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NEUROLOGY 2009;73:356-361
© 2009 American Academy of Neurology

Cognitive activities delay onset of memory decline in persons who develop dementia

C. B. Hall, PhD, R. B. Lipton, MD, M. Sliwinski, PhD, M. J. Katz, MPH, C. A. Derby, PhD and J. Verghese, MB, BS

From the Department of Epidemiology and Population Health (C.B.H., R.B.L., C.A.D.), Department of Neurology (C.B.H., R.B.L., M.S., M.J.K., C.A.D., J.V.), and Einstein Aging Study (C.B.H., R.B.L., M.S., M.J.K., C.A.D., J.V.), Albert Einstein College of Medicine, Bronx, NY; Montefiore Medical Center (R.B.L., J.V.), Bronx, NY; and Department of Psychology (M.S.), Syracuse University, Syracuse, NY is currently affiliated with the Department of Human Development and Family Studies, and Gerontology Center, Pennsylvania State University, University Park.

Address correspondence and reprint requests to Dr. Charles B. Hall, Department of Epidemiology and Population Health, and Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Ave., Bronx, NY 10461 chall{at}aecom.yu.edu

Background: Persons destined to develop dementia experience an accelerated rate of decline in cognitive ability, particularly in memory. Early life education and participation in cognitively stimulating leisure activities later in life are 2 factors thought to reflect cognitive reserve, which may delay the onset of the memory decline in the preclinical stages of dementia.

Methods: We followed 488 initially cognitively intact community residing individuals with epidemiologic, clinical, and cognitive assessments every 12 to 18 months in the Bronx Aging Study. We assessed the influence of self-reported participation in cognitively stimulating leisure activities 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.

Results: Each additional self-reported day of cognitive activity at baseline delayed the onset of accelerated memory decline by 0.18 years. Higher baseline levels of cognitive activity were associated with more rapid memory decline after that onset. Inclusion of education did not significantly add to the fit of the model beyond the effect of cognitive activities.

Conclusions: Our findings show that late life cognitive activities influence cognitive reserve independently of education. The effect of early life education on cognitive reserve may be mediated by cognitive activity later in life. Alternatively, early life education may be a determinant of cognitive reserve, and individuals with more education may choose to participate in cognitive activities without influencing reserve. Future studies should examine the efficacy of increasing participation in cognitive activities to prevent or delay dementia.

Abbreviations: AD = Alzheimer disease; BL = baseline; CAS = Cognitive Activity Scale; CI = confidence interval; DSM = Diagnostic and Statistical Manual of Mental Disorders; dx = diagnosis; NIA = National Institute on Aging; SRT = Selective Reminding Test; WAIS VIQ = Wechsler Adult Intelligence Scale Verbal IQ.

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Supplemental data at www.neurology.org

Supported in part by a program project grant from the National Institute on Aging (P01 AG03949). Original data collection in the Bronx Aging Study had been funded by earlier grants from the National Institute on Aging and the National Institute of Neurological Disorders and Stroke. The sponsors played no role in the study design; nor in the collection, analysis, and interpretation of data; nor in the writing of the report; nor in the decision to submit the paper for publication. Dr. Hall had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Disclosure: Author disclosures are provided at the end of the article.

Received October 23, 2008. Accepted in final form April 22, 2009.

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