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An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia
Abstract
To explore the effect of an activity treatment-mahjong-on the cognitive functioning of persons with mild-to-moderate dementia.
Participants were 62 older persons (M(age) = 83.94, SD = 7.58) who met DSM-IV diagnosis of any dementia condition, had an initial Mini-Mental State Examination (MMSE) score < or = 24, and were able to play, yet not having played mahjong for the past six months. They were randomly assigned to play either twice (n = 33) or four times (n = 29) a week over a 16-week duration. Digit forward span, digit forward sequence, verbal memory and MMSE were measured at baseline, post-test and 1-month follow-up.
Regardless of frequency of playing, mahjong produced consistent gains across all cognitive performance measures. It had large effect sizes on digit forward memory (1.0-1.4 for both span and sequence), moderate-to-large effect sizes on verbal memory (0.5-0.9), and a moderate effect size on MMSE (around 0.6). The effects lasted after mahjong had been withdrawn for a month, suggesting that constant practice is not necessary to achieve therapeutic effect once an initial threshold is attained.
Mahjong is a viable treatment option for dementia. Because mahjong therapy basically does not require professional supervision and can be implemented as widely as space allows at a given time, the potential benefits of integrating mahjong into the daily routines of an institution are enormous vis-à-vis minimal, if any, cost to the institution.
... Mahjong is a popular social entertainment form in China with a gambling nature that requires attention, information processing, visuomotor coordination, and social interaction, and it is closely associated with cognitive improvement [35][36][37][38][39][40]. This repetitive cognitive exercise can improve executive function [41], verbal memory [42], attention [43] and eye-hand coordination [44] in the elderly. Otherwise, the higher frequency of playing Mahjong is associated with improved cognitive function and self-coordination abilities [45]. ...
... Otherwise, the higher frequency of playing Mahjong is associated with improved cognitive function and self-coordination abilities [45]. Importantly, Mahjong does not require professional medical personnel for guidance and participation; it can be organized and maintained by the players themselves, reducing the healthcare burden [42]. On the other hand, Mahjong, as a form of social participation, plays a role in increasing interpersonal communication, social support, and promoting mental health [46][47][48][49][50], which helps alleviate stress-related neuronal changes and improve cognitive function [51,52]. ...
... Previous research indicates that playing Mahjong can provide cognitive bene ts for the elderly [58] and is associated with a slower decline in cognitive function [45,59]. Even among individuals already diagnosed with dementia, Mahjong can yield cognitive bene ts, and these effects persist for up to a month after stopping the activity [42]. Additionally, similar to other cognitive games, playing Mahjong involves various cognitive functions. ...
Objective
Mahjong, a traditional Chinese tile-based game, has been widely reported to be closely associated with better cognitive function. However, its effects on the cognitive function of patients with schizophrenia have not yet been studied.
Method
In a pilot study, 49 patients diagnosed with schizophrenia were randomly assigned to the intervention group (Mahjong combined with standard treatment) and the control group (standard treatment). The intervention group engaged in cognitive training through Mahjong for 2 hours per day, 4 days per week for 12 weeks. Primary cognitive outcomes were assessed using Cambridge Neuropsychological Test Automated Battery (CANTAB), while secondary outcomes were evaluated with the Positive and Negative Syndrome Scale (PANSS), and the Self-report Quality of Life Measure for People with Schizophrenia (SQLS). Assessments were conducted at baseline (T0), the 4th week (T1), the 8th week (T2), and the 12th week (T3).
Results
There is a significant group-by-time interaction effect in RTI and time effect in PAL. The intervention group showed significant improvements in reaction time and movement time of response to a visual target, visual memory and new learning at T3 compared to baseline. Additionally, the intervention group exhibited significant improvements in SQLS over time.
Conclusion
While this pilot study suggests that prolonged Mahjong intervention may benefit certain cognitive functions and quality of life in patients with schizophrenia, these findings should be interpreted with caution. Further research with larger, more diverse samples and longer follow-up periods is necessary to confirm and extend these findings.
Trial registration
The trial is registered with https://www.chictr.org.cn/ under registration number ChiCTR2400083439 (date of registration: 2024-01-25).
... Although mahjong playing may be associated with gambling issues in the past and put a heavy emphasis on good fortune to win the game, its popularity was advocated regardless of socioeconomic status, gender, and geographic areas (7). The game usually involves 136 to 152 tiles and requires players to take turns in drawing and discarding tiles until one of them claims victory by presenting a certain set of combinations (8). The literature on mahjong has classified the game as an intellectual and social leisure activity due to the complexity of its rules and because it involves multiple players (9). ...
