Background

Dementia increase with increasing age -> major public health priority, lack of preventive strategy Katzman : higher educational level = resistant to the effect of dementia Previous studies : Baseline cognitive status, educational level, depression may cofound the relation between leisure activities and dementia

METHOD

Study Population
Bronx Aging Study : english speeking, 75-85 yo, resided in community Exclusion : impairment (visual/hearing), idiopathic parkinsons disease, liver disease, alcoholism, known terminal illness To screen baseline dementia : Blessed Information-Memory-Concentration test

 488 subjects between 1980-1983 Neuropsychological evaluation at enrollment and follow up visit (12-18 mo) Study period 21 yrs (1980-2001) Excluded : 2 (-) documented leisure, 17 moved or decline to return for follow up => 469 subjects

Clinical Evaluation
Structured medical history questionaire + examination by clinician Functional limitation on 10 basic and istrumental activities on 3 point scale for each activity Spouse or family member confirmation on history

Neuropsychological Evaluation
Blessed Information-Memory-Concentration Test Wechsler Adult Intelligence Scale The Fuld Object-Memory Evaluation The Zung Depression Scale

Leisure Activities
11 physical activities & 6 cognitive activities (1 ponits for every activities) Activities reported with the frequency : daily (7 pts), several days a week (4 pts), once weekly (1 pts), monthly, occasionaly or never (0 pts) Scores on cognitive corelated with Blessed test but not with functional status Scores on physical corelated with functional status but not with Blessed test score

Diagnosis of Dementia
Suspected -> Observation : result of neuropsychological test, OR worsening of the scores on Blessed Test by four pts, OR >7 errors underwent a workup incl CT and blood test Case conference, diagnosed according to DSM-III or after 1986 DSM-III-R

Statistical Analysis
Continuous variables : either independentsamples t-test or Mann-Withney U test Categorical variables : Pearson chi-square test Primary analysis : Leisure activities Risk of dementia
Base-line characteristics of subjects to dementia Grouping study cohort by their scores on the two activities to the risk of dementia Comparing the frequency of activities several days or more (frequent) with weekly or less (rare)

 Secondary analyses : influence of base-line cognitive status possible preclinical dementia

Sequentially excluded the subject that developing dementia during the first 2, 4, 7 and 9 yrs Determaining the relation between cognitive activities and base-line cognitive status and the annual change in cognitive status

RESULTS

Demographic Characteristics
Median follow-up : 5,1 yrs Dementia : 124 subjects (alzheimer : 61, vascular dementia : 30, mixed : 8) End of studies : 361 died, 88 dropped out, 20 subjects still active

 Cognitive-activity score were inversely corelated with Zung depression scale (Spearman r=-0.215, P<0.001), as were physical-actrivity (Spearman r=-0.254, P<0.001) low level of participation level of depression