Engaging in arts and crafts and social activities in mid-life and late life and using a computer in late life were associated with a reduced risk for mild cognitive impairment (MCI) in elderly patients, a new study has shown.
"The key point we want to get across is that you need to start these activities early," said lead author Rosebud Roberts, MB, ChB, professor of epidemiology and neurology, Mayo Clinic, Rochester, Minnesota. "There's no cure for Alzheimer's disease and there's no treatment that lasts beyond 18 months to 2 years."
Part of that message is that if you start these activities earlier, perhaps in your 20s, "keep doing them throughout your life; don't stop as you get older," said Dr Roberts.
Their findings, published online April 8 in Neurology, also showed that MCI risk was increased with the APOE ε4 allele; hypertension onset in midlife; and having comorbidities, vascular disease, and depressive symptoms.
Painting and Quilting
The study included cognitively normal patients who were randomly selected from among Olmsted County Minnesota residents participating in the Mayo Clinic Study of Aging. Their evaluation consisted of three components: A nurse or coordinator administered the Clinical Dementia Rating scale and the Functional Activities Questionnaire to an informant; a physical examination included the Short Test of Memory Status and a neurologic examination; and a psychometrist assessed performance on memory, executive function, language, and visuospatial skills.
Participants were asked how often they did arts (eg, painting and drawing) in mid-life and also within the last year. They were asked about crafts pursuits (eg, quilting or woodworking), and they were queried about social engagement (eg, if they went to movies, concerts, theater; went out with friends; or traveled).
Participants could indicate that they pursued an activity once a month or less, two to three times a month, or more frequently. The study participants also reported on use of computers, such as searching the Internet, emailing, or online shopping.
MCI was diagnosed according to published criteria that included cognitive concern, impairment in one or more of the four cognitive domains, essentially normal functional activities, and absence of dementia. MCI was classified as amnestic (aMCI) or nonamnestic (naMCI). Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria.
Of the 301 participants who were cognitively normal at enrollment, 256 (97 men and 159 women; mean age, about 87 years) had 1 or more follow-up evaluations. Of these, there were 121 incident MCI events over a median of 4.1 years.
MCI risk was associated with mid- and late-life hypertension (hazard ratio [HR] for combined mid-life and late life, 2.43; confidence interval [CI], 1.30 - 4.54; P = .005) and with an APOE allele (HR, 1.89; CI, 1.18 - 3.02; P = .008).
For some experts — including James Leverenz, MD, director, Cleveland Clinic Lou Ruvo Center for Brain Health in Ohio, who was asked to comment — the increased risk for conversion in APOE ε4 carriers in these older patients was a surprise.
"Up to this point, it has been suggested that in this older age group, APOE ε4 doesn't seem to play much of a role for conversion to cognitive impairment from normal," he told Medscape Medical News. "Many of us assumed that those APOE ε4 people who survived to this age either had other genes that counteracted the APOE effect or there was some other reason why it no longer seemed to play a big role in conversion. This new study sort of contradicts some of the literature and suggests that ε4 can be a risk for conversion in older age as well."
The MCI risk was also elevated with increasing comorbidities and vascular disease burden.
Compared with participants who lacked depressive symptoms, participants with these symptoms had an increased risk for MCI (HR, 1.78; 95% CI, 1.09 - 2.89; P = .02).
The risk was reduced in those engaging in both mid-life and late life in artistic activities, crafts, and social activities.
Table. Risk for MCI by Activities in Mid-Life and Late Life
|Activities||HR (95% CI)||P Value|
|Artistic activities||0.27 (0.09 - 0.87)||.03|
|Craft activities||0.55 (0.33 - 0.90)||.02|
|Social activities||0.45 (0.26 - 0.78)||.005|
Why artistic pursuits would have a bigger effect on preventing MCI than doing crafts may be because one is producing something for use (eg, a quilt) while the other is producing something with aesthetic qualities (eg, a painting).
"It's a question of how these activities are impacting the brain," said Dr Roberts. "With artistic activities, you are actually creating something and wracking your brain to bring it forth, and so it may be that that actually maintains the brain or stimulates the brain or develops new neurons."
