Daily Intellectual Activities and Risk of Incident Dementia Among Older Chinese Adults | Dementia and Cognitive Impairment | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Association of Daily Intellectual Activities With Lower Risk of Incident Dementia Among Older Chinese Adults

Educational Objective
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.
1 Credit CME
Key Points

Question  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?

Findings  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.

Meaning  Active participation in intellectual activities, even in late life, might help prevent dementia in older adults.

Abstract

Importance  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.

Objective  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.

Results  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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

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 (cwlam@cuhk.edu.hk).

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.

References
1.
World Health Organization and Alzheimer’s Disease International. Dementia: a public health priority. http://www.who.int/mental_health/publications/dementia_report_2012/en. Published 2012. Accessed November 2, 2017.
2.
Brookmeyer  R, Johnson  E, Ziegler-Graham  K, Arrighi  HM.  Forecasting the global burden of Alzheimer’s disease.  Alzheimers Dement. 2007;3(3):186-191.PubMedGoogle ScholarCrossref
3.
Barnes  DE, Yaffe  K.  The projected effect of risk factor reduction on Alzheimer’s disease prevalence.  Lancet Neurol. 2011;10(9):819-828.PubMedGoogle ScholarCrossref
4.
Norton  S, Matthews  FE, Barnes  DE, Yaffe  K, Brayne  C.  Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data.  Lancet Neurol. 2014;13(8):788-794.PubMedGoogle ScholarCrossref
5.
Wilson  RS, Mendes De Leon  CF, Barnes  LL,  et al.  Participation in cognitively stimulating activities and risk of incident Alzheimer disease.  JAMA. 2002;287(6):742-748.PubMedGoogle ScholarCrossref
6.
Wilson  RS, Bennett  DA, Bienias  JL,  et al.  Cognitive activity and incident AD in a population-based sample of older persons.  Neurology. 2002;59(12):1910-1914.PubMedGoogle ScholarCrossref
7.
Verghese  J, Lipton  RB, Katz  MJ,  et al.  Leisure activities and the risk of dementia in the elderly.  N Engl J Med. 2003;348(25):2508-2516.PubMedGoogle ScholarCrossref
8.
Karp  A, Paillard-Borg  S, Wang  HX, Silverstein  M, Winblad  B, Fratiglioni  L.  Mental, physical and social components in leisure activities equally contribute to decrease dementia risk.  Dement Geriatr Cogn Disord. 2006;21(2):65-73.PubMedGoogle ScholarCrossref
9.
Akbaraly  TN, Portet  F, Fustinoni  S,  et al.  Leisure activities and the risk of dementia in the elderly: results from the Three-City Study.  Neurology. 2009;73(11):854-861.PubMedGoogle ScholarCrossref
10.
Paillard-Borg  S, Fratiglioni  L, Winblad  B, Wang  HX.  Leisure activities in late life in relation to dementia risk: principal component analysis.  Dement Geriatr Cogn Disord. 2009;28(2):136-144.PubMedGoogle ScholarCrossref
11.
Valenzuela  M, Brayne  C, Sachdev  P, Wilcock  G, Matthews  F; Medical Research Council Cognitive Function and Ageing Study.  Cognitive lifestyle and long-term risk of dementia and survival after diagnosis in a multicenter population-based cohort.  Am J Epidemiol. 2011;173(9):1004-1012.PubMedGoogle ScholarCrossref
12.
Paillard-Borg  S, Fratiglioni  L, Xu  W, Winblad  B, Wang  HX.  An active lifestyle postpones dementia onset by more than one year in very old adults.  J Alzheimers Dis. 2012;31(4):835-842.PubMedGoogle ScholarCrossref
13.
Yates  LA, Ziser  S, Spector  A, Orrell  M.  Cognitive leisure activities and future risk of cognitive impairment and dementia: systematic review and meta-analysis.  Int Psychogeriatr. 2016;28(11):1791-1806.PubMedGoogle ScholarCrossref
