Cognitive leisure activities and their role in preventing dementia: a systematic review

Background: Dementia inflicts a tremendous burden on the healthcare system. Identifying protective factors or effective prevention strategies may lead to considerable benefits. One possible strategy mentioned in the literature relates to participation in cognitive leisure activities.

Aim: To determine the effectiveness of cognitive leisure activities in preventing Alzheimer's and other dementias among older adults.

Inclusion criteria: Types of participants. Adults aged at least 60 years of age with or without a clinical diagnosis of dementia that resided in the community or care setting. Types of interventions. Cognitive leisure activities, defined as activities that required a mental response from the individual taking part in the activity (e.g. reading). Types of outcomes. The presence or absence of dementia was the outcome of interest. Types of studies. Any randomised controlled trials, other experimental studies, as well as cohort, case-control and cross-sectional studies were considered for inclusion. Search strategy. A search for published and unpublished studies in the English language was undertaken with no publication date restriction.

Methodological quality: Each study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments.

Data collection and analysis: Information was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. Because of the heterogeneity of populations and interventions, meta-analyses were not possible and results are presented in narrative form.

Results: There were no randomised controlled trials located that met inclusion criteria. Thirteen observational studies were included in the review; the majority were cohort design. Because of the heterogeneity of interventions, the study design, the way in which they were grouped and the different stages of life they were measured at, statistical pooling was not appropriate. Studies were grouped by stage of adult life participation when interventions were undertaken, that is, early adulthood, middle adulthood and late life. Five out of six studies showed a positive association between participating in activities and a reduced risk of developing Alzheimer's disease and other dementias when interventions were undertaken in middle adulthood and six out of seven studies produced a positive association for late life participation. Results indicated that some activities might be more beneficial than others; however, results should be interpreted with caution because of the subjective nature of activity inclusion.

Conclusion: • Actively participating in cognitive leisure activities during mid- or late life may be beneficial in preventing the risk of Alzheimer's disease and other dementias in the elderly; however, the evidence is currently not strong enough to infer a direct causal relationship. • Participating in selected cognitive leisure activities may be more favourable than others but currently there is no strong evidence to recommend one over the other.