Context Both higher adherence to a Mediterranean-type diet and more physical activity have been independently associated with lower Alzheimer disease (AD) risk but their combined association has not been investigated.Objective To investigate the combined association of diet and physical activity with AD risk. Design, Setting, and PatientsProspective cohort study of 2 cohorts comprising 1880 community-dwelling elders without dementia living in New York, New York, with both diet and physical activity information available. Standardized neurological and neuropsychological measures were administered approximately every 1.5 years from 1992 through 2006. Adherence to a Mediterranean-type diet (scale of 0-9; trichotomized into low, middle, or high; and dichotomized into low or high) and physical activity (sum of weekly participation in various physical activities, weighted by the type of physical activity [light, moderate, vigorous]; trichotomized into no physical activity, some, or much; and dichotomized into low or high), separately and combined, were the main predictors in Cox models. Models were adjusted for cohort, age, sex, ethnicity, education, apolipoprotein E genotype, caloric intake, body mass index, smoking status, depression, leisure activities, a comorbidity index, and baseline Clinical Dementia Rating score. Main Outcome Measure Time to incident AD.Results A total of 282 incident AD cases occurred during a mean (SD) of 5.4 (3.3) years of follow-up. When considered simultaneously, both Mediterranean-type diet adherence (compared with low diet score, hazard ratio [HR] for middle diet score was 0.98 [95% confidence interval {CI}, 0.72-1.33]; the HR for high diet score was 0.60 [95% CI, 0.42-0.87]; P=.008 for trend) and physical activity (compared with no physical activity, the HR for some physical activity was 0.75 [95% CI, 0.54-1.04]; the HR for much physical activity was 0.67 [95% CI, 0.47-0.95]; P=.03 for trend) were associated with lower AD risk. Compared with individuals neither adhering to the diet nor participating in physical activity (low diet score and no physical activity; absolute AD risk of 19%), those both adhering to the diet and participating in physical activity (high diet score and high physical activity) had a lower risk of AD (absolute risk, 12%; HR, 0.65 [95% CI, 0.44-0.96]; P=.03 for trend). ConclusionIn this study, both higher Mediterranean-type diet adherence and higher physical activity were independently associated with reduced risk for AD.

Background: Vascular factors including medical history (heart disease, stroke, diabetes, and hypertension), smoking, and prediagnosis blood lipid measurements (cholesterol: total, high-density lipoprotein, lowdensity lipoprotein [LDL-C], and triglyceride concentrations) may be predictors for progression of Alzheimer disease (AD).Objective: To determine whether prediagnosis vascular risk factors are associated with progression of AD. Design: Inception cohort followed up longitudinally for a mean of 3.5 (up to 10.2) years.

Factors influencing survival in Alzheimer disease include race/ethnicity and comorbid diabetes and hypertension.

Objective-To determine whether APOE ε4 predicts rate of cognitive change in incident and prevalent AD.Methods-Individuals were recruited from two longitudinal cohort studies -the Washington Heights and Inwood Columbia Aging Project (WHICAP; population-based) and the Predictors Study (clinic-based), and were followed for an average of four years. Three samples of participants diagnosed with Alzheimer's disease, with diverse demographic characteristics and baseline cognitive functioning were studied: 1) 199 (48%) of the incident WHICAP cases; 2) 215 (54%) of the prevalent WHICAP cases; and 3)156 (71%) of the individuals diagnosed with AD in the Predictors Study. Generalized estimating equations (GEE) were used to test whether rate of cognitive change, measured using a composite cognitive score in WHICAP and the Mini-Mental Status Exam in Predictors, varied as a function of ε4 status in each sample.Results-The presence of at least one ε4 allele was associated with faster cognitive decline in the incident population-based AD group (p = .01). Parallel results were produced for the two prevalent dementia samples only when adjusting for disease severity or excluding the most impaired participants from the analysis.Conclusion-APOE ε4 may influence rate of cognitive decline most significantly in the earliest stages of AD.

For reasons that remain unknown, there is marked inter-person variability in awareness of episodic memory loss in patients with Alzheimer's disease (AD). Existing research designs, primarily subjective in nature, have been at a relative disadvantage for evaluating disordered metamemory and its relation to the clinical and neuropathological heterogeneity of AD, as well as its prognosis for various disease outcomes. The current study sought to establish an objective means of evaluating metamemory in AD by modifying traditional metacognitive paradigms in which participants are asked to make predictions regarding their own memory performance. Variables derived from this measure were analyzed in relation to clinically rated awareness for memory loss. As predicted, a range of awareness levels existed across patients with mild to moderate AD (n=24) and clinical ratings of awareness (CRA) were significantly associated with verbal episodic memory monitoring (r = .46, p = .03). Further, patients who were rated as aware of their memory loss remained well calibrated over the course of the task whereas those rated as relatively unaware grew over-confident in their predictions [F (1, 33) = 4.19, p = .02]. Findings suggest that over-confidence may be related to impaired online error recognition and compromised use of metamemory strategies such as the Memory for Past Test (MPT) heuristic. Importantly, clinically rated awareness did not vary as a function of demographic variables, global cognition, or verbal memory. However, participants characterized as relatively unaware were impaired on a nonverbal memory task as compared to aware participants [F (1, 20) = 6.98, p = .02]. The current study provides preliminary support for the use of a recognition-based verbal episodic memory monitoring task as a quantitative measure of awareness for memory loss in AD, and offers insight into the manner in which metamemory breaks down. Discrepancies in nonverbal memory across the two awareness groups provide preliminary support for the idea that metamemory variability in AD may be related to the neuroanatomic presentation of the disease, with disordered awareness potentially reflective of a critical level of right hemisphere involvement.