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Leisure activities, education, and cognitive impairment in Chinese older adults: a population-based longitudinal study

  • Xinyi Zhu (a1), Chengxuan Qiu (a2), Yi Zeng (a3) (a4) and Juan Li (a1)
Abstract
Background:

We examine the association between leisure-time activities and the risk of developing cognitive impairment among Chinese older people, and further investigate whether the association varies by educational level.

Methods:

This follow-up study included 6,586 participants (aged 79.5 ± 9.8 years, range 65–105 years, 51.7% female) of the Chinese Longitudinal Healthy Longevity Survey who were aged ≥65 years and were free of cognitive impairment in 2002. Incident cognitive impairment was defined at the 2005 or 2008/2009 survey following an education-based cut-off on the adapted Chinese version of Mini-Mental State Examination (MMSE). Participation in cognitive activities (e.g. reading) and non-exercise physical activity (e.g. housework) was assessed by a self-reported scale. Cox proportional hazard models were employed to examine the association of leisure activities with incident cognitive impairment while controlling for age, gender, education, occupation, residence, physical exercise, smoking, drinking, cardiovascular diseases and risk factors, negative well-being, and physical functioning, and baseline MMSE score.

Results:

During a five-year follow-up, 1,448 participants developed incident cognitive impairment. Overall, a high level of participation in leisure activities was associated with a 41% decreased risk of cognitive impairment compared to low-level engagement in leisure activities after controlling for age, gender, education, and other confounders. Moreover, there was a significant interaction between leisure activity and educational level, such that the beneficial effect of leisure activities on cognitive function was larger in educated elderly than their uneducated counterparts, and only educated elderly benefited from cognitive activities.

Conclusions:

Late-life leisure activities protect against cognitive impairment among elderly Chinese people, and the protective effects are more profound for educated elderly.

