BackgroundThe association between lifestyle factors and Alzheimer's disease (AD) pathophysiology remains incompletely understood.ObjectiveThe aim of this study was to assess the association of alcohol consumption, smoking behavior, sleep quality and physical, cognitive, and social activity with cerebral amyloid pathology.MethodsFor this cross-sectional study, we selected participants from the Amyloid Biomarker Study data pooling initiative. We used generalized estimating equations to assess associations of dichotomized lifestyle measures with amyloid pathology.ResultsWe included 9171 participants with normal cognition (NC) and 2555 participants with mild cognitive impairment (MCI) from the Amyloid Biomarker Study. Of participants with NC, 58% were women, 34% were APOE ε4 carrier, and 27% had amyloid pathology. Of participants with MCI, 48% were women, 47% were APOE ε4 carrier, and 57% had amyloid pathology. In NC, cognitively active participants were less likely to have amyloid pathology (OR = 0.77, 95%CI 0.66-0.89, p < 0.001). In MCI, participants who had ever smoked or had sleep problems were less likely to have amyloid pathology (OR = 0.85, 95%CI 0.73-0.99, p = 0.029; OR = 0.62, 95%CI 0.45-0.86, p = 0.004).ConclusionsIn NC, cognitive activity was associated with a lower frequency of amyloid pathology. In MCI, favorable lifestyle behaviors were not associated with a lower frequency of amyloid pathology. The results of the current study contribute to the broader evidence base on lifestyle and AD by further characterizing the role of lifestyle behaviors in AD pathology across different clinical stages.

1st Department of Neurology Aiginition Hospital National and Kapodistrian University of Athens Medical School Athens Greece

Ace Alzheimer Center Barcelona Universitat Internacional de Catalunya Barcelona Spain

Aix Marseille Univ INSERM INS Inst Neurosci Syst Jardin du Pharo Marseille France

Alzheimer Center Limburg Department of Psychiatry and Neuropsychology Mental Health and Neuroscience Research Institute Maastricht University Maastricht the Netherlands

Alzheimer's Centre Reina Sofia CIEN Foundation ISCIII Madrid Spain

Alzheimer's Disease and Other Cognitive Disorders Unit Neurology Service Hospital Clínic of Barcelona IDIBAPS Barcelona Spain

APHM Timone Service de Neurologie et Neuropsychologie Hôpital Timone Adultes Marseille France

Applied Biology Council of Scientific and Industrial Research Indian Institute of Chemical Technology Hyderabad Telangana State India

Banner Alzheimer's Institute Phoenix AZ USA

Center for Alzheimer Research and Treatment Department of Neurology Brigham and Women's Hospital Harvard Medical School Boston MA USA

Center for Neuroscience and Cell Biology CIBB University of Coimbra Coimbra Portugal

Center for Research and Advanced Therapies CITA Alzheimer Foundation Donostia San Sebastian Spain

Center for Vital Longevity School of Behavioral and Brain Sciences The University of Texas at Dallas Richardson TX USA

Center of Neurology Department of Neurodegeneration and Hertie Institute for Clinical Brain Research University of Tübingen Tübingen Germany

Centro Disturbi della Memoria Laboratorio di Neurochimica Clinica Clinica Neurologica Università di Perugia Perugia Italy

Charité Universitätsmedizin Berlin CBF Berlin Germany

CIBERNED Network Center for Biomedical Research in Neurodegenerative Diseases National Institute of Health Carlos 3 Madrid Spain

Clinical Neurochemistry Laboratory Sahlgrenska University Hospital Mölndal Sweden

Cognitive disorder research unit Department of Clinical Sciences Lund University Malmö Sweden

Cognitive Neuroscience Division Department of Neurology and the Taub Institute Columbia New York City NY USA

Danish Dementia Research Center Department of Neurology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark

Department of Biochemical Diagnostics University Hospital of Białystok Białystok Poland

Department of Biochemistry Kakatiya Medical College Mahatma Gandhi Memorial Hospital Warangal Telangana State India

Department of Biochemistry Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy

Department of Biomedical Sciences University of Antwerp Antwerp Belgium

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Department of Cognitive Neurology Instituto Neurológico Fleni Buenos Aires Argentina

Department of Epidemiology Biogen Cambridge MA USA

Department of Geriatric Psychiatry Central Institute of Mental Health Medical Faculty Mannheim University of Heidelberg Mannheim Germany

Department of Geriatric Psychiatry University Hospital of Psychiatry Zürich and University of Zürich Zürich Switzerland

Department of Geriatrics Turku University Hospital Wellbeing services county of Southwestern Finland Turku Finland

Department of Health Sciences University of Genoa Genoa Italy

Department of Internal Medicine and Gerontology Faculty of Medicine Jagiellonian University Medical College Krakow Poland

Department of Neurobiology Care Sciences and Society Division of Clinical Geriatrics Karolinska Institutet Center for Alzheimer Research Stockholm Sweden

Department of Neurobiology Care Sciences and Society Karolinska Institutet Stockholm Sweden

Department of Neurodegeneration Diagnostics Medical University of Białystok Białystok Poland

Department of Neurodegenerative Disease University College London Queen Square Institute of Neurology London UK

Department of Neurodegenerative Diseases and Geriatric Psychiatry University of Bonn Bonn Germany

Department of Neurology 2nd Faculty of Medicine Charles University and Motol University Hospital Prague Czech Republic

Department of Neurology Akershus University Hospital Lorenskog Norway

Department of Neurology Alzheimer Centre Amsterdam Amsterdam Neuroscience Amsterdam UMC location VUmc Vrije Universiteit Amsterdam Amsterdam the Netherlands

Department of Neurology and the Alzheimer's Disease Research Center Washington University School of Medicine St Louis MO USA

