Mental and physical activities delay cognitive decline in older persons with dementia

Sheung-Tak CHENG, Pizza K. CHOW, You-Qiang SONG, Edwin C. S. YU, Alfred C.M. CHAN, Tatia M.C. LEE, John H. M. LAM

Research output: Journal PublicationsJournal Article (refereed)

110 Citations (Scopus)

Abstract

Objectives: To examine the effects of cognitive stimulation (mahjong) and physical exercise (tai chi [TC]) on cognitive performance in persons with dementia. Design: Cluster-randomized open-label controlled design. Setting: Nursing homes. Participants: One hundred ten residents, most of whom were cholinesterase-inhibitor naive. Inclusion criteria were Mini-Mental State Examination (MMSE) = 10-24 and suffering from at least very mild dementia (Clinical Dementia Rating >= 0.5). Exclusion criteria were being bedbound, audio/visual impairment, regular activity participation before study, or contraindications for physical or group activities. Interventions: Homes were randomized into three conditions (mahjong, TC, and simple handicrafts [control]). Activities were conducted three times weekly for 12 weeks. Measurements: Primary outcome was MMSE. Secondary outcomes were immediate/delayed recall, categorical fluency, and digit span. Various biological risk factors, including apolipoprotein E epsilon 4 allele, were included as covariates. Measures were collected at 0 (baseline), 3 (posttreatment), 6, and 9 months. Results: Intent-to-treat analyses were performed using mixed-effects regression. Mahjong's effect varied by time for MMSE, delayed recall, and forward digit span. TC had similar effects but not for delayed recall. The typical pattern was that control participants deteriorated while mahjong and TC participants maintained their abilities over time, leading to enlarged treatment effects as time progressed. By 9 months, mahjong and TC differed from control by 4.5 points (95% confidence interval: 2.0-6.9; d = 0.48) and 3.7 points (95% confidence interval: 1.4-6.0; d = 0.40), respectively, on MMSE. No treatment effects were observed for immediate recall and backward digit span. Conclusions: Mahjong and TC can preserve functioning or delay decline in certain cognitive domains, even in those with significant cognitive impairment.
Original languageEnglish
Pages (from-to)63-74
Number of pages12
JournalAmerican Journal of Geriatric Psychiatry
Volume22
Issue number1
Early online date6 Feb 2013
DOIs
Publication statusPublished - 1 Jan 2014

Fingerprint

Tai Ji
Dementia
Short-Term Memory
Confidence Intervals
Apolipoprotein E4
Aptitude
Vision Disorders
Cholinesterase Inhibitors
Biological Factors
Nursing Homes
Cognitive Dysfunction
Alleles
Exercise
Therapeutics

Keywords

  • Cognitive decline
  • dementia
  • leisure activities
  • cluster-randomized controlled trial

Cite this

CHENG, Sheung-Tak ; CHOW, Pizza K. ; SONG, You-Qiang ; YU, Edwin C. S. ; CHAN, Alfred C.M. ; LEE, Tatia M.C. ; LAM, John H. M. . / Mental and physical activities delay cognitive decline in older persons with dementia. In: American Journal of Geriatric Psychiatry. 2014 ; Vol. 22, No. 1. pp. 63-74.
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title = "Mental and physical activities delay cognitive decline in older persons with dementia",
abstract = "Objectives: To examine the effects of cognitive stimulation (mahjong) and physical exercise (tai chi [TC]) on cognitive performance in persons with dementia. Design: Cluster-randomized open-label controlled design. Setting: Nursing homes. Participants: One hundred ten residents, most of whom were cholinesterase-inhibitor naive. Inclusion criteria were Mini-Mental State Examination (MMSE) = 10-24 and suffering from at least very mild dementia (Clinical Dementia Rating >= 0.5). Exclusion criteria were being bedbound, audio/visual impairment, regular activity participation before study, or contraindications for physical or group activities. Interventions: Homes were randomized into three conditions (mahjong, TC, and simple handicrafts [control]). Activities were conducted three times weekly for 12 weeks. Measurements: Primary outcome was MMSE. Secondary outcomes were immediate/delayed recall, categorical fluency, and digit span. Various biological risk factors, including apolipoprotein E epsilon 4 allele, were included as covariates. Measures were collected at 0 (baseline), 3 (posttreatment), 6, and 9 months. Results: Intent-to-treat analyses were performed using mixed-effects regression. Mahjong's effect varied by time for MMSE, delayed recall, and forward digit span. TC had similar effects but not for delayed recall. The typical pattern was that control participants deteriorated while mahjong and TC participants maintained their abilities over time, leading to enlarged treatment effects as time progressed. By 9 months, mahjong and TC differed from control by 4.5 points (95{\%} confidence interval: 2.0-6.9; d = 0.48) and 3.7 points (95{\%} confidence interval: 1.4-6.0; d = 0.40), respectively, on MMSE. No treatment effects were observed for immediate recall and backward digit span. Conclusions: Mahjong and TC can preserve functioning or delay decline in certain cognitive domains, even in those with significant cognitive impairment.",
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Mental and physical activities delay cognitive decline in older persons with dementia. / CHENG, Sheung-Tak; CHOW, Pizza K.; SONG, You-Qiang; YU, Edwin C. S.; CHAN, Alfred C.M.; LEE, Tatia M.C.; LAM, John H. M. .

