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. Key Words: Life's Essential 8, Cardiovascular health, Digital cognitive performance, Alzheimer's disease