Department of Neurology Columbia University New York City NY USA

Department of Neurology Institute of Clinical Medicine University of Eastern Finland Kuopio Finland

Department of Neurology LMU University Hospital LMU Munich Munich Germany

Department of Neurology Mayo Clinic in Florida Jacksonville FL USA

Department of Neurology Nehru Hospital Postgraduate Institute of Medical Education and Research Chandigarh India

Department of Neurology OLV Hospital Aalst Belgium

Department of Neurology Osaka Metropolitan University Graduate School of Medicine Osaka Japan

Department of Neurology Taub Institute for Research on Alzheimer's Disease and the Aging Brain Columbia University Irving Medical Center New York NY USA

Department of Neurology University Hospital of North Norway Tromsø Norway

Department of Nuclear Medicine Klinikum Bayreuth Bayreuth Germany

Department of Nuclear Medicine Klinikum rechts der Isar Technical University of Munich Munich Germany

Department of Nuclear Medicine Marqués de Valdecilla University Hospital and IDIVAL Santander Spain

Department of Nuclear Medicine Medical Center University of Freiburg Faculty of Medicine University of Freiburg Freiburg Germany

Department of Nuclear Medicine University Hospital of Cologne Cologne Germany

Department of Nutrition and Diatetics Harokopio University Kallithea Athens Greece

Department of Old Age Psychiatry Psychology and Neuroscience King's College London UK

Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Mölndal Sweden

Department of Psychiatry and Psychotherapy Klinikum rechts der Isar Technical University of Munich School of Medicine and Health Munich Germany

Department of Psychiatry and Psychotherapy Medical Center Faculty of Medicine University of Freiburg Freiburg Germany

Department of Psychiatry and Psychotherapy University Hospital Friedrich Alexander University Erlangen Nuremberg Erlangen Germany

Department of Psychiatry and Psychotherapy University Medical Center Georg August University Göttingen Germany

Department of Psychiatry and Psychotherapy University Medical Center Göttingen Göttingen Germany

Department of Psychiatry Cognition and Old Age Psychiatry Sahlgrenska University Hospital Västra Götalandsregion Sweden

Department of Psychiatry Faculty of Medicine McGill University Montreal Quebec Canada

Department of Psychiatry Seoul National University College of Medicine Seoul Republic of Korea

Department of Psychology The Arctic University of Norway Tromsø Norway

Department of Radiation Oncology Emory University Atlanta GA USA

Department of Radiology University Medical Center Leiden is the institution Leiden the Netherlands

DINOGMI University of Genoa Genoa Italy

Douglas Mental Health University Institute Montreal Quebec Canada

Epidemiology and Data Science Vrije Universiteit Amsterdam Amsterdam UMC location VUmc Amsterdam the Netherlands

Excellence Center for Memory Diseases Brain Health and Longevity Medicine Ana Aslan International Foundation Bucharest Romania

Faculty of Medicine and Pharmacy Vrije Universiteit Brussel Brussels Belgium

Faculty of Medicine University of Coimbra Coimbra Portugal

Faculty of Medicine University of Lisbon Lisboa Portugal

Geriatrics Gerontology Old Age Psychiatry Geroscience Gerontechnology Carol Davila University of Medicine and Pharmacy Bucharest Romania

German Center for Neurodegenerative Diseases site Munich Munich Germany

Graduate School of Medicine and Faculty of Medicine The University of Tokyo Tokyo Japan

Harvard Aging Brain Study Department of Neurology Harvard Medical School Boston MA USA

Helen Wills Neuroscience Institute University of California Berkeley CA USA

Hong Kong Center for Neurodegenerative Diseases Hongkong China

Institute of Human Behavioral Medicine Medical Research Center Seoul National University Seoul Republic of Korea

Istituto delle Scienze Neurologiche di Bologna IRCCS Padiglione G Bologna Italy

McConnell Brain Imaging Centre Montreal Neurological Institute Montreal Quebec Canada

Memory Clinic University Hospitals and University of Geneva Geneva Switzerland

Memory Unit Neurology Department Hospital de la Santa Creu i Sant Pau Barcelona Spain

Munich Cluster for Systems Neurology Munich Germany

NEUR Research Group Center for Neurosciences Vrije Universiteit Brussel Brussels Belgium

Neurocenter Department of Neurology Kuopio University Hospital Kuopia Finland

Neurochemistry Lab Department of Laboratory Medicine Amsterdam Neuroscience Amsterdam UMC location VUmc Vrije Universiteit Amsterdam Amsterdam the Netherlands

Neurology Department and Laboratory of Neurochemistry Centro Hospitalar e Universitário de Coimbra Coimbra Portugal

Neurology Department Hospital Universitario Marqués de Valdecilla and IDIVAL University of Cantabria Santander CIBERNED Madrid Santander Spain

Neurology Unit Department of Clinical and Experimental Sciences University of Brescia Brescia Italy

Neuropsychiatric Epidemiology Unit Department of Psychiatry and Neurochemistry Institute of Neuroscience and Physiology Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden

Nuclear Medicine Department Aix Marseille University AP HM CNRS Centrale Marseille Institut Fresnel Timone Hospital Centre Européen de Recherche en Imagerie Médicale Marseille France

Old Age Psychiatry Department of Psychiatry University Hospital of Lausanne and University of Lausanne Lausanne Switzerland

Ospedale Policlinico San Martino IRCCS Genoa Italy

School of Medical Sciences Örebro University Örebro Sweden

Turku PET Centre University of Turku Turku Finland

UK Dementia Research Institute London UK

Wisconsin Alzheimer's Disease Research Center University of Wisconsin School of Medicine and Public Health University of Wisconsin Madison Madison WI USA

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