Skip to main content
    • Aa
    • Aa

Association of Crossword Puzzle Participation with Memory Decline in Persons Who Develop Dementia

  • Jagan A. Pillai (a1) (a2), Charles B. Hall (a3) (a4) (a5), Dennis W. Dickson (a5) (a6), Herman Buschke (a3) (a5), Richard B. Lipton (a3) (a4) (a5) and Joe Verghese (a3) (a5)...

Participation in cognitively stimulating leisure activities such as crossword puzzles may delay onset of the memory decline in the preclinical stages of dementia, possibly via its effect on improving cognitive reserve. We followed 488 initially cognitively intact community residing individuals with clinical and cognitive assessments every 12–18 months in the Bronx Aging Study. We assessed the influence of crossword puzzle participation on the onset of accelerated memory decline as measured by the Buschke Selective Reminding Test in 101 individuals who developed incident dementia using a change point model. Crossword puzzle participation at baseline delayed onset of accelerated memory decline by 2.54 years. Inclusion of education or participation in other cognitively stimulating activities did not significantly add to the fit of the model beyond the effect of puzzles. Our findings show that late life crossword puzzle participation, independent of education, was associated with delayed onset of memory decline in persons who developed dementia. Given the wide availability and accessibility of crossword puzzles, their role in preventing cognitive decline should be validated in future clinical trials. (JINS, 2011, 17, 1006–1013)

Corresponding author
Correspondence and reprint requests to: Joe Verghese, Division of Cognitive & Motor Aging, Department of Neurology, Albert Einstein College of Medicine, 1165 Morris Park Avenue, Bronx, NY 10461. E-mail:
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

H. Akaike (1974). A new look at the statistical model identification. IEEE Transactions on Automatic Control, 19(6), 716723. doi:10.1109/TAC.1974.1100705.

A. Baird , S. Samson (2009). Memory for music in Alzheimer's disease: Unforgettable? Neuropsychology Review, 19(1), 85101. doi 10.1007/s11065-009-9085-2.

G. Blessed , B.E. Tomlinson , M. Roth (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. The British Journal of Psychiatry, 114(512), 797811. doi:10.1192/bjp.114.512.797.

H. Buschke (1973). Selective reminding for analysis of memory and learning. Journal of Verbal Learning and Verbal Behavior, 12(5), 543550. doi:10.1016/S0022-5371(73)80034-9.

S. Corkin (1984). Lasting consequences of bilateral medial temporal lobectomy: Clinical course and experimental findings in H.M. Seminars in Neurology, 4(2), 249259. doi:10.1055/s-2008-1041556.

A. Cowles , W.W. Beatty , S.J. Nixon , L.J. Lutz , J. Paulk , K. Paulk , E.D. Ross (2003). Musical skill in dementia: A violinist presumed to have Alzheimer's disease learns to play a new song. Neurocase, 9(6), 493503. doi:10.1076/neur.9.6.493.29378.

J.D. Greene , A.D. Baddeley , J.R. Hodges (1996). Analysis of the episodic memory deficit in early Alzheimer's disease: Evidence from the doors and people test. Neuropsychologia, 34(6), 537551. doi:10.1016/0028-3932(95)00151-4.

C.B. Hall , C. Derby , A. LeValley , M.J. Katz , J. Verghese , R.B. Lipton (2007). Education delays accelerated decline on a memory test in persons who develop dementia. Neurology, 69(17), 16571664. doi:10.1212/01.wnl.0000278163.82636.30.

C.B. Hall , R.B. Lipton , M. Sliwinski , M.J. Katz , C.A. Derby , J. Verghese (2009). Cognitive activities delay onset of memory decline in persons who develop dementia. Neurology, 73(5), 356361. doi:10.1212/WNL.0b013e3181b04ae3.

C.B. Hall , J. Ying , L. Kuo , M. Sliwinski , H. Buschke , M. Katz , R.B. Lipton (2001). Estimation of bivariate measurements having different change points, with application to cognitive ageing. Statistics in Medicine, 20(24), 36953714. doi:10.1002/sim.1113.

D.Z. Hambrick , T.A. Salthouse , E.J. Meinz (1999). Predictors of crossword puzzle proficiency and moderators of age-cognition relations. Journal of Experimental Psychology. General,, 128(2), 131164. doi:10.1037//0096-3445.128.2.131.

R. Katzman (1993). Education and the prevalence of dementia and Alzheimer's disease. Neurology, 43(1), 1320. Retrieved from

M.L. Lindstrom , D.M. Bates (1990). Nonlinear mixed effects models for repeated measures data. Biometrics, 46(3), 673687. doi:10.2307/2532087.