The effects of arts and crafts on risk for MCI were seen in men but were stronger in women, said Dr Roberts. She noted that compared with women, fewer men pursued arts and crafts — and the ones who did were involved in activities such as woodworking, whittling, or pottery.
Asked whether an 80-year-old who has never been social or engaged in arts or crafts could benefit cognitively from taking up these pursuits at such a later age, Dr. Roberts said it's difficult to answer that from the study because few participants did these activities only in later life. The low numbers might explain why the results for late-life pursuit of arts, crafts, and social activities were "not particularly significant."
The MCI risk was also reduced for those using a computer in late life (HR, 0.47; 95% CI, 0.27 - 0.83; P = .008). Computer use wasn't significant for mid-life, but Dr. Roberts pointed out that this might be because computers weren't in common use when these older participants were middle-aged.
When researchers separated this by sex, they found a significant benefit of computer use in late life in women but less of a benefit in men, said Dr Roberts.
As for MCI subtype, depressive symptoms were associated with an increased risk for aMCI, and social activity in both mid-life and late life was associated with reduced risk. Significant predictors of naMCI were mid- and late-life diabetes, mid- and late-life hypertension, increasing comorbidities, increasing vascular disease burden, and an APOE ε4 allele.
The association of APOE ε4 with naMCI was unexpected because the genetic variation is usually linked with amnestic MCI. However, Dr Roberts pointed out that the APOE gene affects vascular disease and that naMCI typically has underlying vascular disease pathology.
As for sex differences for higher MCI risks, the study showed that the risk rose with increasing burden of chronic disease in men and with increasing burden of vascular disease in women. "This difference raises the hypothesis that oldest old men may be sicker than women, and this multifactorial morbidity may contribute to MCI," the authors write.
While self-reports of how often one engaged in artistic or social activities many years ago could be contaminated with reporting bias, the new findings help to clearly demonstrate the benefits of cognitively and socially stimulating activities, commented James Galvin, MD, Departments of Neurology, Psychiatry, and Population Health, NYU Langone Medical Center, New York, in an accompanying editorial.
"Long ago, 'an apple a day keeps the doctor away' was a common expression, suggesting that eating well could improve health. Perhaps today the expression should expand to include painting an apple, going to the store with a friend to buy an apple, and using an Apple product," he writes.
Dr Leverenz cautioned that this is an associational study and association doesn't mean causation. He used the example of gait speed, which in the study was associated with reduced risk of converting to naMCI. "I don't think that suggests necessarily that if you walk faster you prevent dementia. I think it means that walking slowly is probably an indication of other things like medical illnesses."
He noted that the study is retrospective and relies on older people's recollection of what they may have been doing 50 years ago. Further, it included only residents of Olmsted County, so it may not be representative of other populations.
He also pointed out that apathy or loss of interest in activities may play a role in conversion to MCI. "The question is whether it's the activity that's preventing the development of MCI or whether people who are at the earliest stages of developing cognitive impairment are becoming apathetic and are less likely to participate in activities."
On the other hand, he added, there is no "downside" to taking up activities that appear to be preventive. "Some data suggest that being physically active, being socially active, and being mentally active may be protective, although there's some debate still on that issue; but there is really no debate about whether it's bad for you."
The study was supported by the National Institute on Aging, the Mayo Foundation for Medical Education and Research, and the Rochester Epidemiology Project. Dr Roberts and Dr Leverenz have disclosed no relevant financial relationships. Dr Galvin receives research support from the National Institutes of Health, Michael J. Fox Foundation, New York State Department of Health, Morris and Alma Schapiro Fund, and a grant from Applied Science Research Fund at NYU Langone Medical Center; serves as an investigator in clinical trials sponsored by the National Institutes of Health, Merck, Eli Lilly, Takeda, Zinfandel, Neuronix, Lundbeck, and Medivante; and receives licensing fees from Novartis, Pfizer, and Eisai for cocreation of the AD8 dementia screening test.
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Cite this: Arts and Crafts Linked to Lower Risk for Cognitive Decline - Medscape - Apr 09, 2015.