Copyright
Corresponding author
Correspondence should be addressed to: Juan Li, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Beijing 100101, China. Phone: (8610)64861622; Fax: (8610)64872070. Email: lijuan@psych.ac.cn.
References
Hide All
Baltes, P. B. and Kliegl, R. (1992). Further testing of limits of cognitive plasticity: negative age differences in a mnemonic skill are robust. Developmental Psychology, 28, 121125.
Bamidis, P. D. et al. (2015). Gains in cognition through combined cognitive and physical training: the role of training dosage and severity of neurocognitive disorder. Frontiers in Aging Neuroscience, 7. doi:10.3389/fnagi.2015.00152.
Bennett, D. A., Arnold, S. E., Valenzuela, M. J., Brayne, C. and Schneider, J. A. (2014). Cognitive and social lifestyle: links with neuropathology and cognition in late life. Acta Neuropathologica, 127, 137150. doi:10.1007/s00401-013-1226-2.
Bielak, A. A. M. (2010). How can we not 'lose it' if we still don't understand how to 'use it'? Unanswered questions about the influence of activity participation on cognitive performance in older age- a mini-review. Gerontology, 56, 507519. doi:10.1159/000264918.
Bravo, G. and Hébert, R. (1997). Age-and education-specific reference values for the mini-mental and modified mini-mental state examinations derived from a non-demented elderly population. International Journal of Geriatric Psychiatry, 12, 10081018.
Buchman, A. S., Boyle, P. A., Yu, L., Shah, R. C., Wilson, R. S. and Bennett, D. A. (2012). Total daily physical activity and the risk of AD and cognitive decline in older adults. Neurology, 78, 13231329. doi:10.1212/WNL.0b013e3182535d35.
Caamaño-Isorna, F., Corral, M., Montes-Martínez, A. and Takkouche, B. (2006). Education and dementia: a meta-analytic study. Neuroepidemiology, 26, 226232.
Carlson, M. C. et al. (2008). Exploring the effects of an “everyday” activity program on executive function and memory in older adults: experience corps® . The Gerontologist, 48, 793801.
Chang, M. et al. (2010). The effect of midlife physical activity on cognitive function among older adults: ages–reykjavik study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 65, 13691374. doi:10.1093/gerona/glq152.
Colcombe, S. and Kramer, A. F. (2003). Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychological Science, 14, 125130.
Cui, G. H et al. (2011). Cognitive impairment using education-based cutoff points for CMMSE scores in elderly Chinese people of agricultural and rural Shanghai China. Acta Neurologica Scandinavica, 124, 361367. doi:10.1111/j.1600-0404.2010.01484.x6.
EClipSE Collaborative Members et al. (2010). Education, the brain and dementia: neuroprotection or compensation? Brain, 133, 22102216. doi:10.1093/brain/awq185.
Erickson, K. I., Hillman, C. H. and Kramer, A. F. (2015). Physical activity, brain, and cognition. Current opinion in behavioral sciences, 4, 2732. doi:10.1016/j.cobeha.2015.01.005.
Eriksson Sörman, D., Sundstrom, A., Ronnlund, M., Adolfsson, R. and Nilsson, L. G. (2014). Leisure activity in old age and risk of dementia: a 15-year prospective study. Journals of Gerontology B: Psychological Sciences and Social Sciences, 69, 493501. doi:10.1093/geronb/gbt056.
Evans, D. A. et al. (1993). Level of education and change in cognitive function in a community population of older persons. Annals of Epidemiology, 3, 7177.
Farfel, J. M. et al. (2013). Very low levels of education and cognitive reserve: a clinicopathologic study. Neurology, 81, 650657.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Fratiglioni, L., Paillard-Borg, S. and Winblad, B. (2004). An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology, 3, 343353. doi:10.1016/s1474-4422(04)00767-7.
Groot, C. et al. (2016). The effect of physical activity on cognitive function in patients with dementia: a meta-analysis of randomized control trials. Ageing Research Reviews, 25, 1323. doi:http://dx.doi.org/10.1016/j.arr.2015.11.005.
Gu, D. (2007). The CLHLS Technical Report 2007 - No.1. Available at: https://sites.duke.edu/centerforaging/files/2015/12/2005_data_assessment_of_the_2005_wave.pdf; last accessed 20 November 2016.
Harada, N. D., Chiu, V., King, A. C. and Stewart, A. L. (2001). An evaluation of three self-report physical activity instruments for older adults. Medicine and Science in Sports and Exercise, 33, 962970.
Hertzog, C. (2009). Use it or lose it: an old hypothesis, new evidence, and an ongoing case study. In Bosworth, H. B. and Hertzog, C. (eds.), Aging and Cognition: Research Methodologies and Empirical Advances (pp. 161179). Washington DC, USA: American Psychological Association.