D.M. Masur , P.A. Fuld , A.D. Blau , H. Crystal , M.K. Aronson (1990). Predicting development of dementia in the elderly with the Selective Reminding Test. Journal of Clinical and Experimental Neuropsychology, 12(4), 529538. doi:10.1080/01688639008400999.

D.M. Masur , M. Sliwinski , R.B. Lipton , A.D. Blau , H.A. Crystal (1994). Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons. Neurology, 44(8), 14271432. Retrieved from

C. Munro Cullum , N. Butters , A.I. Troster , D.P. Salmon (1990). Normal aging and forgetting rates on the Wechsler Memory Scale-Revised. Archives of Clinical Neuropsychology, 5(1), 2330. doi:10.1093/arclin/5.1.23.

R.C. Petersen , R. Doody , A. Kurz , R.C. Mohs , J.C. Morris , P.V. Rabins , B. Winblad (2001). Current concepts in mild cognitive impairment. Archives of Neurology, 58(12), 19851992. doi:10.1001/archneur.58.12.1985.

C.M. Roe , C. Xiong , J.P. Miller , J.C. Morris (2007). Education and Alzheimer disease without dementia: Support for the cognitive reserve hypothesis. Neurology, 68(3), 223228. doi:10.1001/archneur.58.12.1985.

T.A. Salthouse (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.

T.A. Salthouse , N. Fristoe , S. Rhee (1996). How localized are age-related effects on neuropsychological measures? Neuropsychology, 10(2), 272285. doi:10.1037//0894-4105.10.2.272.

B.G. Skotko , E.A. Kensinger , J.J. Locascio , G. Einstein , D.C. Rubin , L.A. Tupler , S. Corkin (2004). Puzzling thoughts for H. M.: Can new semantic information be anchored to old semantic memories? Neuropsychology, 18(4), 756769. doi:10.1037/0894-4105.18.4.756.

B.G. Skotko , D.C. Rubin , L.A. Tupler (2008). H.M.'s personal crossword puzzles: Understanding memory and language. Memory, 16(2), 8996. doi:10.1080/09658210701864580.

B.J. Small , L. Bäckman (2007). Longitudinal trajectories of cognitive change in preclinical Alzheimer's disease: A growth mixture modeling analysis. Cortex, 43(7), 826834. doi:10.1016/S0010-9452(08)70682-8.

Y. Stern (2009). Cognitive reserve. Neuropsychologia, 47(10), 20152028. doi:10.1016/j.neuropsychologia.2009.03.004.

J. Verghese , H. Buschke , G. Kuslansky , M.J. Katz , K. Weidenheim , R.B. Lipton , D.W. Dickson (2003). Antemortem memory impairment screen performance is correlated with postmortem Alzheimer pathology. Journal of the American Geriatrics Society, 51(7), 10431045. doi:10.1046/j.1365-2389.2003.51326.x.

J. Verghese , A. LeValley , C. Derby , G. Kuslansky , M. Katz , C. Hall , R.B. Lipton (2006). Leisure activities and the risk of amnestic mild cognitive impairment in the elderly. Neurology, 66(6), 821827. doi:10.1212/01.wnl.0000202520.68987.48.

J. Verghese , R.B. Lipton , C.B. Hall , G. Kuslansky , M.J. Katz , H. Buschke (2002). Abnormality of gait as a predictor of non-Alzheimer's dementia. The New England Journal of Medicine, 347(22), 17611768. doi:10.1056/NEJMoa020441.

J. Verghese , R.B. Lipton , M.J. Katz , C.B. Hall , C.A. Derby , G. Kuslansky , H. Buschke (2003). Leisure activities and the risk of dementia in the elderly. The New England Journal of Medicine, 348(25), 25082516. doi:10.1056/NEJMoa022252.

R.S. Wilson , L.D. Bacon , J.H. Fox , A.W. Kaszniak (1983). Primary memory and secondary memory in dementia of the Alzheimer type. Journal of Clinical Neuropsychology, 5(4), 337344. doi:10.1080/01688638308401181.

R.S. Wilson , L.A. Beckett , J.L. Bienias , D.A. Evans , D.A. Bennett (2003). Terminal decline in cognitive function. Neurology, 60(11), 17821787. Retrieved from

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of the International Neuropsychological Society
  • ISSN: 1355-6177
  • EISSN: 1469-7661
  • URL: /core/journals/journal-of-the-international-neuropsychological-society
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Altmetric attention score

Full text views

Total number of HTML views: 17
Total number of PDF views: 81 *
Loading metrics...

Abstract views

Total abstract views: 610 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 28th June 2017. This data will be updated every 24 hours.