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Sleep, physical activity, sedentary behavior, and risk of incident dementia: a prospective cohort study of 431,924 UK Biobank participants

Abstract

Although sleep, physical activity and sedentary behavior have been found to be associated with dementia risk, findings are inconsistent and their joint relationship remains unclear. This study aimed to investigate independent and joint associations of these three modifiable behaviors with dementia risks. A total of 431,924 participants (median follow-up 9.0 years) without dementia from UK Biobank were included. Multiple Cox regressions were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). Models fitted with restricted cubic spline were conducted to test for linear and nonlinear shapes of each association. Sleep duration, leisure-time physical activity (LTPA), and screen-based sedentary behavior individually associated with dementia risks in different non-linear patterns. Sleep duration associated with dementia in a U-shape with a nadir at 7 h/day. LTPA revealed a curvilinear relationship with dementia in diminishing tendency, while sedentary behavior revealed a J-shaped relationship. The dementia risk was 17% lower in the high LTPA group (HR[95%CI]: 0.83[0.76–0.91]) and 22% higher in the high sedentary behavior group (1.22[1.10–1.35]) compared to the corresponding low-level group, respectively. A combination of seven-hour/day sleep, moderate-to-high LTPA, and low-to-moderate sedentary behavior showed the lowest dementia risk (0.59[0.50–0.69]) compared to the referent group (longer or shorter sleep/low LTPA/high sedentary behavior). Notably, each behavior was non-linearly associated with brain structures in a pattern similar to its association with dementia, suggesting they may affect dementia risk by affecting brain structures. Our findings highlight the potential to change these three daily behaviors individually and simultaneously to reduce the risk of dementia.

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Fig. 1: The independent associations between exposures and incident dementia using a restricted cubic spline regression model.
Fig. 2: The independent associations of sleep duration, physical activity, and sedentary behavior with incident dementia.
Fig. 3: The joint association of sleep duration, physical activity, and sedentary behavior with incident dementia.
Fig. 4: Associations between sleep duration, physical activity, sedentary behavior and brain structure.

Data availability

The data that support the findings of this study are available from UK Biobank project site, subject to registration and application process. Further details can be found at https://www.ukbiobank.ac.uk.

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Acknowledgements

The present analyses were conducted under UK Biobank application number 19542. The authors gratefully thank all the participants and professionals contributing to the UK Biobank. This study was supported by grants from the Science and Technology Innovation 2030 Major Projects (2022ZD0211600), National Key R&D Program of China (Program ID: 2021YFC2502200), the National Natural Science Foundation of China (82071201, 81971032), Shanghai Municipal Science and Technology Major Project (No.2018SHZDZX01), Research Start-up Fund of Huashan Hospital (2022QD002), Excellence 2025 Talent Cultivation Program at Fudan University (3030277001), and ZHANGJIANG LAB, Tianqiao and Chrissy Chen Institute, and the State Key Laboratory of Neurobiology and Frontiers Center for Brain Science of Ministry of Education, Fudan University. W.C. was supported by grants from the National Natural Sciences Foundation of China (no. 82071997) and the Shanghai Rising-Star Program (no. 21QA1408700). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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JTY and WC had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. JFF and WC were responsible for the cohort data. SYH performed the statistical analysis between sleep, physical activity, sedentary behaviors and incident dementia. YZL and WZ conducted the brain imaging analysis. SYH, YZL, and YRZ wrote the first draft of the report and YYH, BSW, YTD, SDC, XYH, SFC, QD, CZ, RJC, JS, ETR, JFF, WC, and JTY helped in revising the text. QD, JFF, WC, and JTY provide administrative, technical and material support. All authors read and approved the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

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Correspondence to Wei Cheng or Jin-Tai Yu.

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All participants gave written informed consent prior data collection. The UK Biobank has ethical approval by the National Research Ethics Service (Ref 11/NW/0382).

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Huang, SY., Li, YZ., Zhang, YR. et al. Sleep, physical activity, sedentary behavior, and risk of incident dementia: a prospective cohort study of 431,924 UK Biobank participants. Mol Psychiatry 27, 4343–4354 (2022). https://doi.org/10.1038/s41380-022-01655-y

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