Association of daily intellectual activities with lower risk of incident dementia among older Chinese adults
Open accessAbstract
Importance: Associations between late-life participation in intellectual activities and decreased odds of developing dementia have been reported. However, reverse causality and confounding effects due to other health behaviors or problems have not been adequately addressed. Objective: To examine whether late-life participation in intellectual activities is associated with a lower risk of incident dementia years later, independent of other lifestyle and health-related factors. Design, Setting, and Participants: A longitudinal observational study was conducted at all Elderly Health Centres of the Department of Health of the Government of Hong Kong among 15 582 community-living Chinese individuals age 65 years or older at baseline who were free of dementia, with baseline evaluations performed January 1 to June 30, 2005, and follow-up assessments performed from January 1, 2006, to December 31, 2012. Statistical analysis was performed from January 1, 2015, to December 31, 2016. Main Outcomes and Measures: The main outcome was incident dementia as diagnosed by geriatric psychiatrists in accordance with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, or a Clinical Dementia Rating of 1 to 3. At baseline and follow-up interviews, self-reported information on participation in intellectual activities within 1 month before assessment was collected. Examples of intellectual activities, which were described by a local validated classification system, were reading books, newspapers, or magazines; playing board games, Mahjong, or card games; and betting on horse racing. Other important variables including demographics (age, sex, and educational level), physical and psychiatric comorbidities (cardiovascular risks, depression, visual and hearing impairments, and poor mobility), and lifestyle factors (physical exercise, adequate fruit and vegetable intake, smoking, and recreational and social activities) were also assessed. Results: Of the 15 582 individuals in the study, 9950 (63.9%) were women, and the median age at baseline was 74 years (interquartile range, 71-77 years). A total of 1349 individuals (8.7%) developed dementia during a median follow-up period of 5.0 years. Multivariable logistic regression analysis showed that the estimated odds ratio for incident dementia was 0.71 (95% CI, 0.60-0.84; P < .001) for those with intellectual activities at baseline, after excluding those who developed dementia within 3 years after baseline and adjusting for health behaviors, physical and psychiatric comorbidities, and sociodemographic factors. Conclusions and Relevance: Active participation in intellectual activities, even in late life, might help delay or prevent dementia in older adults.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In a large study in China, people older than 65 years who read, played games, or bet more frequently had reduced dementia risk (n=15,882, OR=0.7, 95% CI 0.6-0.8).
“It found people older than 65 years who read, played games, or bet more frequently had reduced risk of dementia (n=15 882, odds ratio [OR]=0·7, 95% CI 0·6–0·8).”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [40]
The Abstract reports that intellectual activities, including reading, games and betting on horse racing, were associated with lower incident dementia odds (OR 0.71, 95% CI 0.60–0.84), consistent with the rounded figures cited. But the Key Points and Incidence of Dementia sections give a sample of 15,582, not 15,882; the reported OR is for participation in intellectual activities, not specifically for doing them more frequently. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIt is difficult to separate the specific impact of education from overall cognitive ability, and the specific impact of later-life cognitive activity from lifelong cognitive function and activity.
“It is difficult to separate out the specific impact of education from the effect of overall cognitive ability,38, 39 and the specific impact of later-life cognitive activity from lifelong cognitive function and activity.39, 40”
From Dementia prevention, intervention, and care: 2020 report of the Lancet Commission (2020) · cites this paper as [40]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
(2004) · The Lancet · doi:10.1016/s0140-6736(03)15268-3 · Cited by 12,717 · see citing works
