Table 30Cognitive activities and risk of developing AD

StudySample (n)Followup/EventsExposureCase definitionConfounding adjustmentResults
Wilson et al., 2002192Community cohort (some lived in religious order facilities)

4.5 years (mean) (AD cases developed dementia after a mean followup of 3.0 years)

111 AD cases
Self-report of frequency of current involvement in the following activities: viewing television; listening to radio; reading newspapers; reading magazines; reading books; playing games such as cards, checkers, crosswords, or other puzzles; and going to museumsNINCDS-ADRDAAge
Medical conditions
Adjusted HR per 1-point increase on a 5-point cognitive activity scale score: 0.67 (95% CI 0.49 to 0.92)
Verghese et al., 2003194Community cohort

Median 5.1 years

61 AD cases
124 dementia cases
Self-report of frequency of current involvement in the following activities: reading books or newspapers, writing for pleasure, doing crossword puzzles, playing board games or cards, participating in organized group discussions, and playing musical instrumentsNINCDS-ADRDA
Educational level
Medical illness
Baseline Blessed test score
Participation in other leisure activities
Adjusted HR: Higher cognitive activity level: 0.93 (0.88 to 0.98)

Individual cognitive activities associated with decreased risk of dementia:
Reading: HR 0.65 (0.43 to 0.97)
Playing board games: HR 0.26 (0.17 to 0.57)
Playing musical instruments: HR 0.31 (0.11 to 0.90)
Wilson et al., 2007193Community cohort (residents of continuous care retirement communities and subsidized housing facilities) (829)Mean of 3.2 annual followup assessments

90 AD cases
Self-report of frequency of cognitive activities across the lifespan. Activities included activities such as reading a newspaper, playing games like chess or checkers, visiting a library, or attending a playNINCDS-ADRDAAge
Educational level
Adjusted HR: Higher current cognitive activity level: 0.58 (0.44 to 0.77)
Akbaraly et al., 2009195Community cohort (5692)4 years

105 AD cases
Self-report of monthly frequency of doing crosswords, playing cards, attending organizations, going to cinema/theater, and practicing an artistic activityNINCDS-ADRDA
Study center (Dijon or Montpelier)
Marital status
Educational level
Occupational grade
Vascular risk factors:
  • - Diabetes
  • - HTN
  • - High cholesterol
  • - History of vascular disease
Depressive symptoms (CES-D > 16)
Physical function (instrumental ADL score > 0)
Cognitive impairment (MMSE score < 24)
APOE genotype
HR (95% CI) for stimulating leisure activities and AD with lowest tertile as reference:

High: 0.39 (0.21 to 0.71)
Mild: 0.45 (0.26 to 0.77)

In a sensitivity analysis excluding those with low MMSE at baseline, then those with incident AD at 1st followup, then those with MCI at baseline, the HR for stimulating leisure activities and lower risk of AD remained similar to results from entire sample, but some of the confidence intervals included 1.0.

Abbreviations: AD = Alzheimer’s disease; ADL = activities of daily living; APOE = apolipoprotein E gene; CI = confidence interval; CES-D = Center for Epidemiologic Studies Depression scale; DSM = Diagnostic and Statistical Manual of Mental Disorders; HR = hazard ratio; HTN = hypertension; MCI = mild cognitive impairment; MMSE = Mini-Mental State Examination; NINCDS-ADRDA = National Institute of Neurological and Communicative Diseases and Stroke-Alzheimer’s Disease and Related Disorders Association

From: 3, Results

Cover of Preventing Alzheimer's Disease and Cognitive Decline
Preventing Alzheimer's Disease and Cognitive Decline.
Evidence Reports/Technology Assessments, No. 193.
Williams JW, Plassman BL, Burke J, et al.

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