Cognitively normal elderly individuals who engage in specific mentally stimulating activities, even in late life, have a decreased risk of Mild Cognitive Impairment, found a Mayo Clinic study.

Mayo Clinic researchers have found that engaging in mentally stimulating activities, even late in life, may protect against new-onset mild cognitive impairment, which is the intermediate stage between normal cognitive aging and dementia. The study found that cognitively normal people 70 or older who engaged in computer use, craft activities, social activities and playing games had a decreased risk of developing mild cognitive impairment.

Researchers followed 1,929 cognitively normal participants of the population-based Mayo Clinic Study of Aging in Olmsted County, Minnesota, for an average duration of four years. After adjusting for sex, age and educational level, researchers discovered that the risk of new-onset mild cognitive impairment decreased by 30% with computer use, 28% with craft activities, 23% with social activities, and 22% with playing games.

“Our team found that persons who performed these activities at least one to two times per week had less cognitive decline than those who engaged in the same activities only two to three times per month or less,” says Dr Yonas Geda, psychiatrist and behavioral neurologist at Mayo Clinic’s Arizona campus and senior author of the study.

Researchers conducted a neuro-cognitive assessment at the time of enrollment in the study, with evaluations every 15 months. Following the assessment, an expert consensus panel at the Alzheimer Disease Research Centre at Mayo Clinic made the classification of normal cognition or mild cognitive impairment for each study participant, based on published criteria.

“Our previous cross-sectional study had found an association between engagement in mentally stimulating activities in late life and decreased odds of mild cognitive impairment,” says Geda. “However, those findings were considered preliminary until confirmed by a prospective cohort study that we are now reporting in JAMA Neurology.”

The benefits of being cognitively engaged even were seen among apolipoprotein E (APOE) ε4 carriers. APOE ε4 is a genetic risk factor for mild cognitive impairment and Alzheimer’s dementia. However, for APOE ε4 carriers, only computer use and social activities were associated with a decreased risk of mild cognitive impairment.

“Even for a person who is at genetic risk for cognitive decline, engaging in some activities was beneficial,” says Dr Janina Krell-Roesch, the first author of the study and a post-doctoral researcher in Geda’s Translational Neuroscience and Aging Programme (TAP). “So I think the signal is there even for APOE ε4 carriers.”

Abstract

Importance: Cross-sectional associations between engagement in mentally stimulating activities and decreased odds of having mild cognitive impairment (MCI) or Alzheimer disease have been reported. However, little is known about the longitudinal outcome of incident MCI as predicted by late-life (aged ≥70 years) mentally stimulating activities.

Objectives: To test the hypothesis of an association between mentally stimulating activities in late life and the risk of incident MCI and to evaluate the influence of the apolipoprotein E (APOE) ε4 genotype.

Design, Setting, and Participants: This investigation was a prospective, population-based cohort study of participants in the Mayo Clinic Study of Aging in Olmsted County, Minnesota. Participants 70 years or older who were cognitively normal at baseline were followed up to the outcome of incident MCI. The study dates were April 2006 to June 2016.

Main Outcomes and Measures: At baseline, participants provided information about mentally stimulating activities within 1 year before enrollment into the study. Neurocognitive assessment was conducted at baseline, with evaluations at 15-month intervals. Cognitive diagnosis was made by an expert consensus panel based on published criteria. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression models after adjusting for sex, age, and educational level.

Results: The final cohort consisted of 1929 cognitively normal persons (median age at baseline, 77 years [interquartile range, 74-82 years]; 50.4% [n = 973] female) who were followed up to the outcome of incident MCI. During a median follow-up period of 4.0 years, it was observed that playing games (HR, 0.78; 95% CI, 0.65-0.95) and engaging in craft activities (HR, 0.72; 95% CI, 0.57-0.90), computer use (HR, 0.70; 95% CI, 0.57-0.85), and social activities (HR, 0.77; 95% CI, 0.63-0.94) were associated with a decreased risk of incident MCI. In a stratified analysis by APOE ε4 carrier status, the data point toward the lowest risk of incident MCI for APOE ɛ4 noncarriers who engage in mentally stimulating activities (eg, computer use: HR, 0.73; 95% CI, 0.58-0.92) and toward the highest risk of incident MCI for APOE ɛ4 carriers who do not engage in mentally stimulating activities (eg, no computer use: HR, 1.74; 95% CI, 1.33-2.27).

Conclusions and Relevance: Cognitively normal elderly individuals who engage in specific mentally stimulating activities even in late life have a decreased risk of incident MCI. The associations may vary by APOE ε4 carrier status.

Authors

Janina Krell-Roesch, Prashanthi Vemuri, Anna Pink, Rosebud O Roberts, Gorazd B Stokin, Michelle M Mielke, Teresa JH Christianson, David S Knopman, Ronald C Petersen, Walter K Kremers, Yonas E Geda