Leisure Activities and the Risk of Dementia in the Elderly

BACK GROUND Participation in leisure activities has been associated with a lower risk o f dementia. It is unclear whether increased participation in leisure activities lowers the risk o f dementia or participation in leisure activities declines during the preclinical phase o f dementia. M E T H O D S We examined the relation between leisure activities and the risk o f dementia in a prospective cohort o f 469 subjects older than 75 years o f age w ho resided in the com m unity and did not have dementia at base line. We examined the frequency o f participation in leisure activities at enrollm ent and derived cognitive-activity and physical-activity scales in which the units o f measure were activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk o f dementia according to the base-line level o f participation in leisure activities, with adjustment for age, sex, educational level, presence or absence o f chronic medical illnesses, and base-line cognitive status. R E S U L T S Over a median follow-up period o f 5.1 years, dementia developed in 124 subjects (Alzheimer’s disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types o f dementia in 8). Am ong leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk o f dementia. A one-point increment in the cognitive-activity score was significandy associated with a reduced risk o f dementia (hazard ratio, 0.93 [95 percent confidence interval, 0.90 to 0.97]), but a one-point increment in the physical-activity score was not (hazard ratio, 1.00). The association with the cognitive-activity score persisted after the exclusion o f the subjects with possible preclinical dementia at base line. Results were similar for Alzheimer’s disease and vascular dementia. In linear mixed models, increased participation in cognitive activities at base line was associated with reduced rates o f decline in memory. C O N C L U S I O N S Participation in leisure activities is associated with a reduced risk o f dementia, even after adjustment for base-line cognitive status and after the exclusion o f subjects with possible preclinical dementia. Controlled trials are needed to assess the protective effect o f cognitive leisure activities on the risk o f dementia.