Hertzog, C., Kramer, A. F., Wilson, R. S. and Lindenberger, U. (2008). Enrichment effects on adult cognitive development: can the functional capacity of older adults be preserved and enhanced? Psychological Science in the Public Interest, 9, 165. doi:10.1111/j.1539-6053.2009.01034.x.
Jedrziewski, M. K., Lee, V. M. Y. and Trojanowski, J. Q. (2007). Physical activity and cognitive health. Alzheimer's and Dementia, 3, 98108. doi:10.1016/j.jalz.2007.01.009.
Karp, A., Andel, R., Parker, M. G., Wang, H. X., Winblad, B. and Fratiglioni, L. (2009). Mentally stimulating activities at work during midlife and dementia risk after age 75: follow-up study from the kungsholmen project. American Journal of Geriatric Psychiatry, 17, 227236.
Karp, A., Paillard-Borg, S., Wan, H.-X., Silverstein, M., Winblad, B. and Fratiglioni, L. (2006). Mental, physical and social components in leisure activities equally contribute to decrease dementia risk. Dementia and Geriatric Cognitive Disorders, 21, 6573. doi:10.1159/000089919.
Katz, S. (1983). Assessing self-maintenance: activities of daily living, mobility and instrumental activities of daily living. Journal of the American Geriatrics Society, 31, 721726.
Katzman, R. (1993). Education and the prevalence of dementia and Alzheimer's disease. Neurology, 43, 1320.
Kelly, M. E., Loughrey, D., Lawlor, B. A., Robertson, I. H., Walsh, C. and Brennan, S. (2014). The impact of exercise on the cognitive functioning of healthy older adults: a systematic review and meta-analysis. Ageing Research Reviews, 16, 1231. doi:http://dx.doi.org/10.1016/j.arr.2014.05.002.
Lampit, A., Hallock, H. and Valenzuela, M. (2014). Computerized cognitive training in cognitively healthy older adults: a systematic review and meta-analysis of effect modifiers. PLoS Medicine, 11, e1001756. doi:10.1371/journal.pmed.1001756.
Landau, S. M. et al. (2012). Association of lifetime cognitive engagement and low β-amyloid deposition. Archives of Neurology, 69, 623629. doi:10.1001/archneurol.2011.2748.
Lee, S., Kawachi, I., Berkman, L. F. and Grodstein, F. (2003). Education, other socioeconomic indicators, and cognitive function. American Journal of Epidemiology, 157, 712720.
Levine, J. A. (2007). Nonexercise activity thermogenesis-liberating the life-force. Journal of Internal Medicine, 262, 273287. doi:10.1111/j.1365-2796.2007.01842.x.
Lindstrom, H. A. et al. (2005). The relationships between television viewing in midlife and the development of Alzheimer's disease in a case-control study. Brain and Cognition, 58, 157165.
Matthews, C. E. et al. (2007). Influence of exercise, walking, cycling, and overall nonexercise physical activity on mortality in Chinese women. American Journal of Epidemiology, 165, 13431350. doi:10.1093/aje/kwm088.
Niti, M., Yap, K.B., Kua, E.H., Tan, C.H. and Ng, T.P. (2008). Physical, social and productive leisure activities, cognitive decline and interaction with APOE-epsilon 4 genotype in Chinese older adults. International Psychogeriatrics, 20, 237251. doi:10.1017/s1041610207006655.
Nyberg, L. et al. (2003). Neural correlates of training-related memory improvement in adulthood and aging. Proceedings of the National Academy of Sciences of the United States of America, 100, 1372813733. doi:10.1073/pnas.1735487100.
Paillard-Borg, S., Fratiglioni, L., Xu, W., Winblad, B. and Wang, H. X. (2012). An active lifestyle postpones dementia onset by more than one year in very old adults. Journal of Alzheimer's Disease, 31, 835842. doi:10.3233/JAD-2012-120724.
Park, D. C. et al. (2014). The impact of sustained engagement on cognitive function in older adults: the synapse project. Psychological Science, 25, 103112. doi:10.1177/0956797613499592.
Payne, B. R., Jackson, J. J., Noh, S. R. and Stine-Morrow, E. A. L. (2011). In the zone: flow state and cognition in older adults. Psychology and Aging, 26, 738743.
Qiu, C., Winblad, B. and Fratiglioni, L. (2006). Cerebrovascular disease, APOE epsilon4 allele and cognitive decline in a cognitively normal population. Neurological Research, 28, 650656. doi:10.1179/016164106x130443.
Ritchie, S. J., Bates, T. C. and Deary, I. J. (2015). Is education associated with improvements in general cognitive ability, or in specific skills? Developmental Psychology, 51, 573582. doi:10.1037/a0038981.
