More Evidence Mentally Stimulating Activities Linked to Lower Incident MCI

Pauline Anderson

March 08, 2016

Engaging in mentally stimulating activities, such as doing crafts and using a computer, is associated with lower risk for mild cognitive impairment (MCI) among older patients, a new prospective cohort study shows.

"The bottom line is that even in late age, even after age 70, if you engage in these activities, it potentially protects you against developing incident MCI, which has a very high risk for dementia," said study author Yonas Geda, MD, co-investigator, Mayo Clinic Study of Aging.

The benefits of being cognitively engaged were even seen among apolipoprotein E (APOE) ε4 carriers.

The results were released March 3, ahead of their presentation at the upcoming American Academy of Neurology (AAN) 2016 Annual Meeting next month.

A previous cross-sectional study by Dr Geda and his colleagues had shown an association between late-life mentally stimulating activities and decreased risk for MCI.

This, said Dr Geda, generated a hypothesis that researchers wanted to test further. "Sometimes cross-sectional studies may not pan out in a cohort study."

For this new study, Dr Geda and his team conducted a prospective cohort study from the population-based Study of Aging in Olmsted County, Minnesota. They followed 1929 cognitively normal persons aged 70 years and older at baseline (2006).

Participants filled out a questionnaire providing information about engaging in mentally stimulating activities within the previous year. They chose among six different categories: once a month or less, two to three times per month, one to two times per week, three to four times per week, five to six times per week, and every day.

"We compared those who said they engaged in these activities at least once a week vs those who engaged in them less than once a week," said lead author Janina Krell-Roesch, PhD, Mayo Clinic, Scottsdale, Arizona.

Dr Janina Krell-Roesch

During a median of 4 years, participants were seen every 12 to 15 months. An expert consensus panel confirmed diagnoses of MCI.

The study found that participating in games, such as playing cards and doing crossword puzzles, was associated with a decreased risk for incident MCI.

Other mentally stimulating activities also reduced the risk, including reading magazines; doing crafts, such a knitting, woodworking, pottery, quilting, sewing, and ceramics; using the computer to search the Internet, play computer games, and conduct research; and being socially active.

Table. Risk for MCI Associated With Mentally Challenging Activities

Activity Hazard Ratio (95% Confidence Interval)
Games 0.78 (0.65 - 0.95)
Reading magazines 0.66 (0.54 - 0.82)
Crafts 0.72 (0.57 - 0.90)
Computer Internet use 0.70 (0.57 - 0.85)
Being socially active 0.77 (0.63 - 0.94)


Solid Evidence

All the point estimates "are essentially between 0 and 1, indicating that everything is pointing in the direction of possible protection against incident MCI," noted Dr Geda. "The fact that everything is pointing in the same direction suggests that the story is solid."

Researchers stratified subjects by APOE ε4 allele status. Of the total, almost 27% were carriers.

For noncarriers, the findings remained the same, but for carriers, only computer use (hazard ratio [HR], 0.65; 95% confidence interval [CI], 0.46 - 0.92) and social activities (HR, 0.62; 95% CI, 0.43 - 0.89) were associated with a decreased risk for MCI.

"Even for a person who is at genetic risk for Alzheimer's disease, engaging in some activities was beneficial," commented Dr Geda. "So I think the signal is there even for APOE ε4 carriers."

The study results "seem to give elderly people some hope," he said. That's good news for the "many older people who tend to become resigned or give up."

In any case, participating in mentally stimulating activities "doesn't do any harm," added Dr Krell-Roesch. "It will definitely not have a negative impact."

Next steps might include looking at correlations with other measures, such as cerebral spinal fluid biomarkers, said Dr Geda.

Reached for a comment, Heather M. Snyder, PhD, senior director, medical and scientific operations, Alzheimer's Association, said the study seems to uphold the "use it or lose it" idea that continuing to stimulate your brain is important.

"It adds to what we've seen in the literature that using your brain, continuing to stay cognitively active, continuing that life-long learning, and learning new things, is beneficial in cognitive decline as we age."

However, Dr Snyder cautioned that this is an observational study. "So it's hard to say that it's specific to the activity; there may be other things that these subjects are also doing as part of their lifestyle because they're engaged in that type of activity."

It's difficult to interpret the finding that certain activities "stood out" for APOE ε4 carriers, said Dr Snyder. "It could just be a power issue," in terms of the numbers of carriers taking part in the various activities.

"We really don't know what this means," she said. "It warrants further investigation into trying to understand what types of activities mostly benefit them."

The study was supported by the National Institute on Aging, National Institute of Mental Health, Robert Wood Johnson Foundation, Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program, European Regional Development Fund, and Arizona Alzheimer's Consortium.

American Academy of Neurology (AAN) 2016 Annual Meeting. Abstract 2381.


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