The Science

1. The New England Journal of Medicine

Leisure activities and the risk of dementia in the elderly (2003)

Verghese J, Lipton RB, Katz MJ, Hall CB, Derby CA, Kuslanksy G, Ambrose A, Sliwinski M, Buschke H.

"The New England Journal of Medicine", 348: 2508-2516

Conclusion: Participation in cognitive activities was associated with a reduced risk of Alzheimer's disease, vascular dementia, and mixed dementia. Further, subjects who frequently participated in cognitively stimulating activities "had a risk of dementia 63 percent lower than that among subjects" who participated less frequently. Lower levels of participation were also associated with higher levels of depression.

Study Details: Beginning in 1980, the Bronx Aging study enrolled and followed 469 subjects for a median follow-up of 5.1 years. All subjects were between the ages of 75 and 85 years, and had no diagnosis of dementia. Clinical and neuropsychological evaluations were conducted at baseline, with follow-up visits every 12 to 18 months. Frequency of participation in six cognitive activities (reading books or newspapers, writing for pleasure, doing crossword puzzles, playing board games or cards, participating in organized group discussions, and playing musical instruments) was assessed.

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2. Journal of the American Medical Association

Participation in cognitively stimulating activities and the risk of incident Alzheimer disease (2002)

Wilson RS, Mendes de Leon CF, Barnes LL, Schneider JA, Bienias JL, Evans DA, Bennett DA.

"Journal of the American Medical Association", 287: 742-748

Conclusion: With a mean follow-up of 4.5 years, results indicated that those who reported frequent involvement in cognitive activity at baseline were 47% less likely to develop AD than those with infrequent cognitive activity.

Study Details: Beginning in 1994, approximately 730 subjects aged 65 years or older without a clinical diagnosis of dementia were enrolled and followed in the Religious Orders Study. Baseline assessments consisted of structured evaluations, which were repeated annually, including a medical history, neurological examination, assessment of cognitive function, and a review of brain scan when available. Investigators assessed the frequency of participation in "seven common activities that involve information processing as a central component: viewing television; listening to radio; reading newspapers; reading magazines; reading books; playing games such as cards, checkers, crosswords, or other puzzles; and going to museums.

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3. Neurology

Cognitive activity and cognitive decline in a biracial community population (2003)

Wilson RS, Bennett DA, Bienias JL, Mendes de Leon CF, Morris MC, Evans DA.

"Neurology", 61: 812-816

Conclusion: On average, subjects who frequently participated in cognitively stimulating activities experienced 35% less cognitive decline than those with infrequent cognitive activity.

Study Details: This population-based longitudinal study of aging and Alzheimer's disease enrolled and followed more than 4,000 adults, aged 65 years and older as part of the Chicago Health and Aging Project. Persons with memory impairment at baseline were not excluded from the study group. Subjects were interviewed at approximately 3-year intervals, with a mean follow-up of 5.3 years. Cognitive performance tests were administered at baseline, and subjects rated the frequency of participation in seven cognitive activities (same as those listed in study directly above).

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4. Journal of Geriatric Psychiatry and Neurology

Participation in novelty-seeking leisure activities and Alzheimer's disease (2005)

Fritsch T, Smyth KA, Debanne SM, Petot GJ, Friedland RP.

"Journal of Geriatric Psychiatry and Neurology", 18: 134-141

Conclusion: Greater participation in novelty-seeking and exchange-of-ideas activities across the life span was associated with decreased odds of developing Alzheimer's disease.

Study Details: Using a case-control design, researchers collected data on 16 types of activities performed between the ages of 20 and 60 years. 264 subjects with AD served as cases, and 545 subjects without cognitive impairment served as controls. Participation in novelty-seeking activities (defined in this study as: learning a new skill, learning about a new subject, doing things that are challenging mentally, solving a problem, getting a new experience, taking up a new hobby) had the greatest association with reduced risk for AD.

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5. Annals of Internal Medicine

Healthy Aging and Dementia: Findings from the Nun Study (2003)

Snowden, David.

"Annals of Internal Medicine", 139: 450-454

Conclusion: A considerable proportion of subjects with mild to moderate stages of Alzheimer's disease pathology showed no symptoms of memory impairment. It is hypothesized that cognitive reserve, believed to be influenced by educational and occupational attainment, as well as participation in mentally challenging activities, helped these subjects to resist the clinical expression of symptoms of AD.

