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Association Between Mentally Stimulating Activities in Late Life and the Outcome of Incident Mild Cognitive Impairment, With an Analysis of the APOE ε4 Genotype.
JAMA Neurol. 2017 03 01; 74(3):332-338.JN

Abstract

Importance

Cross-sectional associations between engagement in mentally stimulating activities and decreased odds of having mild cognitive impairment (MCI) or Alzheimer disease have been reported. However, little is known about the longitudinal outcome of incident MCI as predicted by late-life (aged ≥70 years) mentally stimulating activities.

Objectives

To test the hypothesis of an association between mentally stimulating activities in late life and the risk of incident MCI and to evaluate the influence of the apolipoprotein E (APOE) ε4 genotype.

Design, Setting, and Participants

This investigation was a prospective, population-based cohort study of participants in the Mayo Clinic Study of Aging in Olmsted County, Minnesota. Participants 70 years or older who were cognitively normal at baseline were followed up to the outcome of incident MCI. The study dates were April 2006 to June 2016.

Main Outcomes and Measures

At baseline, participants provided information about mentally stimulating activities within 1 year before enrollment into the study. Neurocognitive assessment was conducted at baseline, with evaluations at 15-month intervals. Cognitive diagnosis was made by an expert consensus panel based on published criteria. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression models after adjusting for sex, age, and educational level.

Results

The final cohort consisted of 1929 cognitively normal persons (median age at baseline, 77 years [interquartile range, 74-82 years]; 50.4% [n = 973] female) who were followed up to the outcome of incident MCI. During a median follow-up period of 4.0 years, it was observed that playing games (HR, 0.78; 95% CI, 0.65-0.95) and engaging in craft activities (HR, 0.72; 95% CI, 0.57-0.90), computer use (HR, 0.70; 95% CI, 0.57-0.85), and social activities (HR, 0.77; 95% CI, 0.63-0.94) were associated with a decreased risk of incident MCI. In a stratified analysis by APOE ε4 carrier status, the data point toward the lowest risk of incident MCI for APOE ɛ4 noncarriers who engage in mentally stimulating activities (eg, computer use: HR, 0.73; 95% CI, 0.58-0.92) and toward the highest risk of incident MCI for APOE ɛ4 carriers who do not engage in mentally stimulating activities (eg, no computer use: HR, 1.74; 95% CI, 1.33-2.27).

Conclusions and Relevance

Cognitively normal elderly individuals who engage in specific mentally stimulating activities even in late life have a decreased risk of incident MCI. The associations may vary by APOE ε4 carrier status.

Authors+Show Affiliations

Mayo Clinic Translational Neuroscience and Aging Program, Mayo Clinic, Scottsdale, Arizona.Department of Radiology, Mayo Clinic, Rochester, Minnesota.Mayo Clinic Translational Neuroscience and Aging Program, Mayo Clinic, Scottsdale, Arizona.Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota4Department of Neurology, Mayo Clinic, Rochester, Minnesota.International Clinical Research Center, Brno, Czech Republic.Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.Department of Neurology, Mayo Clinic, Rochester, Minnesota.Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota4Department of Neurology, Mayo Clinic, Rochester, Minnesota.Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.Mayo Clinic Translational Neuroscience and Aging Program, Mayo Clinic, Scottsdale, Arizona3Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota7Department of Psychiatry and Psychology, Mayo Clinic, Scottsdale, Arizona8Department of Neurology, Mayo Clinic, Scottsdale, Arizona.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