... Intervention studies have only partially supported the effectiveness of playing mahjong in achieving specific outcomes in older adults. For example, it has been found to support general cognitive performance and digit forward memory but not verbal or digit backward memory (8,20). Therefore, it would be premature to conclude that playing mahjong improves general cognitive and psychological functioning in older adults. ...
... Five of the studies (83.3%) examined the effects of a 12-week mahjong intervention in which participants played an hour of mahjong three times a week. Only one study (16.7%), which investigated the effects of a 16-week mahjong intervention, manipulated the frequency of playing (8). All of the studies involved at least one control group that participated either passively or actively by engaging in different activities such as tai chi or handicrafts. ...
Playing mahjong is a popular intellectual and social leisure activity in Asian countries. It is culturally believed that this activity is beneficial to cognitive and psychological functioning in older adults. However, empirical evidence of the benefits of playing mahjong is scant and scattered across the Western and Asian literature. This scoping review comprehensively examined previous studies of the relationships between playing mahjong and cognitive, psychological, and functional abilities in older adults, highlighted gaps in the literature, and identified directions for future research. A systematic search of the literature was conducted across thirteen Western and Asian databases. Fifty-three studies, including forty-seven observational and six intervention studies, were identified. Overall, the results of the observational studies suggested that more mahjong-playing experience was associated with better cognitive, psychological, and functional abilities. As an intervention, playing mahjong was found to enhance general cognitive abilities and short-term memory and relieve depressive symptoms. However, because most of the reviewed studies adopted a correlational methodology, the neural mechanism underlying the benefits of playing mahjong awaits further elucidation. The findings of this review suggest that more randomized controlled trials should be conducted to explore the effects of playing mahjong on higher-level cognitive functioning in older populations.
... Players must analyze and strategize with the titles they receive, then engage in constant logical operations (66). Furthermore, the game requires participants to memorize the titles discarded by others in each round, contributing to memory exercises (67). Prior research indicates that strategic games can enhance individuals' logical reasoning skills (29). ...
... Prior research indicates that strategic games can enhance individuals' logical reasoning skills (29). Specifically, games like Mahjong, are considered to improve memory accuracy and reaction ability (29,67). Our research findings align with these previous studies (29,(32)(33)(34)(35). Moving to the data from 2011, older people who played Mahjong not only exhibited higher scores in attention and calculation but also demonstrated higher scores in language, understanding, and self-coordination. ...
... Older people can mitigate age-related cognitive decline and improve their reaction, sustain attention and calculation, enhance memory, and increase self-coordination through regular Mahjong activities. Moreover, the positive effects of Mahjong on these cognitive abilities imply their interrelatedness (73) and mutual reinforcement (67). Improved reaction can influence attention and calculation abilities, leading to the maintenance and restoration of memory in older people, ultimately facilitating better self-coordination. ...
Background
Cognitive decline is prevalent among older adults, often resulting in decreased capabilities for self-care and a diminished quality of life. Mahjong, a culturally cherished and extensively played intellectual game in China, demands considerable cognitive function. While the cognitive benefits of playing Mahjong have been widely accepted, this study investigates an under explored aspect and aimed to ascertain the game’s potential contributions toward bolstering self-care abilities, enhancing overall quality of life, and mitigating against rising societal healthcare costs.
Methods
The data analyzed in the study is collected from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with cognitive functioning being assessed through the Mini-Mental State Examination (MMSE). The frequency of playing Mahjong was measured through a self-reported questionnaire. Multiple linear regression models, latent variable growth models, and cross-lagged models were used to investigate the longitudinal relationship between game frequency and cognitive function in older people.
Results
Of the 7,535 participants, the mean (SD) age was 81.96 (10.53) years. There were 7,308 (97%), 4,453 (59%), and 1,974 (26%) participants in 2011, 2014, and 2018, respectively. The results showed that Mahjong players had significantly higher MMSE scores compared to non-players from 2008 to 2018 (β = 0.893; p < 0.001), and non-players had significantly lower scores in 2011, 2014, and 2018 than in 2008 (β = −1.326, −0.912, −0.833; Ps > 0.05). Moreover, the frequency of playing Mahjong was associated with improved various cognitive domains. The declining frequency of playing Mahjong was substantially associated with the declining rate of MMSE scores (r = 0.336; p < 0.001). Mahjong frequency showed positive effects on MMSE scores, while the influence of Mahjong on MMSE scores were not significant.
