Cutting MCI Risk: The More Mental Activities, the Better

Michael Vlessides

July 10, 2019

Engaging in mentally stimulating activities, such as playing games, using a computer, and crafting — whether individually or in combination — is associated with a lower risk for mild cognitive impairment (MCI), new research suggests.

A large population-based study shows that using a computer in middle age was associated with a 48% lower MCI risk; engaging in social activities in both middle age and later life was associated with a 20% lower risk. Engaging in crafts was linked to a 42% lower risk, but only when such engagement occurred in later life.

Interestingly, the more activities individuals engaged in during later life, the less likely they were to develop MCI.

Study author Janina Krell-Roesch, PhD, Mayo Clinic, Scottsdale, Arizona, said there are two primary take-home messages from the study.

"The first is that we found good evidence that the more activities people engage in, particularly during late life, the less likely they are to develop mild cognitive impairment. The second is that there seems to be a positive association between the number of activities and the reduction in risk of developing mild cognitive impairment," Krell-Roesch told Medscape Medical News.

The current study takes the investigators' previous findings one step further, she noted. In the past, participants were classified as either engaging or not engaging in mentally stimulating activities.

"In the current study, we took a more detailed look into the relationship. We didn't just want to know if it's good to engage or not but...wanted to get more information regarding the frequency and the number of activities," Krell-Roesch said.

The results were published online July 10 in Neurology.

Potential Prevention Strategies

The current lack of effective treatment for Alzheimer disease (AD) has prompted interest in the potential of lifestyle factors to positively affect aging of the brain, the investigators note. Examining MCI, a presymptomatic stage of AD, may offer insight into potential preventive strategies, they add.

Of these, mentally stimulating activities are common targets, given their low cost and broad availability. Moreover, previous research has linked mental, cognitive, or intellectual activities with a reduced risk for cognitive decline.

A 2016 meta-analysis of 19 studies concluded that participation in such activities is associated with a reduced risk for cognitive impairment and dementia.

As reported by Medscape Medical News, a study published in 2017 by the current investigators showed that cognitively unimpaired older people who engaged in certain mentally stimulating activities were at lower risk of developing new-onset MCI.

"However," the authors write, "we only focused on activities carried out in late life and it remains unclear whether the risk of incident mild cognitive impairment is also associated with mentally stimulating activities carried out in midlife."

"Our research team wants to understand if the general public can do something simple and accessible that will either delay or prevent early-stage mild cognitive impairment or dementia," study author Yonas E. Geda, MD, Mayo Clinic in Scottsdale, told Medscape Medical News.

"People are living longer, and they want to know if mild cognitive impairment can be delayed or prevented by simple activities, not expensive gimmicks," Geda added. "Because we know there are no available medications at this point, our best option at this time is lifestyle modification."

Population-Based Study

To help answer these questions, the investigators accessed data from the longitudinal, population-based Mayo Clinic Study of Aging.

They examined cognitively unimpaired individuals who were at least 70 years old. All of the participants had completed a questionnaire regarding their engagement in five mentally stimulating activities during midlife (ages 50–65) and late life (ages 66 or older): reading books, using a computer, engaging in social activities, playing games, and engaging in craft activities. All underwent cognitive evaluation at baseline and every 15 months thereafter.

The final cohort included 2000 individuals (average age, 78 years) who were followed for a median of 5 years until they either developed new-onset MCI or remained cognitively unimpaired. Data were collected between June 2006 and December 2016.

All participants underwent a face-to-face evaluation, which included a neurologic examination, assessment of risk factors, and neuropsychological testing. The neurologic evaluation included a neurologic history review, a neurologic examination, and administration of the Short Test of Mental Status.

Performance in a variety of cognitive domains, including memory, language, visuospatial skills, and attention/executive function, was assessed via neuropsychological testing. An expert consensus panel determined the cognitive status of each participant.

Mentally simulating activities were defined broadly and included reading books; engaging in craft activities, such as pottery, quilting, or sewing; being active on the computer; playing games, such as cards or crossword puzzles; and engaging in social activities, such as going to the movies or going out with friends.

A structured survey was used to assess the frequency of participants' engagement in each activity.

More Is More

Results showed that 532 participants developed MCI during the course of the study. The risk was reduced by 20% for participants who engaged in social activities (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.64 – 0.99) and played games (HR, 0.80; 95% CI, 0.66 – 0.98) in both late life and midlife.

Using a computer was associated with a decreased risk for MCI regardless of timing: not late life but midlife (HR, 0.52; 95% CI, 0.31 – 0.88), late life but not midlife (HR, 0.70; 95% CI, 0.56 – 0.88), and both late life and midlife (HR, 0.63; 95% CI, 0.51 – 0.79).

Enging in craft activities was also associated with a reduced risk for incident MCI, though only when carried out in late life, not midlife (HR, 0.58; 95% CI, 0.34 – 0.97).

Perhaps not surprisingly, engaging in a higher number of activities in late life was associated with a reduced risk for incident MCI.

Engaging in any two activities reduced the risk by 28% (HR, 0.72; 95% CI, 0.53 – 0.99); any three reduced the risk by 45% (HR, 0.55; 95% CI, 0.40 – 0.77); any four reduced the risk by 56% (HR, 0.44; 95% CI, 0.30 – 0.65); and engaging in all five activities reduced the risk by 43% (HR, 0.57; 95% CI, 0.34 – 0.96).

The findings have broad potential implications and may open the door to stemming the tide of MCI in an aging population, the researchers note.

Interestingly, although previous studies have shown that engaging in cognitive and social activities during midlife was associated with better late-life cognitive scores, the current work revealed differing associations between late-life and midlife activities and incident MCI. Specifically, mentally stimulating activities carried out in late life were more relevant to reducing such risk than were midlife activities.

"This study is good news for people 70 years and older because it showed that if a person at that age engages in a number of activities, it reduces their risk significantly more than if they engage in only one or two," Geda said.

"The most beneficial effect seems to be for late-life activities," Krell-Roesch added. "I think that is really interesting, because it implies that it may never be too late to start."

Encouraging Research

Commenting for Medscape Medical News, Elaine C. Jones, MD, a fellow of the American Academy of Neurology, said she is encouraged and that such findings offer neurologists guidance regarding the type and timing of activities to help aging patients.

"We know people get more isolated as they get older, which can decrease their stimulation. So there's no question that when people get out and get engaged socially or get involved in things, they do better," said Jones, a teleneurologist with SOC Telemed. She was not involved in the study.

"I have seen it over and over in my practice," she added. "I always encourage my older folks to stay active."

Geda noted that the study contradicts the notion that cognitive impairment can only be prevented with rigorous, lifelong training.

"Sometimes people assume that they should have been doing these activities all their life," he explained. "But we've shown that you can pick up activities even after age 70, and they don't have to be expensive computerized gadgets. It can be as simple as social activities, playing games, crafts, or simply reading books," he said.

"These types of simple activities, even if they're done a few times a week, seem to decrease the risk of mild cognitive impairment," he said.

Support for the study was provided by the National Institutes of Health (NIH), the National Institute of Mental Health, the Robert Wood Johnson Foundation, the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer's Disease Research Program, the GHR Foundation, the Mayo Foundation for Medical Education and Research, the Edli Foundation, and the Arizona Alzheimer's Consortium. Krell-Roesch has received research funding from the NIH. Geda has received funding from the NIH and Roche and has served on the Lundbeck advisory board. Jones has disclosed no relevant financial relationships.

Neurology. Published online July 10, 2019. Abstract

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