Exercise as it relates to Disease/Can cognitive and leisure activities reduce the risk of dementia in the elderly?

A critique of the research article from the New England Journal of Medicine: Richard B. Lipton, M.D. Mindy J. Katz, M.P.H. Charles B. Hall, Ph.D. et al. Leisure activities and the risk of dementia in the elderly 2003 June 19 N Engl J Med;

Written as an assignment Health, Disease and Exercise Unit University of Canberra, 2021.

What Is The Background To This Research?
Dementia is the second leading cause of death of Australians and is a term that refers to a group of chronic disorders that affect the brain's ability to operate. As the brains function deteriorates over time it starts to impair memory, problem-solving abilities, as well as emotional, social, and behavioural disorders. Dementia is not unknown and is extremely prominent is aspects of our elderly populations, affecting an estimated 55 million people globally, 472,000 of those being Australians. It has been found that leisure activity participation can be linked to a lower risk of dementia. However, it's unclear if higher leisure activity participation lowers the risk of dementia or whether leisure activity participation just declines throughout the preclinical stage of dementia.

This research is particularly important as it seeks to fill a knowledge gap in whether or not the risk of dementia can be significantly reduced by the participation in everyday leisure and cognitive activities. This is extremely important as Australia itself is an ageing population with the risk of getting dementia being a 2 in 100 chance in adults aged 65 to 69. To add to this, as the population ages, the percentage of dementia cases will rise significantly, putting a greater load on the working-age population, so small prevention efforts may be able to minimise these debilitating effects.

Where Is The Research From?
The research was from the New England Journal of Medicine using a prospective cohort of 469 people over 75yrs old. The study takes findings from a sample population in which the independent variable, being dementia, that is not under the researchers' control.

This article was published by a group of researchers with a wide range of experience in this field, especially Joe Verghese, Richard Lipton, and Mindy J. Katz who's research predominantly follows the elder population and alzheimers/dementia. Although despite this it seems that these researchers previous work has been centred around a more cognitive focus on dementia rather than a physical activity approach.

What Kind Of Research Was This?
This research was a cohort observational study and is classified as unfiltered information in the hierarchy of evidence. Using English-speaking subjects in the community who were 75 to 85 years old. At baseline, subjects were evaluated to make sure there was no prior existence of dementia. Those who produced eight or less errors on the Blessed Information–Memory–Concentration test were able to participate.

What Did The Research Involve?
The method for this research was done using a representative sample of 469 people who are over 75 years old that live in the community and did not have dementia at the start. The link between leisure activities and the risk of dementia was explored by looking at the frequency with which people participated in leisure activities. At the time of enrolment, the researchers created cognitive-activities and physical-activity scales, using 'activity-days' as the units of measurement. Age, sex, educational level, presence or absence of chronic medical diseases, and baseline cognitive status were all adjusted in regards to the Cox proportional-hazards analysis to determine the risk of dementia based on baseline levels of participation in leisure activities. The articles approach to the research was using independent-samples t-test or the Mann–Whitney U test were used to compare continuous variables, and the Pearson chi-square test was used to compare categorical variables.

The methodologies approach was well rounded in the fact that they used a large cohort. However, the limitations of the research was that the sample used was community-based; filled with volunteers who were predominately white as well all over the age of 75. This leads to a disproportionately represented group and could have heavily restricted the quality of the findings.

What Were The Basic Results?
During a median follow up of 5.1 years dementia ended up being developed in 124 out of 469 patients. Reading, board games, using musical instruments, and dancing were reported to be linked with a decreased risk of dementia. It was found that higher participation in cognitive activities at baseline was linked to lower rates of memory deterioration. However this was only in linear mixed models, similar to that of Alzheimers and vascular dementia results. The only physical activity linked to a lower incidence of dementia was dancing. Interestingly those who did develop dementia were older more likely to be female and had lower levels of education. However, in terms of how cognitive and physical activity influenced the risk of developing dementia, you can see in the above table that those who did not develop dementia had a higher physical activity and cognitive skills score. This can be linked to a more active use of the brain and was found that with participation once a week in any activity, there was a decrease of 7 percent in the risk of dementia.

What Conclusions Can We Take From This Research?
The findings may support recommendations for getting involved in cognitive activities to reduce the risk of dementia. For example, it was found that elderly people who completed crossword puzzles 4 times a week had a 47% reduced risk of dementia than those who only managed to complete puzzles once a week. Another recent research done in 2020 found that physical activity has been shown to have advantages across various areas, and such interventions may be advised for patients in medical and psychiatric settings, to avoid decline in an older persons risk of dementia.

From this article I took away a personal insight, among many others I have become a caregiver for a family member that suffers from dementia. Although the experience I have gained from caring for them has been difficult the knowledge I've learnt about such a debilitating disease first hand is insightful. This article brings together research on ways to reduce risks early on in a way that allows patients and elderly to take control and provide better odds for them in the future.

Practical Advice
This research article provides recommendations on monitoring cognitive and physical exercises within elderly populations which is vital for healthcare providers and caregivers. The research gives encouragement for older populations to take part in exercise whether physical or cognitive to benefit their future self. Although physical activities are definitely beneficial to overall health, their ability to guard against dementia is still unknown.

Further Resources
Further readings regarding dementia and cognitive interventions as well as more research on reducing risk factors linked to developing dementia are listed below:
 * Alzheimer's Australia: https://www.fightdementia.org.au
 * 'The Effect of Exercise Interventions on Cognitive Outcome in Alzheimer's Disease: A Systematic Review' (Research article)
 * Ball K, Berch DB, Helmers KF, et al. Effects of cognitive training interventions with older adults: a randomised controlled trial.
 * Health Direct - Dementia Prevention (website)
 * Integrated Living - Dementia Care (website)
 * The Effects of Cognitive Activity Combined with Active Extremity Exercise on Balance, Walking Activity, Memory Level and Quality of Life of an Older Adult Sample with Dementia (Research Article) https://www.jstage.jst.go.jp/article/jpts/25/12/25_jpts-2013-274/_article/-char/ja/