14.
Scarmeas  N, Stern  Y.  Cognitive reserve and lifestyle.  J Clin Exp Neuropsychol. 2003;25(5):625-633.PubMedGoogle ScholarCrossref
15.
Fratiglioni  L, Paillard-Borg  S, Winblad  B.  An active and socially integrated lifestyle in late life might protect against dementia.  Lancet Neurol. 2004;3(6):343-353.PubMedGoogle ScholarCrossref
16.
Valenzuela  MJ, Sachdev  P.  Brain reserve and dementia: a systematic review.  Psychol Med. 2006;36(4):441-454.PubMedGoogle ScholarCrossref
17.
Valenzuela  MJ, Breakspear  M, Sachdev  P.  Complex mental activity and the aging brain: molecular, cellular and cortical network mechanisms.  Brain Res Rev. 2007;56(1):198-213.PubMedGoogle ScholarCrossref
18.
Lövdén  M, Xu  W, Wang  HX.  Lifestyle change and the prevention of cognitive decline and dementia: what is the evidence?  Curr Opin Psychiatry. 2013;26(3):239-243.PubMedGoogle ScholarCrossref
19.
Di Marco  LY, Marzo  A, Muñoz-Ruiz  M,  et al.  Modifiable lifestyle factors in dementia: a systematic review of longitudinal observational cohort studies.  J Alzheimers Dis. 2014;42(1):119-135.PubMedGoogle ScholarCrossref
20.
Leung  GT, Lam  LC.  Leisure activities and cognitive impairment in late life: a selective literature review of longitudinal cohort studies.  Hong Kong J Psychiatry. 2007;17:91-100.Google Scholar
21.
Cheng  ST.  Cognitive reserve and the prevention of dementia: the role of physical and cognitive activities.  Curr Psychiatry Rep. 2016;18(9):85.PubMedGoogle ScholarCrossref
22.
Sajeev  G, Weuve  J, Jackson  JW,  et al.  Late-life cognitive activity and dementia: a systematic review and bias analysis.  Epidemiology. 2016;27(5):732-742.PubMedGoogle ScholarCrossref
23.
Chiu  HF, Lam  LC, Chi  I,  et al.  Prevalence of dementia in Chinese elderly in Hong Kong.  Neurology. 1998;50(4):1002-1009.PubMedGoogle ScholarCrossref
24.
Leung  GT, Leung  KF, Lam  LC.  Classification of late-life leisure activities among elderly Chinese in Hong Kong.  East Asian Arch Psychiatry. 2011;21(3):123-127.PubMedGoogle Scholar
25.
WHO Expert Consultation.  Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.  Lancet. 2004;363(9403):157-163.PubMedGoogle ScholarCrossref
26.
Lee  AT, Richards  M, Chan  WC, Chiu  HF, Lee  RS, Lam  LC.  Intensity and types of physical exercise in relation to dementia risk reduction in community-living older adults.  J Am Med Dir Assoc. 2015;16(10):899.e1-899.e7.PubMedGoogle ScholarCrossref
27.
Lee  ATC, Richards  M, Chan  WC, Chiu  HFK, Lee  RSY, Lam  LCW.  Lower risk of incident dementia among Chinese older adults having three servings of vegetables and two servings of fruits a day.  Age Ageing. 2017;46(5):773-779.PubMedGoogle ScholarCrossref
28.
World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th revision. http://apps.who.int/classifications/apps/icd/icd10online2004/fr-icd.htm. Accessed November 2, 2017.
29.
Morris  JC.  Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type.  Int Psychogeriatr. 1997;9(suppl 1):173-176.PubMedGoogle ScholarCrossref
30.
Leung  GT, Fung  AW, Tam  CW,  et al.  Examining the association between participation in late-life leisure activities and cognitive function in community-dwelling elderly Chinese in Hong Kong.  Int Psychogeriatr. 2010;22(1):2-13.PubMedGoogle ScholarCrossref
31.
Richards  M, Deary  IJ.  A life course approach to cognitive reserve: a model for cognitive aging and development?  Ann Neurol. 2005;58(4):617-622.PubMedGoogle ScholarCrossref
32.
Stern  Y.  Cognitive reserve in ageing and Alzheimer’s disease.  Lancet Neurol. 2012;11(11):1006-1012.PubMedGoogle ScholarCrossref
33.
Suo  C, Singh  MF, Gates  N,  et al.  Therapeutically relevant structural and functional mechanisms triggered by physical and cognitive exercise.  Mol Psychiatry. 2016;21(11):1633-1642.PubMedGoogle ScholarCrossref
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close