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Int J Geriatr Psychiatry. 2006 Jul;21(7):611-7.

An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia.

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Department of Applied Social Studies, City University of Hong Kong.



To explore the effect of an activity treatment-mahjong-on the cognitive functioning of persons with mild-to-moderate dementia.


Participants were 62 older persons (M(age) = 83.94, SD = 7.58) who met DSM-IV diagnosis of any dementia condition, had an initial Mini-Mental State Examination (MMSE) score < or = 24, and were able to play, yet not having played mahjong for the past six months. They were randomly assigned to play either twice (n = 33) or four times (n = 29) a week over a 16-week duration. Digit forward span, digit forward sequence, verbal memory and MMSE were measured at baseline, post-test and 1-month follow-up.


Regardless of frequency of playing, mahjong produced consistent gains across all cognitive performance measures. It had large effect sizes on digit forward memory (1.0-1.4 for both span and sequence), moderate-to-large effect sizes on verbal memory (0.5-0.9), and a moderate effect size on MMSE (around 0.6). The effects lasted after mahjong had been withdrawn for a month, suggesting that constant practice is not necessary to achieve therapeutic effect once an initial threshold is attained.


Mahjong is a viable treatment option for dementia. Because mahjong therapy basically does not require professional supervision and can be implemented as widely as space allows at a given time, the potential benefits of integrating mahjong into the daily routines of an institution are enormous vis-à-vis minimal, if any, cost to the institution.

[Indexed for MEDLINE]

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