Association of mid-age Life's Essential 8 score with digital cognitive performance and incident Alzheimer's disease: The Framingham Heart Study.

Background: Cardiovascular health (CVH) is a modifiable risk factor for Alzheimer's disease (AD). However, studies examining the association between mid-age CVH, as indicated by Life's Essential 8 (LE8) health metrics, and digital cognitive performance or AD risk are limited.

Objective: To examine the associations between mid-age CVH, assessed by LE8 scores during ages 45 to 65, and digital Clock Drawing Test (dCDT) performance as well as the incidence of AD.

Methods: We included 1198 participants (51.6% women) from the Framingham Heart Study (FHS) Offspring cohort. Linear regression and Cox proportional hazards models were applied to examine the associations between mid-age CVH and dCDT performance, as well as the incidence of AD.

Results: Over a median follow-up of 17.5 years, 45 participants developed AD. Each standard deviation (SD) higher mid-age LE8 total score was associated with a 0.16 SD higher level of the dCDT total score (p < 0.001) and a 0.35-fold lower risk of incident AD (HR = 0.65, 95% CI: 0.49-0.87, p = 0.003). The dCDT measures showed stronger associations with mid-age LE8 and AD risk compared to the conventional CDT (cCDT). For example, the drawing score on copy tasks was more strongly associated with LE8 (beta = 0.10, p = 0.007 versus beta = 0.08, p = 0.27) and had higher discrimination for incident AD (C-statistic = 0.89 versus 0.83) compared to the cCDT.

Conclusions: Our results highlight the potential of digital cognitive assessments for evaluating AD risk and emphasize the importance of mid-age CVH in shaping cognitive outcomes and the development of AD.