DOI: 10.1002/alz.075918 ISSN: 1552-5260

Associations of AHA’s Life’s Essential 8 health behaviors with cognitive function among U.S. Black and White midlife adults

Yuqi Shen, Lindsay Master, May A Beydoun, Alan B Zonderman, Orfeu M. Buxton, Alyssa A. Gamaldo, Michele K Evans
  • Psychiatry and Mental health
  • Cellular and Molecular Neuroscience
  • Geriatrics and Gerontology
  • Neurology (clinical)
  • Developmental Neuroscience
  • Health Policy
  • Epidemiology



Life’s Simple 7 (LS7), originally proposed as the seven most important predictors of heart health, is associated with negative cognitive outcomes (Thacker et al., 2014). The recently updated Life’s Essential 8 (LE8) includes sleep. Limited research has investigated the association between LE8 and cognition, particularly within Black and White adults. We hypothesize that higher composite LE8 scores will be associated with better cognitive performance, particularly within Black adults.


Cross‐sectional analyses were conducted including adults from the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) study conducted in Baltimore, MD. Study participants (36‐76 years old; 41% male; 61% Black) completed all LE8 (Lloyd‐Jones et al., 2022) and global cognition measurements in wave 4 data collection (2013‐2017). Cognitive performance on a computerized cognitive battery (Joggle Research) yielded a total global cognition score and individual domains (e.g., working memory, attention). Linear regression analyses were stratified by race and poverty status (below 125% Federal poverty guidelines), education attainment (high school), and reading literacy (median split) respectively. Covariates included age, sex, sleep apnea, and depression. All reported models were fully adjusted.


Among Black adults, higher LE8 scores (better CVH) were associated with better working memory only among individuals living above the poverty level (all b unstandardized; b = 0.008, p = .016), or only with high school education (b = 0.009, p = .027). Among White adults, higher LE8 score was associated with better working memory, particularly among individuals living above poverty level (b = 0.014, p = .002), having an education above high school (b = 0.019, p = .002), or high literacy (b = 0.021, p<.001) . Additionally, higher LE8 scores were associated with better attention, and higher global cognition score among individuals living above poverty (b = 0.015, p = .042; b = 0.039, p = .025) or with a high literacy on (b = 0.023, p = .014; b = 0.049, p = .027).


Higher score of LE8 was associated with better working memory among both U.S. Black and White adults. However, higher LE8 scores were associated with performance across a larger variety of cognitive domains within White adults from diverse socioeconomic indicators. These findings illustrate unique LE8 and cognition associations when disentangling socioeconomic heterogeneity within racial groups.

More from our Archive