Conclusion
Playing Mahjong has a positive influence on the cognitive functioning among older people. It can help buffer against the decline in cognitive function and maintain cognitive function levels. The higher frequency of playing Mahjong is associated with improved reaction, attention and calculation, and self-coordination. A decline in the frequency of playing Mahjong was associated with a declining rate of cognitive function. The higher frequency of playing Mahjong among older people unilaterally influenced the improvement of cognitive function levels in older people in China.
... Mahjong is a game that involves four players and usually uses 144 tiles (Cheng, Chan, & Yu, 2006). It is a culturally-accepted or family-endorsed gambling game at festivals and parties that is usually played for small amounts of money (Ohtsuka & Chan, 2010). ...
... Mahjong seems to have benefits to older adults. It is a highly demanding mental game because it requires players to memorize and calculate others' moves to win, and it has been found to be effective in increasing cognitive performance among dementia patients in Hong Kong (Cheng et al., 2006). On the other hand, due to the excitement, nervousness, and sedentary features of playing mahjong, it may increase the potential for health risks, such as heart attacks or strokes, (Tang, 2010). ...
... Most of them played mahjong believing that it helps to exercise their brains and, thus, fend off Alzheimer's disease in old age. In fact, the hand-eye coordination required during mahjong play makes it an affordable and effective way to treat dementia patients (Cheng et al., 2006). Betting money, even a small amount, makes it a more exciting form of entertainment, whereas a large amount of betting could not only cause financial problems but was also considered a health risk for older adults because of a surplus of excitement. ...
Mahjong is considered a popular form of gambling in the Chinese culture, especially among older Chinese populations. However, there is a lack of research on mahjong playing among older Chinese immigrants and its impact on their lives. The current study explored the beliefs and experiences of mahjong through the lens of older Chinese immigrants residing in New York City. A total of 14 participants who played mahjong were included in the analysis. Thematic analysis revealed two major themes: The first theme, healthy mahjong, encompasses the positive roles and meaning of mahjong among older Chinese immigrants as it promotes social engagement and cognitive activity, and eliminates boredom. The second theme, little mahjong, focuses on the attitudes and behaviours used to keep their play under control, through small-scale betting, casual acceptance of winning and losing, and not making it a habit. Negative cases were also included to provide a full illustration of the participants’ views. The findings suggest that, despite a low risk of problem gambling, there may be a need for an intervention in order to increase awareness to prevent health consequences contributed by long periods of time spent sitting to play mahjong.
... Mahjong is one of the most popular entertainment games among Chinese. Older adults in particular enjoy playing mahjong because the game requires attention control and alertness, heightened speed and volume of information processing, visual-motor coordination and the game's gambling element is also attractive 6) . In addition, playing mahjong indirectly improves psychological well-being by way of social interaction 7) . ...
... Many older adults play mahjong at social gatherings and in their leisure time 6) . Studies have shown that playing mahjong can directly or indirectly promote social interaction 7) . ...
... Some experienced players can even finish a session within 2 hours. In addition, just like other mental games, each game is a new exercise presenting a completely different combination of stimuli for the players 6) . Repeated mahjong playing could therefore be expected to maintain or improve players' fast finger-pointing performance. ...
[Purpose] Eye-hand coordination declines with age, but physical activity is known to slow down the degeneration. Playing mahjong involves lots of eye-hand coordination. The objective was to investigate the relationship between playing mahjong and eye-hand coordination in older adults using a fast finger-pointing paradigm. [Subjects and Methods] Forty-one community dwelling older adults aged sixty or above were recruited by convenience sampling in this cross-sectional study. They were tested on their ability to point quickly and accurately 1) toward a stationary visual target and 2) toward a moving visual target. [Results] The mahjong players demonstrated significantly better end-point accuracy when pointing with their non-dominant hand toward a stationary target. They also demonstrated significantly faster movement of their dominant hands; shorter reaction times and better end-point accuracy when pointing with their non-dominant hands toward a moving target. [Conclusion] Mahjong players have better eye-hand coordination than non-players. Playing mahjong could usefully be introduced to older adults as a leisure time activity.
... The mahjong group was instructed to play mahjong three times a week for 1 h each time for 12 weeks based on previous reports (17,18). Each mahjong game was played by a group of four players randomly assembled at the time. ...
... It was first reported in 2006 that playing mahjong can significantly improve the cognitive function of patients with dementia (18). In a separate study, these authors also showed that mahjong playing had produced better outcomes than tai chi exercise in improving the cognition function of elderly people. ...
