In a cross-sectional analysis of 13,866 adults from the All of Us Research Program, four modifiable lifestyle factors were measured against sustained attention performance using the Gradual-Onset Continuous Performance Task (GradCPT). Low social satisfaction was the strongest predictor, associated with approximately 5.8 additional age-equivalent years of cognitive aging compared to high social satisfaction. Heavy smoking (>20 cigarettes/day) corresponded to roughly a 5-year cognitive aging deficit versus never-smokers, following a dose-response pattern. Stage 2 hypertension showed a modest non-significant negative trend, while binge drinking yielded limited associations, complicated by survivor and abstainer biases. Critically, combinations of risk factors — especially those involving low social satisfaction — produced larger deficits than a purely additive model would predict, suggesting interactive vulnerability.
These findings matter because sustained attention is among the earliest cognitive functions to decline with age and predicts downstream dementia risk. The social satisfaction result is striking: it rivals smoking in magnitude, reinforcing the growing body of evidence linking social isolation to accelerated neurological aging. Translating associations into 'age-equivalent years' is a useful clinical communication tool, though this is an observational, cross-sectional design — causality cannot be established, and reverse causation (cognitive decline reducing social engagement) is plausible. The sample, while large and diverse, relied on self-reported exposures. As a preprint not yet peer-reviewed, these results should be treated as preliminary. If replicated, the interactive model suggests that addressing social isolation alongside smoking cessation and blood pressure control could yield outsized cognitive benefits.