In: American Journal of Geriatric Psychiatry, Vol. 22, No. 1, 01.01.2014, p. 63-74.

Research output: Journal PublicationsJournal Article (refereed)

TY - JOUR

T1 - Mental and physical activities delay cognitive decline in older persons with dementia

AU - CHENG, Sheung-Tak

AU - CHOW, Pizza K.

AU - SONG, You-Qiang

AU - YU, Edwin C. S.

AU - CHAN, Alfred C.M.

AU - LEE, Tatia M.C.

AU - LAM, John H. M.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives: To examine the effects of cognitive stimulation (mahjong) and physical exercise (tai chi [TC]) on cognitive performance in persons with dementia. Design: Cluster-randomized open-label controlled design. Setting: Nursing homes. Participants: One hundred ten residents, most of whom were cholinesterase-inhibitor naive. Inclusion criteria were Mini-Mental State Examination (MMSE) = 10-24 and suffering from at least very mild dementia (Clinical Dementia Rating >= 0.5). Exclusion criteria were being bedbound, audio/visual impairment, regular activity participation before study, or contraindications for physical or group activities. Interventions: Homes were randomized into three conditions (mahjong, TC, and simple handicrafts [control]). Activities were conducted three times weekly for 12 weeks. Measurements: Primary outcome was MMSE. Secondary outcomes were immediate/delayed recall, categorical fluency, and digit span. Various biological risk factors, including apolipoprotein E epsilon 4 allele, were included as covariates. Measures were collected at 0 (baseline), 3 (posttreatment), 6, and 9 months. Results: Intent-to-treat analyses were performed using mixed-effects regression. Mahjong's effect varied by time for MMSE, delayed recall, and forward digit span. TC had similar effects but not for delayed recall. The typical pattern was that control participants deteriorated while mahjong and TC participants maintained their abilities over time, leading to enlarged treatment effects as time progressed. By 9 months, mahjong and TC differed from control by 4.5 points (95% confidence interval: 2.0-6.9; d = 0.48) and 3.7 points (95% confidence interval: 1.4-6.0; d = 0.40), respectively, on MMSE. No treatment effects were observed for immediate recall and backward digit span. Conclusions: Mahjong and TC can preserve functioning or delay decline in certain cognitive domains, even in those with significant cognitive impairment.

AB - Objectives: To examine the effects of cognitive stimulation (mahjong) and physical exercise (tai chi [TC]) on cognitive performance in persons with dementia. Design: Cluster-randomized open-label controlled design. Setting: Nursing homes. Participants: One hundred ten residents, most of whom were cholinesterase-inhibitor naive. Inclusion criteria were Mini-Mental State Examination (MMSE) = 10-24 and suffering from at least very mild dementia (Clinical Dementia Rating >= 0.5). Exclusion criteria were being bedbound, audio/visual impairment, regular activity participation before study, or contraindications for physical or group activities. Interventions: Homes were randomized into three conditions (mahjong, TC, and simple handicrafts [control]). Activities were conducted three times weekly for 12 weeks. Measurements: Primary outcome was MMSE. Secondary outcomes were immediate/delayed recall, categorical fluency, and digit span. Various biological risk factors, including apolipoprotein E epsilon 4 allele, were included as covariates. Measures were collected at 0 (baseline), 3 (posttreatment), 6, and 9 months. Results: Intent-to-treat analyses were performed using mixed-effects regression. Mahjong's effect varied by time for MMSE, delayed recall, and forward digit span. TC had similar effects but not for delayed recall. The typical pattern was that control participants deteriorated while mahjong and TC participants maintained their abilities over time, leading to enlarged treatment effects as time progressed. By 9 months, mahjong and TC differed from control by 4.5 points (95% confidence interval: 2.0-6.9; d = 0.48) and 3.7 points (95% confidence interval: 1.4-6.0; d = 0.40), respectively, on MMSE. No treatment effects were observed for immediate recall and backward digit span. Conclusions: Mahjong and TC can preserve functioning or delay decline in certain cognitive domains, even in those with significant cognitive impairment.

KW - Cognitive decline

KW - dementia

KW - leisure activities

KW - cluster-randomized controlled trial

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M3 - Journal Article (refereed)

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