Cognitive reserve in ageing and Alzheimer's disease
Stern, Y. (2012) · The Lancet Neurology · doi:10.1016/s1474-4422(12)70191-6 · Cited by 3,557 · see citing works
Forecasting the global burden of Alzheimer's disease
Brookmeyer, R., Johnson, E., Ziegler‐Graham, K., & Arrighi, H. M. (2007) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2007.04.381 · Cited by 3,370 · see citing works
The projected effect of risk factor reduction on Alzheimer's disease prevalence
Barnes, D. E., & Yaffe, K. S. (2011) · The Lancet Neurology · doi:10.1016/s1474-4422(11)70072-2 · Cited by 2,668 · see citing works
Potential for primary prevention of Alzheimer's disease: an analysis of population-based data
Norton, S., Matthews, F. E., Barnes, D. E., Yaffe, K., & Brayne, C. (2014) · The Lancet Neurology · doi:10.1016/s1474-4422(14)70136-x · Cited by 2,466 · see citing works
An active and socially integrated lifestyle in late life might protect against dementia
Fratiglioni, L., Paillard-Borg, S., & Winblad, B. (2004) · The Lancet Neurology · doi:10.1016/s1474-4422(04)00767-7 · Cited by 2,135 · see citing works
Leisure Activities and the Risk of Dementia in the Elderly
Verghese, J., Lipton, R. B., Katz, M. J., Hall, C. B., Derby, C. A., Kuslansky, G., Ambrose, A. F., Sliwinski, M., & Buschke, H. (2003) · New England Journal of Medicine · doi:10.1056/nejmoa022252 · Cited by 1,961 · see citing works
Morris, J. C. (1997) · International Psychogeriatrics · doi:10.1017/s1041610297004870 · Cited by 1,641 · see citing works
Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease
Wilson, R. S. (2002) · JAMA · doi:10.1001/jama.287.6.742 · Cited by 1,312 · see citing works
Brain reserve and dementia: a systematic review
VALENZUELA, M. J., & SACHDEV, P. (2006) · Psychological Medicine · doi:10.1017/s0033291705006264 · Cited by 932 · see citing works
Cognitive Reserve and Lifestyle
Scarmeas, N., & Stern, Y. (2003) · Journal of Clinical and Experimental Neuropsychology · doi:10.1076/jcen.25.5.625.14576 · Cited by 869 · see citing works
Karp, A., Paillard-Borg, S., Wang, H.-X., Silverstein, M., Winblad, B., & Fratiglioni, L. (2006) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000089919 · Cited by 542 · see citing works
Ashwal, S., Bale, J. F., Coulter, D. L., Eiben, R., & Garg, B. P. (2006) · Annals of Neurology · doi:10.1002/(issn)1531-8249 · Cited by 514 · see citing works
Cognitive activity and incident AD in a population-based sample of older persons
Wilson, R. S., Bennett, D. A., Bienias, J. L., Aggarwal, N. T., Mendes de Leon, C. F., Morris, M. C., Schneider, J. A., & Evans, D. A. (2002) · Neurology · doi:10.1212/01.wnl.0000036905.59156.a1 · Cited by 456 · see citing works
Cognitive Reserve and the Prevention of Dementia: the Role of Physical and Cognitive Activities
Cheng, S.-T. (2016) · Current Psychiatry Reports · doi:10.1007/s11920-016-0721-2 · Cited by 385 · see citing works
A life course approach to cognitive reserve: a model for cognitive aging and development?
Richards, M., & Deary, I. J. (2005) · Annals of Neurology · doi:10.1002/ana.20637 · Cited by 331 · see citing works
Self-citationYates, L. A., Ziser, S., Spector, A., & Orrell, M. (2016) · International Psychogeriatrics · doi:10.1017/s1041610216001137 · Cited by 323 · see citing works
Leisure activities and the risk of dementia in the elderly
Akbaraly, T. N., Portet, F., Fustinoni, S., Dartigues, J.-F., Artéro, S., Rouaud, O., Touchon, J., Ritchie, K. A., & Berr, C. (2009) · Neurology · doi:10.1212/wnl.0b013e3181b7849b · Cited by 321 · see citing works
Di Marco, L. Y., Marzo, A., Muñoz-Ruiz, M., Ikram, M. A., Kivipelto, M., Ruefenacht, D., Venneri, A., Soininen, H., Wanke, I., Ventikos, Y. A., et al. (2014) · Journal of Alzheimer's Disease · doi:10.3233/jad-132225 · Cited by 215 · see citing works
Suo, C., Singh, M. F., Gates, N., Wen, W., Sachdev, P., Brodaty, H., Saigal, N., Wilson, G. C., Meiklejohn, J., Singh, N., et al. (2016) · Molecular Psychiatry · doi:10.1038/mp.2016.19 · Cited by 212 · see citing works
Prevalence of dementia in Chinese elderly in Hong Kong
Chiu, H. F. K., LAM, L. C. W., Chi, I., Leung, T. W. H., Li, S. W., Law, W. T., Chung, D. W. S., Fung, H. H.-L., Kan, P., Lum, C., et al. (1998) · Neurology · doi:10.1212/wnl.50.4.1002 · Cited by 210 · see citing works
Self-citationComplex mental activity and the aging brain: molecular, cellular and cortical network mechanisms.
