Can our leisure activities help to prevent cognitive decline?
Janice E. Knoefel, MD and
Janet Jankowiak, MD
As our society ages, especially the baby boomer generation,many are asking, "What can we do to postpone the effects ofgetting older?" This question applies not only to the obviouschanges in how we look but also to our cognitive, or thinking,abilities.
Minor incidents such as misplacing keys or glasses, temporarilylosing the car in a parking lot, or momentarily forgetting afriend’s name happen so often that we worry that our mindis failing. A good joke to cover up one of these minor glitchesis that this is just "old timer’s disease." Yet underneaththis humor is the fear that, indeed, as we age, we may loseour mental abilities. So what can we do about it? What, if anything,can be done to prevent or delay cognitive decline that may goalong with aging? See About Brain Health below.
In the current issue of Neurology, a group of researchers fromChina, led by John Y.J. Wang,1 posed just such a question. Theirresults are intriguing. More than 5,000 people, aged 55 yearsor older, and living in nine randomly selected communities inChongqing, China, took part in the study. The subjects wereinterviewed concerning age, sex, education, occupation, smokingand drinking habits, medical conditions, and medication use.To test their thinking abilities they were given a well-knownscreening test called the Mini-Mental State Examination (MMSE).Scores were adjusted for educational level. Additional measureswere used to look for signs of depression and to assess thelevel of independence in caring for one’s own daily needs,called activities of daily living (ADLs).
Detailed information was collected regarding leisure activities.The researchers wished to know how often these people participatedin leisure time activities, for how long, and the nature ofthe activity. Activities such as playing board games, reading,writing, painting, playing music, dancing, performing drama,watching television, or listening to the radio were classifiedas cognitive. Other activities were either physical (walking,fishing, running, gardening) or social (visiting friends/relativesor traveling).
The study group was followed for nearly 5 years, repeating theoriginal tests each year. The final analysis looked at lifefactors such as age, sex, education, occupation, medical conditions,smoking, drinking, depressive symptoms, initial MMSE and ADLscores, and participation in the leisure activities. What didthe researchers find?
Over the 5 years, 11% of the people showed a drop in their thinkingability. These people were more often women, had lower education,had been in a blue collar occupation, were currently smoking,were drinking daily, were older, had more medical conditions,started off with lower (i.e., worse) cognitive scores on theMMSE, and had higher scores (i.e., less independence) in ADLs.Except for smoking and drinking, these were factors that generallycould not be changed.
The point of the study was to look at the relationship betweenparticipation and duration of leisure activities and the riskfor cognitive decline. The study did not disappoint. The analysisshowed that playing board games and reading were associatedwith a reduced risk of developing cognitive impairment. Watchingtelevision was associated with an increased risk of developingcognitive impairment. When the individual leisure activitieswere grouped together, only cognitive activity, and not physicalor social activity, was associated with a reduced risk of developingcognitive decline.
The authors added that the top three leisure activities in thisstudy group were watching television, playing board games, andreading. The participation in other cognitive leisure activities(such as playing music, writing, dancing, painting) was so small(about 1/100th to 1/500th the participation rate of televisionwatching, reading, and playing board games) that it is possiblethat a significant association was present but just not notedbecause so few people did these activities.
The authors tried to explain why certain cognitive activitiesincreased or decreased the risk for cognitive decline. Theysuggested that the cognitive activities, but not physical orsocial activities, had a protective effect against cognitivedecline because of mental stimulation (a positive effect) andnot just being active. They further speculated that watchingtelevision was too passive an activity (did not require enoughmental effort) to counterbalance the effects of aging. However,they admitted that those who chose to spend more time watchingtelevision may have been more impaired at the start and chosenot to participate in other more stimulating activities. Clearly,this study suggests that, like exercising your muscles to stayhealthy, the brain does better with more activity. Turn offthe television and go play a board game!
When people think of good health, the image of a muscular, lean,young, often beautiful person may come to mind. However, aswe age, we come to realize more and more the importance of brainhealth as well. There are increasing reports about a predictedrise in the number of cases of Alzheimer disease (AD) and otherdementias as the baby boomers age. Are there measures that canbe taken to lessen this gloomy forecast? Hopefully there are.
