Behavioral Components of Life's Essential 8 Are More Strongly Associated with Cognitive Function than Clinical...

Cardiovascular health is increasingly recognized as a key determinant of cognitive aging. The American Heart Association recently introduced Life's Essential 8 (LE8), integrating both behavioral and clinical components of cardiovascular health. However, the relative contributions of behavioral versus clinical factors to cognitive outcomes remain unclear, particularly in Chinese older adults.

This study included 2,527 participants aged ≥ 65 years from the Ma'anshan Healthy Aging Cohort. Weighted linear and logistic regression models were used to examine the associations of LE8 scores with cognitive function and mild cognitive impairment (MCI). Restricted cubic spline (RCS) models were applied to assess dose-response relationships. Subgroup and sensitivity analyses were conducted.

Higher LE8 scores were significantly associated with better cognitive function and lower risk of MCI. Each 10-point increase in LE8 score was associated with a 0.532-point higher MMSE score (95% CI: 0.353-0.712, P < 0.001) and a 16.5% lower risk of MCI (OR = 0.835, 95% CI: 0.742-0.945, P = 0.004). Notably, behavioral components-including diet, sleep, and physical activity-demonstrated more robust and pronounced associations with cognitive outcomes than clinical factors such as blood glucose and lipids. Dose-response analyses indicated significant linear relationships. Subgroup analyses suggested possible heterogeneity by sex and depressive status; findings were robust across sensitivity analyses.

Behavioral aspects of cardiovascular health appear to play a dominant role in cognitive function among older adults. These findings highlight the importance of modifiable health behaviors as potential targets for preventing cognitive decline and support behavior-focused strategies in healthy aging.