Examination of Neurofilament Light Chain Serum Concentrations, Physical Activity, and Cognitive Decline in Older Adults

IMPORTANCE Little is known about the association of serum neurofilament light chain (NfL) concentrations and physical activity with the rate of cognitive decline in older adults. OBJECTIVE To examine the association of physical activity and NfL concentrations with cognitive decline in older adults over time. DESIGN, SETTING, AND PARTICIPANTS This cohort study used data from the Chicago Health and Aging Project (CHAP), a population-based cohort study that recruited participants through door-todoor census in 4 Chicago-area communities and collected data between 1993 and 2012 in cycles of 3 years. Participants in CHAP who had 2 or more cognitive function assessments and at least 1 blood sample collected for NfL measurement were selected for inclusion in the current study. Data were analyzed from January to December 2021. EXPOSURES Self-reported physical activity (minutes per week) and serum NfL concentration (pg/mL). MAIN OUTCOMES AND MEASURES Associations of baseline physical activity and NfL concentrations with changes in global cognitive function over time as evaluated using the East Boston Memory Test for episodic memory, the Symbol Digit Modalities Test for perceptual speed, and the Mini-Mental State Examination. Mixed-effects regression analyses were conducted to examine associations at baseline and longitudinally. RESULTS The study sample included 1158 participants (695 [60%] African American; 728 [63%] female), with a mean (SD) age of 77.4 (6.0) years and a mean educational level of 12.6 (3.5) years. Among participants with high NfL concentrations (>25 pg/mL), those who engaged in medium physical activity (<150 minutes per week) had a 12% slower rate of global cognitive decline (SD units, or beta, -0.065; 95% CI, -0.099 to -0.032) and participants who engaged in high physical activity (similar to 150 minutes per week) had a 36% slower rate of decline (beta, -0.048; 95% CI, -0.080 to -0.016) than did participants with lowphysical activity (no reported participation) (beta, -0.075; 95% CI, -0.108 to -0.041). For participants with low NfL concentrations (similar to 25 pg/mL), those who took part in medium physical activity had 43% slower global cognitive decline (beta, -0.025; 95% CI, -0.043 to -0.007) and individuals who participated in high physical activity had 30% slower decline (beta, -0.031; 95% CI, -0.048 to -0.014) than did those who participated in low physical activity (beta, -0.046; 95% CI, -0.066 to -0.025). CONCLUSIONS AND RELEVANCE The findings suggest that physical activity is associated with diminished cognitive decline among older adults with increased serum NfL concentrations. The results support the potential use of blood biomarkers in measuring the benefits of health behaviors, such as physical activity, and early intervention for older adults at risk for cognitive decline.