Do Leisure Activities Really Mitigate
Dementia Risk?

Megan Brooks

November 02, 2020

Contrary to some previous research, new findings question whether leisure activities in middle age really do help mitigate subsequent dementia risk.

The study showed no association between taking part in more leisure activities at age 56 and the risk of dementia over the next 18 years. There was some benefit when leisure activity participation was assessed later in life.

"Of course there are many reasons to participate in leisure activities and this finding does not question the importance of keeping active for general health and well-being, but it does suggest that simply increasing leisure activity may not be a strategy for preventing dementia," study investigator Andrew Sommerlad, PhD, from University College London, United Kingdom, said in a news release.

The study also showed that some people who were later diagnosed with dementia stopped participating in leisure activities years before they were diagnosed, suggesting that changes in the amount of leisure activity may be an early sign of dementia.

"Dementia appeared to be the cause, rather than consequence, of low levels of leisure activities," Sommerlad told Medscape Medical News.

The study was published online October 28 in the journal Neurology

Still Beneficial

The study included 8280 adults (mean age, 56 years) who were followed for an average of 18 years as part of the Whitehall II study. Participants reported their leisure activities at the beginning of the study, 5 years later, and again 10 years later.

They were placed in low, medium, and high groups based on their levels of participation in leisure activities such as reading, listening to music, taking classes, participating in clubs, visiting friends/ relatives, playing cards or games, taking part in religious activities, and gardening.

During the study, 360 people developed dementia at a mean age of 76.2 years. The overall dementia incidence rate was 2.4 cases for 1000 person-years.

In fully adjusted Cox regression analyses, taking part in more leisure activities at an average age of 56 was not associated with a lower risk of dementia 18 years later (hazard ratio [HR] 0.92, 95% CI, 0.79 - 1.06). 

However, those with higher participation in leisure activities later in life, at a mean age of 66, were less likely to develop dementia over the next 8 years than those with lower participation (HR, 0.82; 95% CI, 0.69 - 0.98).

In addition, a decline in leisure activity during the study was associated with an increased risk of dementia (HR, 1.38; 95% CI, 1.20 - 1.59). 

Of the 1159 people whose activity decreased during the study, 53 (5%) developed dementia, compared with 17 (2%) of 820 people who maintained their leisure activity level.

"More research is needed to confirm these results, but we know that early changes in the brain can start decades before any symptoms emerge," Sommerlad said in the news release.

"It's plausible that people may slow down their activity level up to 10 years before dementia is actually diagnosed, due to subtle changes and symptoms that are not yet recognized," he added.

"There is no question of the wider benefits of taking part in leisure activities, for promoting enjoyment, quality of life and general physical and mental health," Sommerlad said in an interview.

"But other measures have better evidence specifically for dementia prevention. These are treating health problems like diabetes and hypertension, reducing smoking and alcohol intake, physical activity, treating hearing problems, and having social contact with others," he added.

Experts Weigh In

Commenting on the findings for Medscape Medical News, Ronald C. Petersen, MD, PhD, from the Mayo Clinic in Rochester, Minnesota, urged caution in drawing any firm conclusions from this study. 

"It's hard to do these kinds of studies accurately and actually demonstrate that something, in this case leisure activities, can prevent dementia. That's a tall order," he said.

It's possible, he noted, that people who may be experiencing "very early features of a cognitive decline would be less likely to engage in these activities, so it's a little bit of a selection bias from the get-go. On the other hand, we certainly don't want to send the message, 'Don't do these things.' "

"Staying involved in your social network, eating a heart-healthy diet, engaging in some physical activity are things I tell my patients in the office," Petersen said.

The authors of an editorial note that the role of leisure activity in dementia prevention is "far from settled and additional research is needed."

"Midlife and late-life leisure activity certainly does no harm, but its role in dementia prevention is not yet clear. There is more work to be done," write Victor Henderson, MD, with Stanford University in California, and Merrill Elias, PhD, University of Maine in Orono.

They note that long-term, population-based or representative cohort studies, although tough to do, will provide "increasingly precise estimates of the role that lifestyle choices in adulthood — leisure activity, aerobic activity, social engagement, adult education, nutrition, and others — might play in reducing dementia risk."

In addition, large, long-term, randomized controlled trials "could provide even stronger evidence of any causal relationship," they point out.

Several such trials that focus on lifestyle interventions are planned or underway in the US and other countries. They include the FINGER study, which incorporates diet, exercise, cognitive training, and the amelioration of vascular comorbidity.

Another is the US POINTER study, a multisite randomized clinical trial evaluating whether lifestyle interventions — including exercise, cognitively stimulating activities, and the MIND diet — may protect cognitive function in older adults who are at increased risk for cognitive decline.

The Whitehall II study is supported by grants from the US National Institutes of Health, the UK Medical Research Council, and the British Heart Foundation. The authors, editorial writers, and Petersen have disclosed no relevant financial relationships.

Neurology. Published October 28, 2020. Abstract

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