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Elizabeth P. Helzner, PhD; Nikolaos Scarmeas, MD; Stephanie Cosentino, PhD; Florence Portet, MD; Yaakov Stern, PhD

Arch Neurol. 2007;64(12):1749-1754.

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.

Author Affiliations: Gertrude H. Sergievsky Center (Drs Helzner, Scarmeas, Cosentino, and Stern), Departments of Neurology (Drs Scarmeas and Stern) and Psychiatry (Dr Stern), and Taub Institute for Research in Alzheimer's Disease and the Aging Brain (Drs Scarmeas and Stern), Columbia University College of Physicians and Surgeons, New York, New York; and Memory Research Resource Center for Alzheimer's Disease, Neurology B Department, Institut National de la Sante et de la Recherche Medicale, Montpellier Hospital, Montpellier, France (Dr Portet).