Ritchie, S. J., Bates, T. C., Der, G., Starr, J. M. and Deary, I. J. (2013). Education is associated with higher later life IQ scores, but not with faster cognitive processing speed. Psychology and Aging, 28, 515521. doi:10.1037/a0030820.
Salthouse, T. A. (2006). Mental exercise and mental aging evaluating the validity of the “use it or lose it” hypothesis. Perspectives on Psychological Science, 1, 6887. doi:10.1111/j.1745-6916.2006.00005.x.
Scarmeas, N., Levy, G., Tang, M. X., Manly, J. and Stern, Y. (2001). Influence of leisure activity on the incidence of Alzheimer's disease. Neurology, 57, 2236.
Smith, P. J. et al. (2010). Aerobic exercise and neurocognitive performance: a meta-analytic review of randomized controlled trials. Psychosomatic Medicine, 72, 239252. doi:10.1097/PSY.0b013e3181d14633.
Smith, J., Gerstorf, D. and Li, Q. (2008). Psychological resources for well-being among octogenarians, nonagenarians, and centenarians: differential effects of age and selective mortality. In Zeng, Y., Poston, D. L., Vlosky, D. A. and Gu, D. (eds.), Healthy Longevity in China (pp. 329346). The Netherlands: Springer.
Snowden, M. et al. (2011). Effect of exercise on cognitive performance in community-dwelling older adults: review of intervention trials and recommendations for public health practice and research. Journal of the American Geriatrics Society, 59, 704716. doi:10.1111/j.1532-5415.2011.03323.x.
Stern, Y. (2012). Cognitive reserve in ageing and Alzheimer's disease. Lancet Neurology, 11, 10061012. doi:10.1016/S1474-4422(12)70191-6.
Stine-Morrow, E. A. L. and Chui, H. (2012). Cognitive resilience in adulthood. Annual Review of Gerontology and Geriatrics, 32, 93114. doi:10.1891/0198-8794.32.93.
Troyer, A. K. (2000). Normative data for clustering and switching on verbal fluency tasks. Journal of Clinical and Experimental Neuropsychology, 22, 370378. doi:10.1076/1380-3395(200006)22:3;1-V;FT370.
Valenzuela, M. J. et al. (2012). Multiple biological pathways link cognitive lifestyle to protection from dementia. Biological Psychiatry, 71, 783791. doi:10.1016/j.biopsych.2011.07.036.
Valenzuela, M. J., Sachdev, P., Wen, W., Chen, X. and Brodaty, H. (2008). Lifespan mental activity predicts diminished rate of hippocampal atrophy. PLoS One, 3, e2598. doi:10.1371/journal.pone.0002598.
Verghese, J. et al. (2003). Leisure activities and the risk of dementia in the elderly. New England Journal of Medicine, 348, 25082516.
Voss, M. W., Vivar, C., Kramer, A. F. and van Praag, H. (2013). Bridging animal and human models of exercise-induced brain plasticity. Trends in cognitive sciences, 17, 525544. doi:10.1016/j.tics.2013.08.001.
Wang, H.-X., Karp, A., Winblad, B. and Fratiglioni, L. (2002). Late life engagement in social and leisure activities is associated with a decreased risk of dementia: a longitudinal study from the Kungsholmen Project. American Journal of Epidemiology, 155, 10811087.
Wang, J. Y. et al. (2006). Leisure activity and risk of cognitive impairment: the Chongqing aging study. Neurology, 66, 911913.
Wilson, R. S., Hebert, L. E., Scherr, P. A., Barnes, L. L., Mendes de Leon, C. F. and Evans, D. A. (2009). Educational attainment and cognitive decline in old age. Neurology, 72, 460465. doi:10.1212/01.wnl.0000341782.71418.6c.
Wilson, R. S. et al. (2002). Participation in cognitively stimulating activities and risk of incident Alzheimer disease. JAMA, 287, 742748.
Zahodne, L. B. et al. (2011). Education does not slow cognitive decline with aging: 12-year evidence from the victoria longitudinal study. Journal of the International Neuropsychological Society, 17, 10391046. doi:10.1017/S1355617711001044.
Zeng, Y. and Vaupel, J. W. (2002). Functional capacity and sel-fevaluation of health and life of oldest old in China. Journal of Social Issues, 58, 733748. doi:10.1111/1540-4560.00287.
Zeng, Y., Vaupel, J. W., Xiao, Z., Zhang, C. and Liu, Y. (2001). The healthy longevity survey and the active life expectancy of the oldest old in China. Population: English Selection, 13, 95116.
Zhang, M. et al. (1990). The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Annals of Neurology, 27, 428437.
Zhang, Z. (2006). Gender differentials in cognitive impairment and decline of the oldest old in China. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 61, S107–S115.
Ziegler, M., Cengia, A., Mussel, P. and Gerstorf, D. (2015). Openness as a buffer against cognitive decline: the openness-fluid-crystallized-intelligence (OFCI) model applied to late adulthood. Psychology and Aging, 30, 573588. doi:10.1037/a0039493.
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