Dementia is a label given when a person has problems thinkingand remembering that interfere with his or her normal dailyfunctioning. AD is the most common form of dementia. It makesup about 60 to 80% of all dementia.
Age is a key factor but that cannot be changed. Still, in someways perhaps thinking young does help. By staying active, thebrain, like a muscle, may do better. Heart health is also important.Irregular heartbeats (arrhythmia), heart attacks, and abnormalheart valves may contribute directly to strokes which, in turn,contribute to cognitive decline. In fact, one of the best-knownways to prevent symptoms of AD is to prevent stroke. Strokemay unmask underlying Alzheimer disease, allowing problems ofmemory loss and impaired thinking to surface earlier.
Some of the major risk factors for heart disease are the samefor stroke and probably certain types of dementia. The biggestone of these is high blood pressure, which can easily be treated.There is increasing evidence that untreated high blood pressureover a long period can cause changes in the small blood vesselsin the brain. This contributes to vascular dementia (usuallyassociated with strokes) and perhaps even to Alzheimer dementia.Most often there are few or no signs of high blood pressureso it is important to have it checked regularly by a healthcare provider.
Diabetes is another leading cause of damage to the small bloodvessels in the brain. Recent research suggests that even ata stage before full-blown diabetes is recognized changes maybe occurring in brain blood vessels. This may result in subtleproblems with thinking.
Smoking is another factor that is associated with damage tobrain blood vessels. It is well known to increase the risk ofheart disease and stroke and probably contributes to vasculardementia as well.
Some of the same things that are good for maintaining good physicalhealth also help your brain stay healthy. These include whatyou eat, how physically active you are, and probably how youuse your brain (both in avoiding risky behaviors and stayingmentally active).
So many different theories exist about what foods are good orbad that it is hard to know what advice to follow. However,it is clear that the obesity epidemic in the United States isa major problem. Obesity is, by nature, associated with an increasedrisk of diabetes and high blood pressure, both risk factorsfor certain types of dementia. Probably the wisest solutionis to eat "in moderation." That is, do not eat too much of anyone type of food and do not take big helpings or seconds. Itseems that eating lots of different fruits and vegetables (atleast six to nine servings per day) is a good idea. Fatty foods,including red meat, should be eaten in much smaller amounts.Some research suggests that eating fish two to three times perweek is good for the brain. Avoiding drinks with a high sugarcontent (sodas, fruit drinks) is also a good way to keep offunwanted pounds. Substitute by drinking lots of fresh water(eight cups of liquid per day is recommended, more in hot weather).There is some research that suggests that a small amount ofalcohol daily may be a good thing, i.e., one glass of wine fora woman, two for a man. However, if you do not already drinkalcohol it may not be a good idea to start, as there can beother risks associated with alcohol.
Exercise is a bad word for many people because they think ofbeing hot, sweaty, and tired. Fortunately, studies suggest thatyou do not necessarily have to do intense exercise to get goodresults. Simple walking, going up and down stairs, gardening,and doing housework can all count. The importance is to stayactive, to move around on a regular basis. Try to find an activitythat you enjoy or try a new one: dancing, swimming, tai chiare examples. Doing an activity regularly with a friend or groupof friends has many added benefits.
Staying mentally alert by challenging yourself seems to be veryhelpful. Learning new hobbies such as needlework, playing boardgames, and carpentry are a few examples. Reading and solvingcrossword puzzles are also great. Activities that require youto use your imagination, memory, and mental flexibility areprobably much better than passive activities like watching television.Socialization also keeps you young longer. Studies suggest thatpeople who attend religious services and are active in theircommunities are happier and tend to live longer.
Depression is common in the elderly and may be associated withdementia. Feelings of depression can unmask symptoms of cognitivedecline and contribute to poor social and psychological function.Most cases of depression can be treated with either supportivecounseling and/or medications.
Brain health depends on staying active: use it or lose it mayapply to the brain as well as to muscles.
Wang JYJ, Zhou DHD, Li J, et al. Leisure activity and risk of cognitive impairment: The Chongqing aging study. Neurology 2006;66:911–913.[Abstract/Free Full Text]
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