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Does participation in intellectual activity reduce the risk of dementia in older adults, independent of other healthy lifestyle practices such as regular physical exercise, adequate fruit and vegetable intake, and not smoking?
In this population-based study, 15 582 community-living Chinese individuals age 65 years or older who were free of dementia were followed up for a median period of 5 years. Daily participation in intellectual activities was associated with a significantly lower risk of dementia several years later independent of other health behaviors, physical health limitations, and sociodemographic factors.
Active participation in intellectual activities, even in late life, might help prevent dementia in older adults.
Associations between late-life participation in intellectual activities and decreased odds of developing dementia have been reported. However, reverse causality and confounding effects due to other health behaviors or problems have not been adequately addressed.
To examine whether late-life participation in intellectual activities is associated with a lower risk of incident dementia years later, independent of other lifestyle and health-related factors.
Design, Setting, and Participants
A longitudinal observational study was conducted at all Elderly Health Centres of the Department of Health of the Government of Hong Kong among 15 582 community-living Chinese individuals age 65 years or older at baseline who were free of dementia, with baseline evaluations performed January 1 to June 30, 2005, and follow-up assessments performed from January 1, 2006, to December 31, 2012. Statistical analysis was performed from January 1, 2015, to December 31, 2016.
Main Outcomes and Measures
The main outcome was incident dementia as diagnosed by geriatric psychiatrists in accordance with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, or a Clinical Dementia Rating of 1 to 3. At baseline and follow-up interviews, self-reported information on participation in intellectual activities within 1 month before assessment was collected. Examples of intellectual activities, which were described by a local validated classification system, were reading books, newspapers, or magazines; playing board games, Mahjong, or card games; and betting on horse racing. Other important variables including demographics (age, sex, and educational level), physical and psychiatric comorbidities (cardiovascular risks, depression, visual and hearing impairments, and poor mobility), and lifestyle factors (physical exercise, adequate fruit and vegetable intake, smoking, and recreational and social activities) were also assessed.
Of the 15 582 individuals in the study, 9950 (63.9%) were women, and the median age at baseline was 74 years (interquartile range, 71-77 years). A total of 1349 individuals (8.7%) developed dementia during a median follow-up period of 5.0 years. Multivariable logistic regression analysis showed that the estimated odds ratio for incident dementia was 0.71 (95% CI, 0.60-0.84; P < .001) for those with intellectual activities at baseline, after excluding those who developed dementia within 3 years after baseline and adjusting for health behaviors, physical and psychiatric comorbidities, and sociodemographic factors.
Conclusions and Relevance
Active participation in intellectual activities, even in late life, might help delay or prevent dementia in older adults.
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Accepted for Publication: February 25, 2018.
Corresponding Author: Linda C. W. Lam, MD, Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong SAR, China (email@example.com).
Published Online: May 30, 2018. doi:10.1001/jamapsychiatry.2018.0657
Author Contributions: Drs A. T. C. Lee and Lam had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: All authors.
Acquisition, analysis, or interpretation of data: A. T. C. Lee, Richards, Chan, Lam.
Drafting of the manuscript: A. T. C. Lee, Chiu.
Critical revision of the manuscript for important intellectual content: A. T. C. Lee, Richards, Chan, R. S. Y. Lee, Lam.
Statistical analysis: A. T. C. Lee, Richards, Lam.
Obtained funding: Lam.
Administrative, technical, or material support: A. T. C. Lee, Chan, R. S. Y. Lee, Lam.
Study supervision: Chiu, Lam.
Conflict of Interest Disclosures: None reported.
Funding/Support: This work was supported by grant 09100071 from the Health and Health Services Research Fund of the Government of Hong Kong in 2011.
Role of the Funder/Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Additional Contributions: Shelley Chan, MMedSc, Elderly Health Service, provided the anonymized data and cross-checked the participants who did not complete the study with the Deaths Registry. Ada Fung, PhD, Shelly Leung, MSc, Janette Chow, BA, Alicia Chan, BA, Jeanie Law, MSc, and Jonathan Liu, BA, Department of Psychiatry, Chinese University of Hong Kong, helped with the tracing of the participants who did not complete the study. They were not compensated for their contributions. All staff members of the 18 Elderly Health Centres and all study participants and their family members gave their time to be involved in this study.
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