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Reference: Akbaraly, 2009
Cohort: Three-City Study
Risk Factor: Cognitive Activity


Average Follow-up Time Detail
The average follow-up time was not reported. The maximum follow-up time was 4 years.

Exposure Detail
Participants completed questionnaires at baseline about their participation in various common leisure activities, and received a score for each activity based on their frequency of participation in that activity. Activities requiring lower levels of cognitive demand than activities considered to be "stimulating leisure activities" were grouped together as "passive leisure activities". These activities were: (i) watching television, (ii) listening to the radio, (iii) listening to the music, and (iv) knitting/sewing. Participants received a score from 0 to 3 for each of these four items, according to their participation frequency. Total scores ranged from 0 to 8 and were categorized for analysis into tertiles, corresponding to "low" (total score <3), "mild" (total score =3) and "high" (total score >3) levels of passive leisure activity.

"First, participants were asked, “Usually, how much time in a day did you engage for each of the following activities: watching TV, listening to the radio, listening to music, doing odd jobs, gardening, knitting/sewing, going for a walk.” The frequency of participation for each of these activities was rated on a 3-point scale: 0, never or less than 1 hour per day; 1, 1–2 hours per day; 2, 2 hours per day.

"Within each type of frequency questionnaire, the categorization of leisure activities according to their predominantly mental, physical, or social characteristics was drawn from the existing literature.15,16 At the end, 4 independent composite scores were built by summing the corresponding items scores as following.

"Finally, activities such as watching television, listening
to the radio, listening to music, and knitting/sewing constitute leisure activities which are less cognitively demanding16,19 compared to those classified as stimulating leisure activities and were categorized as “passive leisure activities” (score ranging from 0 to
8, median score: 2).17...In the present analyses, leisure activities were considered as categorical variables. Given the non-normal distribution of the dependent variables, they were categorized by tertiles: high (tertile 3), mild (tertile 2), and low (tertile 1) levels of activity being defined for each of the 4 variables."

Ethnicity Detail
The vast majority (97%) of participants were French-speaking and 88% were born in France.

Screening and Diagnosis Detail
Screening Method:
ISTIsaacs' Set Test (Isaacs & Kennie 1973)
MMSEMini-Mental State Examination (Folstein 1975)

AD Diagnosis:
NINCDS ADRDA National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association Criteria (McKhann 1984)

Total dementia diagnosis: DSM-IV

"At baseline, diagnosis of dementia was based on a 3-step procedure.14 First, trained psychologists administered a battery of neuropsychological tests detailed elsewhere.14 Second, all the participants in Montpellier were then examined by a neurologist, whereas in Dijon, because of the larger number of participants, only those who screened positive underwent further examination. Finally, an independent committee of neurologists reviewed all potential prevalent and incident cases of dementia to obtain a consensus on its diagnosis and etiology according to the criteria of the DSM-IV.20 Similar procedures were performed at follow-up for incident dementia screening. Cases of AD were classified according to the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association21 and cases of mixed/vascular dementia according to the National Institute of Neurological Disorders and Stroke Association Internationale pour la Recherche en l’Enseignement en Neurosciences22 criteria."

Covariates & Analysis Detail
Analysis Type:
Cox proportional hazards regression

Participant age was used as the time scale in the proportional hazards analysis.

AD Covariates:
Aage
Eeducation
Ggender
ADLIactivities of daily living impairment
APOE4APOE e4 genotype
MMSEbaseline MMSE
DEPdepression
DMdiabetes mellitus
HChigh cholesterol
HTNhypertension
MSmarital status
OSOccupational status
SPstudy population
VDvascular disease

TD Covariates:
Aage
Eeducation
Ggender
ADLIactivities of daily living impairment
APOE4APOE e4 genotype
MMSEbaseline MMSE
DEPdepression
DMdiabetes mellitus
HChigh cholesterol
HTNhypertension
MSmarital status
OSOccupational status
SPstudy population
VDvascular disease