Study Details: 678 Catholic sisters, ages 75 to 102 years of age, participated in the Nun Study, a longitudinal study of Alzheimer's disease and aging. Researchers analyzed convent archives, annual physical and cognitive examinations, and brain autopsies upon death to determine correlations between aging and dementia among this population. The conclusion stated above was found by comparing the results of the last cognitive examination before death to level of neuropathology in the brain after death.

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6. Journal of the American Medical Association

Long-term effects of cognitive training on everyday functional outcomes in older adults (2006)

Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, Morris JN, Rebok GW, Unverzagt FW, Stoddard AM, Wright E.

"Journal of the American Medical Association", 296: 2805-2814

Conclusion: Overall, improvement in each cognitive ability trained was retained after 5 years. Significantly less difficulty in the instrumental activities of daily living (IADL) was reported from the reasoning training group only, when compared to the control group. Additionally, when controlling for baseline age and cognitive function, participants who received booster training in the speed-of-processing intervention training group demonstrated better performance on functional measures of everyday speed-of-processing, compared to those who did not receive booster training.

Study Details: Approximately 2,800 subjects, 65-94 years of age, residing independently in the community, without significant functional or cognitive decline or diagnosis of AD were enrolled and followed in the ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) study. The ACTIVE study included three intervention groups (memory training, reasoning training, speed-of-processing training), and one no-contact control group. Booster training was provided to a random subsample within each intervention group. Memory training involved verbal episodic memory; reasoning training involved the ability to solve problems that follow a serial pattern; and speed-of-processing training involved visual search skills as well as the ability to identify and locate visual information quickly in a divided-attention format. Sixty-seven percent of the sample was retained 5 years after training (approximately 1,800 individuals).

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7. Acta Psychiatrica Scandinavica

Cognitive training in Alzheimer's disease: a meta-analysis of the literature (2006)

Sitzer DI, Twamley EW, Jeste DV.

"Acta Psychiatrica Scandinavica", 114: 75-90

Conclusion: In general, cognitive training can improve the cognitive and functional abilities of patients with AD. Restorative strategies resulted in larger effect sizes than compensatory strategies. Studies involving individual treatment modalities reported greater effect sizes compared to group modalities.

Study Details: Researchers defined cognitive training for the purposes of this review as "any non-pharmacologic intervention designed to improve cognitive functioning, regardless of mechanism of action." Cognitive training strategies were divided into two basic categories: compensatory and restorative. Compensatory strategies aim to teach new ways of performing cognitive tasks by 'working around' cognitive deficits; examples include categorizing information to be remembered, procedural training, and others. Restorative strategies attempt to improve functioning in specific domains with the ultimate goal of returning functioning in those domains to premorbid levels; examples include spaced retrieval, reminiscence therapy, and others. Results of the literature review were based on 19 studies, 14 of which were randomized controlled trials.

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8. British Journal of Psychiatry

Cognitive stimulation therapy for people with dementia: a cost-effectiveness analysis (2006)

Knapp M, Thorgrimsen L, Patel A, Spector A, Hallam A, Woods B, Orrell M.

"British Journal of Psychiatry", 188: 574-580

Conclusion: In relation to the two primary outcome measures, cognition and quality of life, the investigators determined that there seems to be a high probability that cognitive stimulation therapy is more cost-effective than treatment as usual

Study Details: An evidence-based cognitive stimulation program was developed based on reality orientation and reminiscence therapy for dementia. All subjects met DSM-IV criteria for dementia and scored between 10 and 24 on the MMSE, and had a baseline mean age of approximately 85 years. There were approximately 150 subjects at the 8-week follow-up.

Cognitive stimulation groups consisted of five participants and two staff members, ran for seven weeks, with a mean attendance of 11.6 sessions. Primary and secondary outcome measures were based on the Mini-Mental State Examination and Quality of Life in Alzheimer's Disease (QoL-AD) assessment. Changes in MMSE and QoL-AD scores were used to determine cost-effectiveness of the cognitive stimulation training (CST) compared to treatment as usual. The cost estimate of the CST intervention included researchers' time, travel expenses, care assistant time, and equipment.

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