Background: Mild cognitive impairment (MCI) is common among elderly people. So far, effective treatment that can stabilize or reverse the cognitive decline associated with MCI is lacking. Recent studies suggest that playing mahjong may improve attention and memory in elderly people. However, its effect on executive function remains unknown.
Methods: 56 elderly people (74.3 ± 4.3 years of age) with MCI from the First Social Welfare the First Nursing Home of Nanchong were randomized into mahjong and control groups (N = 28, each group). Subjects in the mahjong group played mahjong three times a week for 12 weeks, while people in the control group assumed normal daily activity. Executive function was evaluated using the Montreal Cognitive Assessment—Beijing (MoCA-B), the Shape Trail Test (STT), and the Functional Activities Questionnaire (FAQ) before the study and then at 6 and 12 weeks after mahjong administration.
Results: There were no baseline differences in MoCA-B, STT, and FAQ scoring between the two groups. The MoCA-B, STT, and FAQ scores, however, improved significantly in the mahjong group but not in the control group after the 12-week mahjong administration. Significant correlations were also found between STT and FAQ scores.
Conclusions: Playing Mahjong for 12 weeks improved the executive function of elderly people with MCI. Because Mahjong is a simple, low-cost entertainment activity, it could be widely applied to slow down or reverse the progression of cognitive decline in people with MCI, including those with traumatic brain injury.
... However, there has been little previous research into mahjong and Chinese square dance. Researchers [5][6][7] have reported that mahjong can affect the cognitive function of people with dementia and can preserve the functioning or delay the decline in certain cognitive domains, even in those people with significant cognitive impairment. Researchers 8,9 showed that Chinese square dance can promote cognitive function in middleaged females, in addition to relieving depression and anxiety in old adults. ...
... It also can be a potentially benefit for communities in terms of expenditure when mahjong is used in daily routine care. 5 Mahjong can preserve functioning or delay decline in specific cognitive domains, even in those with significant cognitive impairment. 6 One study showed that playing mahjong can enhance shortterm memory, attention, and logical reasoning capability in the middle-aged and elderly populations. ...
Objective
The elderly population has proliferated worldwide. The empty-nest family pattern has become predominant among the aging people, and they are more vulnerable to the development of cognitive disorders. However, there is no standardized service in the community nursing care that includes procedures on how to improve the cognitive function of the elderly. Meanwhile, the booming number of empty-nest elderly stimulates the community nurses to assume the responsibility for their care. All of these bring more difficulties and opportunities for community nurses who are dedicated to the prevention of geriatric cognitive disorders.
Methods
The authors reviewed the literature related to “empty-nest elderly”, “cognitive function”, “mahjong”, and “Chinese square dance” in the Elsevier, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), Springer and PubMed databases. The study illustrates the utility possibility of an efficient and straightforward method for improving the cognitive function among the elderly in the context of community nursing care in China and even in the rest of the world.
Results
Mental and physical activity contributes to cognitive fitness and may be beneficial in delaying cognitive decline. Mental activities, such as playing mahjong, and physical activities, such as the Chinese square dance, are common Chinese activities. Both of them can affect cognitive function in some way.
Conclusions
China is experiencing one of its most severe aging problems. Community health personnel and related professionals may consider using mahjong and Chinese square dance to promote psychological health in empty-nest elderly individuals in the community.
... In particular, there are several intervention studies utilizing mahjong. [7][8][9] Mahjong is a famous board game in Asian countries, usually played together by 4 people. Mahjong set includes 136 to 152 tiles and the rules for winning and calculating scores are rather complex. ...
... Mahjong set includes 136 to 152 tiles and the rules for winning and calculating scores are rather complex. 7 Interventions utilizing mahjong have shown positive intervention effects on cognitive function across a range of cognitive domains including attention, short-term memory, and working memory, and these effects were long-lasting. 8 Furthermore, mahjong was shown to delay the progression of dementia. ...
This study investigated the effects of an intervention using the game “GO” on cognitive function in nursing home residents and evaluated the acquisition of GO according to each stage of dementia. Participants were randomly assigned to either the GO intervention group or a control group, and the intervention was performed once weekly for 15 weeks. Cognitive tests were conducted before and after intervention, and 17 participants were included in the final analysis. Analysis of covariance demonstrated that in the intervention group, the digit span total score significantly improved and the digit span backward score was maintained, whereas these scores decreased in the control group. All participants, including those who had moderate dementia, acquired the rules of the game, and participants with mild cognitive impairment and mild dementia could play the game successfully. This study indicates that GO might improve the cognitive function of residents living in nursing homes.
