Lifestyle Behavior Pattern Is Associated with Different levels of Risk for Incident Dementia and Alzheimer's Disease: The Cache County Study


lifestyle, health-related behaviors, dementia


OBJECTIVES: To identify distinct behavioral patterns of diet, exercise, social interaction, church attendance, alcohol consumption, and smoking and to examine their association with subsequent dementia risk.

DESIGN: Longitudinal, population‐based dementia study.

SETTING: Rural county in northern Utah, at‐home evaluations.

PARTICIPANTS: Two thousand four hundred ninety‐one participants without dementia (51% male, average age 73.0 ± 5,7; average education 13.7 ± 4.1 years) initially reported no problems in activities of daily living and no stroke or head injury within the past 5 years.

MEASUREMENTS: Six dichotomized lifestyle behaviors were examined (diet: high ≥ median on the Dietary Approaches to Stop Hypertension scale; exercise: ≥5 h/wk of light activity and at least occasional moderate to vigorous activity; church attendance: attending church services at least weekly; social Interaction: spending time with family and friends at least twice weekly; alcohol: currently drinking alcoholic beverages ≥ 2 times/wk; nonsmoker: no current use or fewer than 100 cigarettes ever). Latent class analysis (LCA) was used to identify patterns among these behaviors. Proportional hazards regression modeled time to dementia onset as a function of behavioral class, age, sex, education, and apolipoprotein E status. Follow‐up averaged 6.3 ± 5.3 years, during which 278 cases of incident dementia (200 Alzheimer's disease (AD)) were diagnosed.

RESULTS: LCA identified four distinct lifestyle classes. Unhealthy–religious (UH‐R; 11.5%), unhealthy–nonreligious (UH‐NR; 10.5%), healthy–moderately religious (H‐MR; 38.5%), and healthy–very religious (H‐VR; 39.5%). UH‐NR (hazard ratio (HR) = 0.54, P = .028), H‐MR (HR = 0.56, P = .003), and H‐VR (HR = 0.58, P = .005) had significantly lower dementia risk than UH‐R. Results were comparable for AD, except that UH‐NR was less definitive.

CONCLUSION: Functionally independent older adults appear to cluster into subpopulations with distinct patterns of lifestyle behaviors with different levels of risk for subsequent dementia and AD.

Original Publication Citation

Norton, M. C., Dew, J. P., Smith, H*., Fauth, E., Piercy, K. W., Breitner, J. C. S., Tschanz, J., Wengreen, H., Welsh-Bohmer, K. (2012). Lifestyle behavior patternis associatedwith different levels of risk for incident dementia and Alzheimer’s Disease: The Cache County Study. Journal of the American Geriatrics Society, 60, 405–412.

Document Type

Peer-Reviewed Article

Publication Date



Journal of the American Geriatrics Society




Family, Home, and Social Sciences


Family Life

University Standing at Time of Publication

Associate Professor