Bidirectional Association Between Lifestyle and Cognitive Function in Aging Adults

Abstract

Lifestyle research on cognitive health has been largely unidirectional and cross-sectional, with limited attention to multidimensional and bidirectional relationships; this study examines longitudinal associations in middle- and older adults. Data from the Korean Longitudinal Study of Aging (2006–2020) included physiological and psychosocial lifestyle factors and cognition assessed by the Korean version of the Mini-Mental State Examination (K-MMSE). Analyses used Mplus 8.9 with cross-lagged panel model (CLPM) and random intercept CLPM (RI-CLPM), adjusting for sex, age, smoking, drinking, and disability. CLPM showed significant lagged effects of lifestyle on cognition across waves (β = .010 to .013, p < .01), with intermittent reverse effects (β = .013 to .015, p < .05). The RI-CLPM confirmed a stable effect of lifestyle on cognition (β = .013 to .017, p < .05), whereas effects from cognition to lifestyle were mixed and nonsignificant (β = −.054 to .034, p > .05). A multidimensional lifestyle was associated with cognitive maintenance, whereas cognitive decline shows variable influences on lifestyle.

Plain Language Summary

The Role of Lifestyle in Cognitive Function Among Older Adults Over Time

As people age, changes in memory and thinking become more common. Understanding what helps maintain brain health is important for supporting independence and quality of life. Many previous studies have focused on single lifestyle factors—such as exercise or diet—and often looked at them at only one point in time. This study examined how a combination of everyday habits relates to thinking ability over a long period. We used data from over 5,101 middle-aged and older adults in Korea who were followed for 14 years. We looked at several aspects of lifestyle, including physical activity, eating habits, social relationships, and participation in work or community activities. We then examined how these factors were related to changes in cognitive function over time. The findings showed that people with healthier and more active lifestyles tended to maintain better cognitive function over time. In contrast, declines in cognitive function did not consistently lead to changes in lifestyle. This suggests that daily habits may play a more important role in supporting brain health than changes in cognition do in shaping lifestyle. Overall, the results highlight the importance of maintaining a balanced and active lifestyle that includes both physical and social activities. Encouraging older adults to stay physically active, socially connected, and engaged in meaningful daily activities may help support their cognitive health. These findings are especially relevant for health care professionals, including occupational therapists, who work to promote healthy aging and independence in later life.

Keywords

older adults lifestyle cognitive function longitudinal study cross-lagged panel model random intercept cross-lagged panel model

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