Leisure Activities and Dementia
Leisure Activities Reduce Risk of Dementia in the Elderly
What is the problem and what is known about it so far?
The number of people developing dementia increases with increasing age. Although prevention of dementia has emerged as a major public health priority, there are few known preventive strategies.
Why did researchers do this particular study?
Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether this association is truly protective or the result of reduced capacity for such activities during the preclinical (before the illness is evident) phase of dementia. A long period of observation before diagnosis is needed to clarify this issue as well as the associations between activities and particular types of dementia.
Who was studied?
The Bronx Aging Study is a community based study which has followed a group of persons who did not have dementia at the beginning of the study, with the use of detailed clinical and neuropsychological evaluations performed at intervals for up to 21 years. All participants were English-speaking aged 75 to 85 years and resided in the community. Those with severe visual or hearing impairment or diagnosed with Parkinson's disease, liver disease, alcoholism, known terminal illness or dementia were excluded. 469 of initial 488 (96%) subjects enrolled between 1980 and 1983 underwent detailed clinical and neuropsychological evaluations at enrollment and at follow up visits every 12-18 months. The potential study period consisted of the 21 year period from 1980 to 2001.
How was the study done?
Clinical Evaluation: People in the study were interviewed with a structured questionnaire and were examined by study clinicians. Limitations of 10 activities of daily living were rated on a 3-point scale for each activity A spouse or family member accompanied most subjects or was contacted for confirmation of the history.
Neuropsychological Evaluation: A series of neuropsychological tests were administered at study visits. Performance was measured with established scales for assessing memory, concentration, verbal ability, performance IQ and depression
Leisure Activities: Subjects were interviewed regarding participation in 6 cognitive activities (reading books/newspapers, writing for pleasure, doing crossword puzzles, playing board games or cards, participation in group discussions, and playing musical instruments) and 11 physical activities (playing golf/tennis, swimming, bicycling, dancing, participating in group exercises, playing team games, climbing more than two flights of stairs, doing housework, and babysitting).
What did the researchers find?
Over a median follow-up of 5.1 years, dementia developed in 124 people (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia is 25, and other types of dementia in 8). On average, people in whom dementia developed were older, had lower levels of education, and had significantly lower scores on the cognitive-activity scale, but not on the physical-activity scale, than persons in whom dementia did not develop. Lower levels of participation were associated with increased levels of depression. Among cognitive activities, reading, playing board games, and playing musical instruments were associated with a lower risk of dementia. Dancing was the only physical activity associated with a lower risk of dementia. Participation in cognitive activities was associated with a reduced risk of Alzheimer's disease, vascular dementia, and mixed dementia. Lower levels of participation in cognitive activities were associated with increased risk of dementia and higher levels of participation in cognitive activities at the beginning of the study with reduced rates of decline in memory.
What were the limitations of the study?
The group contained a subgroup of volunteers who resided within a certain community; whites and subjects older than 75 years of age were overrepresented, as compared with the general population of those over 65 years of age, thus potentially limiting the generalizabilty of the results. Time spent in each activity was not directly measured, although history was verified by family members or other informants. It is difficult to quantify the cognitive demands of leisure activities, since such demands vary among activities and among people who engage in each activity. The leisure activities studied reflect the interests of the cohort, and it is quite likely that activities other than the ones studied are also protective.
What are the implications of this study?
Participation in leisure activities is associated with a reduced risk of development of dementia, both Alzheimer's disease and vascular dementia. The reduction of risk is related to the frequency of participation. The results of this study may in the future support recommendations for participation in cognitive activities to lower the risk of dementia that parallel current recommendations for participation in physical activities to reduce the risk of cardiovascular disease.
Leisure Activities Reduce Risk of Dementia in the Elderly
Summarized by Sundip Karsan, College of Medicine, University of Vermont
Summarized from "Leisure Activities and the Risk of Dementia in the Elderly". Verghese, Joe et al. The New England Journal of Medicine, June 19, 2003, Volume 348, Number 25, pages 2508-2516.