28135351

Citation

Krell-Roesch, Janina, et al. "Association Between Mentally Stimulating Activities in Late Life and the Outcome of Incident Mild Cognitive Impairment, With an Analysis of the APOE Ε4 Genotype." JAMA Neurology, vol. 74, no. 3, 2017, pp. 332-338.
Krell-Roesch J, Vemuri P, Pink A, et al. Association Between Mentally Stimulating Activities in Late Life and the Outcome of Incident Mild Cognitive Impairment, With an Analysis of the APOE ε4 Genotype. JAMA Neurol. 2017;74(3):332-338.
Krell-Roesch, J., Vemuri, P., Pink, A., Roberts, R. O., Stokin, G. B., Mielke, M. M., Christianson, T. J., Knopman, D. S., Petersen, R. C., Kremers, W. K., & Geda, Y. E. (2017). Association Between Mentally Stimulating Activities in Late Life and the Outcome of Incident Mild Cognitive Impairment, With an Analysis of the APOE ε4 Genotype. JAMA Neurology, 74(3), 332-338. https://doi.org/10.1001/jamaneurol.2016.3822
Krell-Roesch J, et al. Association Between Mentally Stimulating Activities in Late Life and the Outcome of Incident Mild Cognitive Impairment, With an Analysis of the APOE Ε4 Genotype. JAMA Neurol. 2017 03 1;74(3):332-338. PubMed PMID: 28135351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association Between Mentally Stimulating Activities in Late Life and the Outcome of Incident Mild Cognitive Impairment, With an Analysis of the APOE ε4 Genotype. AU - Krell-Roesch,Janina, AU - Vemuri,Prashanthi, AU - Pink,Anna, AU - Roberts,Rosebud O, AU - Stokin,Gorazd B, AU - Mielke,Michelle M, AU - Christianson,Teresa J H, AU - Knopman,David S, AU - Petersen,Ronald C, AU - Kremers,Walter K, AU - Geda,Yonas E, PY - 2017/1/31/pubmed PY - 2017/5/31/medline PY - 2017/1/31/entrez SP - 332 EP - 338 JF - JAMA neurology JO - JAMA Neurol VL - 74 IS - 3 N2 - Importance: Cross-sectional associations between engagement in mentally stimulating activities and decreased odds of having mild cognitive impairment (MCI) or Alzheimer disease have been reported. However, little is known about the longitudinal outcome of incident MCI as predicted by late-life (aged ≥70 years) mentally stimulating activities. Objectives: To test the hypothesis of an association between mentally stimulating activities in late life and the risk of incident MCI and to evaluate the influence of the apolipoprotein E (APOE) ε4 genotype. Design, Setting, and Participants: This investigation was a prospective, population-based cohort study of participants in the Mayo Clinic Study of Aging in Olmsted County, Minnesota. Participants 70 years or older who were cognitively normal at baseline were followed up to the outcome of incident MCI. The study dates were April 2006 to June 2016. Main Outcomes and Measures: At baseline, participants provided information about mentally stimulating activities within 1 year before enrollment into the study. Neurocognitive assessment was conducted at baseline, with evaluations at 15-month intervals. Cognitive diagnosis was made by an expert consensus panel based on published criteria. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression models after adjusting for sex, age, and educational level. Results: The final cohort consisted of 1929 cognitively normal persons (median age at baseline, 77 years [interquartile range, 74-82 years]; 50.4% [n = 973] female) who were followed up to the outcome of incident MCI. During a median follow-up period of 4.0 years, it was observed that playing games (HR, 0.78; 95% CI, 0.65-0.95) and engaging in craft activities (HR, 0.72; 95% CI, 0.57-0.90), computer use (HR, 0.70; 95% CI, 0.57-0.85), and social activities (HR, 0.77; 95% CI, 0.63-0.94) were associated with a decreased risk of incident MCI. In a stratified analysis by APOE ε4 carrier status, the data point toward the lowest risk of incident MCI for APOE ɛ4 noncarriers who engage in mentally stimulating activities (eg, computer use: HR, 0.73; 95% CI, 0.58-0.92) and toward the highest risk of incident MCI for APOE ɛ4 carriers who do not engage in mentally stimulating activities (eg, no computer use: HR, 1.74; 95% CI, 1.33-2.27). Conclusions and Relevance: Cognitively normal elderly individuals who engage in specific mentally stimulating activities even in late life have a decreased risk of incident MCI. The associations may vary by APOE ε4 carrier status. SN - 2168-6157 UR - https://www.unboundmedicine.com/medline/citation/28135351/Association_Between_Mentally_Stimulating_Activities_in_Late_Life_and_the_Outcome_of_Incident_Mild_Cognitive_Impairment_With_an_Analysis_of_the_APOE_ε4_Genotype_ L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2016.3822 DB - PRIME DP - Unbound Medicine ER -