Valenzuela, M., Breakspear, M., & Sachdev, P. (2007) · Brain Research Reviews · doi:10.1016/j.brainresrev.2007.07.007 · Cited by 123 · see citing works
Valenzuela, M., Brayne, C., Sachdev, P. S., & Wilcock, G. K. (2011) · American Journal of Epidemiology · doi:10.1093/aje/kwq476 · Cited by 123 · see citing works
Leisure Activities in Late Life in Relation to Dementia Risk: Principal Component Analysis
Paillard‐Borg, S., Fratiglioni, L., Winblad, B. G., & Wang, H. (2009) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000235576 · Cited by 86 · see citing works
An Active Lifestyle Postpones Dementia Onset by More than One Year in Very Old Adults
Paillard‐Borg, S., Fratiglioni, L., Xu, W., Winblad, B. G., & Wang, H. (2012) · Journal of Alzheimer s Disease · doi:10.3233/jad-2012-120724 · Cited by 81 · see citing works
Late-life Cognitive Activity and Dementia: A Systematic Review and Bias Analysis
Sajeev, G., Weuve, J., Jackson, J. W., VanderWeele, T. J., Bennett, D. A., Grodstein, F., & Blacker, D. (2016) · Epidemiology · doi:10.1097/ede.0000000000000513 · Cited by 76 · see citing works
Lifestyle change and the prevention of cognitive decline and dementia
Lövdén, M., Xu, W., & Wang, H. (2013) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e32835f4135 · Cited by 58 · see citing works
Leung, G. T. Y., Fung, A. W. T., Tam, C. W. C., Lui, V. W.-C., Chiu, H. F. K., Chan, W.-C., & Lam, L. C. W. (2009) · International Psychogeriatrics · doi:10.1017/s1041610209991025 · Cited by 44 · see citing works
Self-citationLee, A. T. C., Richards, M., Chan, W. C., Chiu, H. F. K., Lee, R. S. Y., & LAM, L. C. W. (2015) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2015.07.012 · Cited by 39 · see citing works
Self-citationLee, A. T. C., Richards, M., Chan, W. C., Chiu, H. F. K., Lee, R. S. Y., & LAM, L. C. W. (2017) · Age and Ageing · doi:10.1093/ageing/afx018 · Cited by 37 · see citing works
Self-citationClassification of late-life leisure activities among elderly Chinese in Hong Kong.
Leung, G. T. Y., Leung, K. F., & LAM, L. C. W. (2011) · PubMed · Cited by 34 · see citing works
Self-citationLeung, G., & Lam, L. C. W. (2007) · Hong Kong journal of psychiatry · Cited by 5 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Dementia prevention, intervention, and care: 2020 report of the Lancet Commission
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30367-6 · Cited by 10,430 · see citing works
RetractedInfluence of young adult cognitive ability and additional education on later-life cognition
Kremen, W. S., Beck, A., Elman, J. A., Gustavson, D. E., Reynolds, C. A., Tu, X. M., Sanderson-Cimino, M. E., Panizzon, M. S., Vuoksimaa, E., Toomey, R., et al. (2019) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1811537116 · Cited by 180 · see citing works
Heger, I., Deckers, K., van Boxtel, M., de Vugt, M., Hajema, K., Verhey, F., & Köhler, S. (2019) · BMC Public Health · doi:10.1186/s12889-019-7010-z · Cited by 140 · see citing works
Cognitive and social activities and long-term dementia risk: the prospective UK Million Women Study
Floud, S., Balkwill, A., Sweetland, S., Brown, A., Reus, E. M., Hofman, A., Blacker, D., Kivimaki, M., Green, J., Peto, R., et al. (2021) · The Lancet Public Health · doi:10.1016/s2468-2667(20)30284-x · Cited by 83 · see citing works
Hwang, P. H., Ang, T. F. A., De Anda‐Duran, I., Liu, X., Liu, Y., Gurnani, A., Mez, J., Auerbach, S., Joshi, P., Yuan, J., et al. (2023) · Alzheimer's & Dementia · doi:10.1002/alz.12940 · Cited by 28 · see citing works
Brain exercise and brain outcomes: does cognitive activity really work to maintain your brain?
Blacker, D., & Weuve, J. (2018) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2018.0656 · Cited by 9 · see citing works
- Authors
- Lee, A. T. C., Richards, M., Chan, W. C., Chiu, H. F. K., Lee, R. S. Y., & Lam, L. C. W.
- Affiliations
- Chinese University of Hong Kong (HK)
- MRC Unit for Lifelong Health and Ageing (GB)
- University of Hong Kong (HK)
- Department of Health (CN)
- Corresponding author
- Lam, Linda C. W.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2018-07-01
- Volume
- 75
- Issue
- 7
- Pages
- 697
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC6583858
- OpenAlex
- W2805179967
- Cited by
- 124
- References
- 32
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 15 · 2023: 19 · 2022: 26 · 2021: 14 · 2020: 14 · 2019: 10 · 2018: 3
- FWCI
- 8.07
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Neuropsychology and Physiological Psychology › Aging and Gerontology Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- intellectual activity, dementia risk, incident dementia, older adults, reading, board games, mahjong, reverse causality, confounding, Chinese older adults, Hong Kong, lifestyle factors, physical activity, fruit and vegetable intake, smoking, social activity, cognitive reserve, dementia prevention, hearing and visual impairment, mobility, cardiovascular risk
- MeSH terms
- Games, Recreational, Aged, Aged, 80 and over, China, Dementia, Diet, Female, Gambling, Humans, Longitudinal Studies, Male, Reading, Risk, Exercise, Incidence, Multivariate Analysis, Logistic Models, Social Participation, Protective Factors
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
