Late-life mentally stimulating activities may decrease risk of mild cognitive impairment

1. This prospective cohort study showed that mentally stimulating activities (computer use, craft activities, social activities and playing games) in late-age (>70 years old) were associated with decreased risk of incident mild cognitive impairment (MCI).

2. When stratified by apolipoprotein E ε4 (APOE ε4) carrier status, those at lowest risk of developing MCI engaged in mentally stimulating activities and were non-carriers of APOE ε4, and those at highest risk did not partake in mentally stimulating activities and were APOE ε4 carriers.

Evidence Rating Level: 2 (Good)

Study Rundown: Dementia is a common morbid condition among the elderly. Given lack of current medical treatment, prevention through lifestyle modification is important to investigate. Previous studies have shown an association between mentally stimulating activities and mild cognitive impairment (MCI), however it is unclear how these activities, if done in later life, can impact incidence of MCI. This population-based prospective cohort study aimed to investigate the effect of late-life mentally stimulating activities on the incidence of MCI and to evaluate the influence of the apolipoprotein E ε4 (APOE ε4) genotype.

Certain late-life mentally stimulating activities, such as playing games, engaging in craft activities, computer use, and social activities, significantly decreased the risk of MCI. When stratified for APOE ε4 genotype, lowest risk of MCI was among participants without APOE ε4 and who engaged in mentally stimulating activities. The highest risk was among participants who were APOE ε4 carriers and who did not engage in these activities. Strengths of this study included its population-based cohort and robust outcome analysis using many validated neurocognitive-testing tools. Limitations included use of questionnaires to determine the exposure of interest, thus affected by recall bias. Also, effects of activities conducted earlier in life may also have confounded the results.

Click to read the study, published today in JAMA Neurology

Relevant Reading: Risk and protective factors for cognitive impairment in persons aged 85 years and older

In-Depth [prospective cohort]: This prospective, population-based cohort study was conducted from April 2006 to June 2016 using patients from the Mayo Clinic Study of Aging (MCSA) in Olmsted County, Minnesota. This cohort included participants 70 or older who were cognitively normal at baseline. Information about the frequency of mentally stimulating activities (reading books, craft activities, computer use, playing games, social activities) was gathered for the year prior to enrollment into the MCSA as the exposure of interest. Additionally, blood samples were taken to determine the participants APOE ε4 genotype. These participants were then followed for 4 years for the primary outcome of incident MCI diagnosed as per published criteria. Statistical analysis included hazard ratio calculations with Cox proportional hazards regression models.

This study of 1,929 participants showed that certain late-life mentally stimulating activities significantly decreased the risk of MCI. These activities included: playing games (HR 0.78; 95% CI 0.65-0.95), engaging in craft activities (HR 0,72; 95% CI 0.57-0.90), computer use (HR 0.70; 95% CI 0.57-0.85) and social activities (HR 0.77; 95% CI 0.58-0.92). When stratified for APOE ε4 genotype, those with lowest risk of MCI were APOE ε4 non-carriers who engaged in mentally stimulating activities and those at highest risk were APOE ε4 carriers who did not engage in mentally stimulating activities.

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