Wang et al, 2002

This study sought to explore whether social and leisure activities in later life diminished the risk of dementia. It followed two acknowledged case control and follow-up studies to adopt a longitudinal approach. To this end, it drew upon data from the Kungsholmen Project, a population-based study carried out in a central area of Stockholm. In 1987–9, information was gathered – through interviews with nurses, examinations by physicians and assessments by psychologists – from 1,810 participants, aged over 75, about their mental, physical, social, productive and recreational activities. Of these, 1,375 people were determined to be cognitively intact and living outside an institution. They were followed up in 1991–3 (during which 158 dementia cases were identified among 934 participants) and 1994–6 (at which point a further 123 dementia cases were identified among 683 participants). The study group was taken to be those subjects who developed dementia between the first and second follow-ups. Age, gender, education, cognitive functioning, comorbidity (indicated by hospitalisation), depressive symptoms and physical functioning at baseline were taken into account as potential confounders.

Type and frequency of social and leisure participation was arranged according to: mental activity (reading books/newspapers, writing, studying, undertaking crossword puzzles, painting or drawing); physical activity (swimming, walking or gymnastics); social activity (attending the theatre, concerts or art exhibitions, traveling, playing cards/games or participating in social groups or a pension organisation); productive activity (gardening, housekeeping, cooking, working for pay after retirement, doing voluntary work or sewing, knitting, crocheting or weaving); recreational activity (watching television or listening to the radio). Of relevance to the present analysis is the fact that solitary/participatory engagement – including reading, painting and drawing – was categorised as mental activity, while attendance at the theatre, concerts or exhibitions was considered social activity, irrespective of the potential for mental stimulation. Within the four activity groups, no separate account was taken of different activities.

Cox proportional hazard models were used to estimate the relative risks and corresponding 95 percent confidence intervals for the social and leisure activities associated with development of dementia, followed by multivariate analysis for each of the potential confounders. The results ‘suggest that stimulating activity, either mentally or socially oriented, may protect against dementia, indicating that both social interaction and intellectual stimulation may be relevant to preserving mental functioning in the elderly’ (p. 1081). Conversely, physical activity was not deemed to have a discernible effect on dementia risk.

The significance of this finding to the present analysis is that both participatory creative activity (including painting and drawing, classified as mental activity) and cultural attendance (understood as social activity) were found to be beneficial in protecting against dementia. Various hypotheses were offered as to why this might be the case, with mental stimulation thought to improve cognition and social participation thought to increase self-efficacy. The possibility of environmental enrichment giving rise to physiological changes in the cerebral cortex was also discussed.

Hui-Xin Wang, Anita Karp, Bengt Winblad and Laura Fratiglioni, ‘Late-Life Engagement in Social and Leisure Activities Is Associated with a Decreased Risk of Dementia: A Longitudinal Study from the Kungsholmen Project’, American Journal of Epidemiology, 155, no. 12, 2002, pp. 1081–87.

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