Contribution of social and lifestyle factors to cognitive status and 5-year change among middle-aged and older Americans

Cognitive decline is a global health concern that leads to significant impairment in daily functioning and quality of life. Limited large-scale cohort studies have concurrently examined the effects of lifestyle and social factors on cognitive status and the potential gender and age cohort differences in middle-aged and older adults. This longitudinal study examined the temporal associations between lifestyle and social factors and cognitive status in middle-aged and older adults in the United States. The sample comprised 2192 individuals (mean age = 71.6 years, SD = 6.6) drawn from two waves of the National Social Life, Health, and Aging Project conducted in 2010–11 and 2015–16. Lifestyle factors (vigorous physical activity, cigarette smoking, alcohol drinking, and sleep quality) and social factors (number of close social ties, frequency of volunteering, participation in group meetings, informal socialization, and religious services) were measured in 2010–11. Cognitive status was assessed via the Chicago Cognitive Function Measure at both waves. Regression analysis examined the effects of lifestyle and social factors on cognitive status and its change across the two waves. Past smoking and current drinking showed significant and positive effects on cognitive status. Maintaining robust social connections and active attendance in formal and informal social activities were significant predictors of healthier changes in cognitive status for those with normal cognition or mild cognitive impairment. Subgroup analysis revealed gender and age cohort differences in the effects of lifestyle and social factors on cognitive status, with females showing stronger effects for lifestyle and social factors than males. The present findings underscored the predominant influence of social factors over lifestyle factors on cognitive status and provided a more nuanced understanding of the social and lifestyle determinants across gender and age groups. Further research should aim to explore the causal direction of these associations, considering specific cognitive domains and underlying mechanisms.