Living a healthy lifestyle as an older adult may provide cognitive protection even if an individual has neuropathologies of dementia, a new study found.

According to the authors of the study published Monday in JAMA Neurology, managing five lifestyle factors — diet, physical activity, cognitive engagement, smoking and alcohol consumption — may help a person keep their cognitive abilities strong even if they’re prone to dementia. 

“These interesting results add strength to the concept that health and lifestyle factors are important strategies for prevention and suggest that several mechanisms may be at work,” Yue Leng, PhD, and Kristine Yaffe, MD, both epidemiologists at University of California, San Francisco, wrote in an accompanying editorial. 

As part of the study, the researchers examined autopsy data from 586 deceased individuals. The team developed healthy lifestyle scores (from 0 to 5) with the higher score indicating a healthier lifestyle. The scores were based on self-reported factors such as getting at least 150 minutes of physical activity per week and having a Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet score over 7.5, along with a late-life cognitive activity score over 3.2. Of those studied, 70.8% were women and the average age at death was 90.9 years old. 

The team looked at brain pathology measures for β-amyloid load, phosphorylated tau tangles, global Alzheimer disease pathology, vascular brain pathologies, Lewy body, hippocampal sclerosis and TAR DNA-binding protein 43. These are tied to neurodegenerative disease.

People with higher lifestyle scores had better global cognitive functioning near the time they died. When the researchers brought in data on dementia-related brain pathologies, it did not significantly affect the strength or significance of the lifestyle association. Meaning, even if a person had some of the pathologies tied to neurodegenerative disease, it didn’t impair their cognitive function as much so long as they had higher lifestyle scores.

Data showed that 11.6% of the link between lifestyle score and cognition was through the pathway of β-amyloid load, and 88.4% was likely a direct association of lifestyle with cognition.

Authors of the accompanying editorial noted that it’s been more than a decade since researchers found that the risk for dementia could be attributed to seven possibly modifiable risk factors (Yaffe was involved in that study). Since then, studies have looked at the mechanisms of how these modifiable risk factors may affect cognitive aging and drive interventions — though questions remain. The authors said the current study is “one of the first to harness brain pathology to investigate these mechanisms and is a crucial step forward in addressing these important questions.”