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Leisure activity and cognitive decline in incident Alzheimer disease
Elizabeth P Helzner1, Nikolaos Scarmeas, Stephanie Cosentino
1Gertrude H Sergievsky Center, Columbia University Medical Center, New York, NY 10032, USA.
Background:
High rates of leisure activity have been associated with reduced risk of Alzheimer disease (AD).
Objective:
To determine whether prediagnosis leisure activity modifies the rate of cognitive decline in patients with AD.
Design:
Inception cohort followed up longitudinally for a mean of 5.3 years (up to 13.9 years).
Setting:
Urban community.
Participants:
A total of 283 patients with incident AD (mean age, 79 years; 56.2% Hispanic and 31.1% African American).
Main Outcome Measures:
Change in a composite cognitive score from diagnosis on and during the entire study follow-up.
Results:
In multivariate-adjusted generalized estimating equation models of postdiagnosis change (n = 133), each leisure activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P = .17). In models expanded to include cognitive change during study follow-up, including evaluations before and after diagnosis (n = 283), each activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P = .03). The association was strongest for intellectual activities.
Conclusions:
Greater participation in prediagnosis leisure activities, especially intellectual activities, was associated with faster cognitive decline, supporting the hypothesis that the disease course in AD may vary as a function of cognitive reserve.
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