Determinants of cognitive decline in older European men

In our ageing population, the number of persons with cognitive impairment, dementia and Alzheimer's disease still increase and cause many problems for the elderly themselves, their relatives and caregivers and for health care. Therefore, the need for preventive action is high. In this thesis we identified social, lifestyle and dietary risk factors for the postponement of cognitive impairment and decline in elderly European men.For the results presented in this thesis, data from theFinland,Italyand the Netherlands Elderly (FINE) Study were used. This prospective population-based cohort study was carried out between 1985 and 2000 among 2,285 Finnish, Italian and Dutch men bornbetween 1900 - 1920. Cognitive functioning was measured with the Mini-Mental State Examination (MMSE).In the FINE Study, cognitive functioning decreased on average with 1.5 points during the 10-year follow-up period. This decline was due to an age effect, but also to a period and birth cohort effect.Men who were married or who lived with others during five years had at least a two times smaller subsequent 10-year cognitive decline compared with men who lost a partner, who were unmarried, who started to live alone and who lived alone during these five years.Cognitive decline did not differ among men with a high or low duration of physical activity at baseline. However, men who participated in activities with at leasta medium-low intensity had a 1.8 to 3.5 times smaller cognitive decline compared with men who participated in activities with lowest intensity. Moreover, a decrease in duration or intensity of physical activity resulted respectively in a 2.6 or 3.6 times stronger cognitive decline than maintaining duration or intensity.Men who consumed coffee had a two times smaller 10-year cognitive decline than non-consumers. In addition, an inverse and J-shaped association between the number of cups of coffee per day consumed and 10-year cognitive decline was present, with the least decline for men consuming three cups of coffee per day.Fish consumers had significantly less 5-year subsequent cognitive decline than non-consumers. A linear trend was observed for the relation between the intake of the n-3 fatty acids EPA + DHA and cognitive decline. An average difference of about 380 mg/day in EPA + DHA intake was associated with a 1.1 points difference in cognitive decline.Men whose cognition decreased between 1990 and 1995 had a twofold higher risk of dying in the following five years compared with men whose cognition was stable. Mortality risk of men whose cognition improved between 1995 and 2000 was not different from men with a stable cognition. The associations between marital status, living situation and physical activity are strong and provide in combination with the existing literature enough evidence for justifying public health recommendations for postponing cognitive decline. However, our findings on coffee and fish consumption and on the intake of the fatty acids EPA + DHA in relation with cognitive functioning need confirmation in other studies.