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Reference: Heser, 2014
Cohort: German Study on Ageing, Cognition and Dementia in Primary Care Patients
Risk Factor: Cognitive Activity


Average Follow-up Time Detail
Members of the cohort were followed for up to 3 years. Average follow-up time is not reported.

Exposure Detail
Participants provided information at follow-up period 2 (baseline for the current study) on the frequency of the participation in a variety of activities over the previous four weeks. Frequency of participation was categorized as daily, several times per week, once a week, less than once a week, or never. Activities considered cognitive in nature consisted of (i) doing crossword puzzles, (ii) memory training/brain teasers, (iii) games (card, board or individual games), (iv) reading, (v) writing, and (vi) playing music. Participants received a score ranging from 0-4 on each of these items with higher scores indicating higher frequency of participation. In analyses, the mean of the 6 cognitive activity frequency scores was used to represent the average frequency of cognitive engagement (range, 0-4).

For participants without a dementia diagnosis at follow-up 4, the mean cognitive activity score was 1.44 (SD 0.55).
For participants with a diagnosis of Alzheimer's disease at follow-up 4, the mean cognitive activity score was 1.17 (SD 0.48).
For participants with a diagnosis of any dementia at follow-up 4, the mean cognitive activity score was 1.19 (SD 0.48).

In addition to leisure activities deemed cognitive in nature, participants also provided information regarding physical activities, depressive symptoms, and social engagement.

Evaluation of leisure activities was based on published literature.

Age Detail
Participants without a dementia diagnosis at follow-up 4 had a mean age of 82.31 (SD 3.31). Participants with a diagnosis of Alzheimer disease at follow-up 4 had a mean age of 84.02 (SD 3.51). Participants with any dementia diagnosis at follow-up 4 had a mean age of 83.84 (SD 3.51).

Screening and Diagnosis Detail
AD Diagnosis:
DSM IV Diagnostic and Statistical Manual IV

Total dementia definition: Structured Interview for Diagnosis of Dementia of Alzheimer Type, Multi-Infarct Dementia and Dementia of Other Aetiology according to DSM-IV and ICD-10 criteria (SIDAM)

"Dementia assessment was based on the Structured Interview for Diagnosis of Dementia of Alzheimer Type, Multi-Infarct Dementia and Dementia of Other Aetiology according to DSM-IV and ICD-10 criteria (SIDAM) implemented by a trained research assistant. When SIDAM could not be assessed, a Global Deterioration Scale score of at least 4 and/or Blessed Dementia Rating Scale score were used. Each case of incident dementia and its aetiological subtype was validated by a geriatric expert on the basis of medical information relevant to the aetiology of dementia provided by the GP. AD was diagnosed according to DSM-IV criteria.Vascular dementia was diagnosed according to the NINDS-AIREN criteria. Target variables of this publication were all-cause dementia that included all cases (i.e., AD, mixed forms, vascular dementia, specific types of dementia such as Lewy body dementia or dementia caused by substance abuse, and dementia not otherwise specified) and AD (including AD and mixed forms), whereas dementia of other aetiology was not included as separate aetiology due to small sample sizes."

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

"Cox regression analyses were used to investigate the effect of leisure activities, social support, depressive symptoms, and covariates assessed at follow-up 2 on the time until dementia was diagnosed in crude and adjusted proportional hazards models."

Additional models further adjusted for depressive symptoms, social engagement, physical activity, and social support. The results for cognitive activity were not materially different.

AD Covariates:
Aage
Eeducation
Ggender
APOE4APOE e4 genotype
MMSEbaseline MMSE
IADLIinstrumental activities of daily living impairment

TD Covariates:
Aage
Eeducation
Ggender
APOE4APOE e4 genotype
MMSEbaseline MMSE
IADLIinstrumental activities of daily living impairment