scores compared to intermediate CVH. Furthermore, higher mid-age LE8 scores were associated to a decreased risk of AD, with ideal CVH significantly lowering AD risk compared to intermediate CVH. The combination of dCDT performance, mid-age LE8 scores, APOE ε4 status, and other covariates provided the best prediction performance for incident AD, with an AUC of 0.84. Notably, mid-life LE8 scores improved its predictive accuracy by 5.7%. Conclusion Our findings emphasize the critical role of CVH in middle age as a predictor of both digital cognitive performance and the risk of developing AD, highlighting the importance of early intervention on CVH to delay the progression of cognitive decline.