Abstract

Objectives: Cognitive impairment significantly induces demand for long-term care. Engagement in cognitive activities is one of the approaches to prevent cognitive decline in older adults with dementia, while its effects on non-demented older adults have not been adequately explored. Among these activities, mentally stimulating leisure activities in later life have been suggested to enhance cognitive reserve, which has the potential to delay the onset of dementia and cognitive decline. Cognition-enhancing interventions in healthy and at-risk older adults, however, have not provided unequivocal results supporting such benefits. The main study objectives were to examine the respective contributions of late-life mentally stimulating leisure activities and structured cognition-enhancing interventions on cognitive outcome. Factors associated with the cognitive change were also explored.

Methods: This was a 2-year prospective cohort study of 1,793 healthy older residents aged 65 or above living in 11 public housing estates. An ageing-in-place scheme was implemented in these estates where some residents were invited to participate in the structured cognition-enhancing programmes. General cognition was assessed using the Montreal Cognitive Assessment (MoCA).

Results: Older residents with mentally active lifestyles had better baseline physical health and cognitive functioning. A mentally stimulating lifestyle promoted cognitive performance (baseline standardized mean difference of 0.08, t = -3.8; P < 0.001), but did not appear to reduce rate of cognitive decline. Participation in the structured cognitive programme was associated with cognition improvements (standardized mean differences of 0.22 and 0.27 in the mentally active and mentally inactive groups, respectively; P < 0.01 for both), which endured through the second year in the former group. Residents with lower baseline cognitive scores (coefficient = - 0.34; 95% CI -0.46 to -0.22; P < 0.001) and pre-frail (coefficient = 0.30; 95% CI 0.10 to 0.50; P = 0.003; reference = robust) and frail status (coefficient = 0.34; 95% CI 0.04 to 0.64; P = 0.026) predicted greater cognitive gains when enrolled on the structured cognitive programme.

Conclusions: Both a mentally stimulating lifestyle and structured cognitive activities resulted in cognitive benefits. Benefit resulted from structured cognitive activities were better maintained among older adults with mentally active lifestyles.