Verghese Joe, Lipton Richard B, Katz Mindy J, Hall Charles B, Derby Carol A, Kuslansky Gail, Ambrose Anne F, Sliwinski Martin, Buschke Herman
Einstein Aging Study, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
N Engl J Med. 2003 Jun 19;348(25):2508-16. doi: 10.1056/NEJMoa022252.
Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia.
We examined the relation between leisure activities and the risk of dementia in a prospective cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line. We examined the frequency of participation in leisure activities at enrollment and derived cognitive-activity and physical-activity scales in which the units of measure were activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities, with adjustment for age, sex, educational level, presence or absence of chronic medical illnesses, and base-line cognitive status.
Over a median follow-up period of 5.1 years, dementia developed in 124 subjects (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). Among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia. A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia (hazard ratio, 0.93 [95 percent confidence interval, 0.90 to 0.97]), but a one-point increment in the physical-activity score was not (hazard ratio, 1.00). The association with the cognitive-activity score persisted after the exclusion of the subjects with possible preclinical dementia at base line. Results were similar for Alzheimer's disease and vascular dementia. In linear mixed models, increased participation in cognitive activities at base line was associated with reduced rates of decline in memory.
Participation in leisure activities is associated with a reduced risk of dementia, even after adjustment for base-line cognitive status and after the exclusion of subjects with possible preclinical dementia. Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia.
参与休闲活动与较低的痴呆风险相关。目前尚不清楚休闲活动参与度的增加是否会降低痴呆风险，还是在痴呆临床前期休闲活动参与度就已下降。
我们在一个前瞻性队列中研究了休闲活动与痴呆风险之间的关系，该队列由469名75岁以上居住在社区且基线时无痴呆的受试者组成。我们在入组时调查了休闲活动的参与频率，并得出认知活动量表和身体活动量表，其测量单位为每周活动天数。采用Cox比例风险分析，根据休闲活动参与的基线水平评估痴呆风险，并对年龄、性别、教育程度、是否存在慢性疾病以及基线认知状态进行调整。
在中位随访期5.1年期间，124名受试者发生痴呆（61名患阿尔茨海默病，30名患血管性痴呆，25名患混合型痴呆，8名患其他类型痴呆）。在休闲活动中，阅读、玩棋盘游戏、演奏乐器和跳舞与较低的痴呆风险相关。认知活动得分每增加1分与痴呆风险显著降低相关（风险比，0.93 [95%置信区间，0.90至0.97]），但身体活动得分每增加1分则不然（风险比，1.00）。排除基线时可能处于临床前期痴呆的受试者后，与认知活动得分的关联依然存在。阿尔茨海默病和血管性痴呆的结果相似。在线性混合模型中，基线时认知活动参与度的增加与记忆衰退率降低相关。
即使在调整基线认知状态以及排除可能处于临床前期痴呆的受试者后，参与休闲活动仍与较低的痴呆风险相关。需要进行对照试验来评估认知休闲活动对痴呆风险的保护作用。
