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.