... Additionally, mind exercises refer to games based primarily on intellectual rather than physical skills [18], including playing cards or mahjong [19], which have therapeutic effects on cognitive function in older people [20]. It refers to activities that engage cognitive functions through intellectual games, brain-training toys, and similar tools that stimulate the brain, promote neural connectivity, and enhance attention, memory, and problem-solving skills [21][22][23][24]. ...
Objective
In an aging society, it is essential for older adults to maintain their ability for independent daily living. This study investigates the effects of physical and mind exercise on functional impairment in activities of daily living among older adults aged 80 years and older.
Methods
Data were sourced from the CLHLS database for the years 1998, 2000, 2002, 2005, 2008, and 2018, with a final sample of 62,581 respondents included in the analysis. Binary logistic regression models were employed for data analysis.
Results
Our analysis suggests that the oldest-old adults engaging in physical exercise have an approximately 44.9% lower probability of ADL disability than those not exercising (95%CI: 0.509, 0.596), whereas those engaging in mind exercise have an approximately 40.4% lower probability (95%CI: 0.537, 0.661). when the oldest-old engage in both physical and mind exercise, their risk of ADL disability is reduced by 53.6% (95%CI: 0.399, 0.538).
Conclusion
In addition to encouraging the oldest-old to engage in appropriate physical exercise, promoting simultaneous engagement in mind exercises is important. This approach is more beneficial for sustaining older adults’ health and contributes to healthy aging.
... Improved interpersonal skills and relationships lead to greater social capital, embedding individuals within a social network that fosters a stronger sense of identity and value (48). Cognitive ability may also serve as a key mechanism (49). Engaging in intellectually demanding activities like playing mahjong or cards requires coordination of various cognitive abilities, including attention, observation, memory, language, and communication (50). ...
Background
As China’s population ages, intellectual sports have become a key leisure activity with a significant impact on the subjective wellbeing of middle-aged and older adult individuals. These activities promote social engagement, counteract the “empty nest” phenomenon, and offer a pathway to successful aging.
Methods
This study utilized mixed cross-sectional data from the China Health and Retirement Longitudinal Study (CHARLS), encompassing 36,934 adults aged 45 and above. The relationship between intellectual sports, such as mahjong and bridge, and subjective wellbeing was analyzed using ordinal logistic regression modeling.
Results
Participation in mahjong and bridge was positively associated with subjective wellbeing, a finding that remained consistent across multiple regression tests. Social interaction and cognitive ability emerged as critical mediators, enhancing wellbeing through increased social engagement and cognitive stimulation. Retirement status moderated this relationship, with retired individuals showing a stronger propensity to engage in these activities, thereby boosting their wellbeing. It is noteworthy that this positive impact was more pronounced among women and rural and eastern participants.
Conclusion
This study elucidates the mechanisms through which mahjong and bridge influence the subjective wellbeing of middle-aged and older adult Chinese individuals. The findings offer valuable insights for policymakers, suggesting that promoting diverse cultural and sports activities within older adult communities could foster socialization, prevent cognitive decline, and ultimately enhance wellbeing.
... Although previous studies have offered strong support for the benefits of cognitive training to reasoning performance (Ball et al., 2002;Cheng et al., 2006;Saczynski et al., 2002;Kelly et al., 2014;Mowszowski et al., 2010), little is known about whether leisure activities (LA) also benefit the reasoning performance of elderly individuals. LA, can be defined as activities people engage in during free time, encompass a diverse range of pursuits that individuals partake in for enjoyment, relaxation, or personal development (Sala et al., 2019). ...
Although there is evidence that cognitive training enhances logical reasoning among the elderly, it remains unclear whether cognitive leisure activities (LA), which are inherently enjoyable and more accessible to older adults than cognitive training, can also improve their reasoning performance. Accordingly, we investigated the effect of cognitive LA on reasoning performance among the elderly and further explored the potential mechanism underlying this relationship. 107 elder participants from the community university for the elderly were randomized into two intervention groups (mahjong group N = 34, chess groups N = 33) and the control group (N = 40). Subjects in the intervention groups received activity sessions three times a week for 6 weeks, while those in the control group received regular physical and mental health care sessions. Need for cognition (NFC) was evaluated using the NFC scale before the study and then after intervention administration. Additionally, all participants were tasked to completing a syllogistic reasoning task after the intervention to evaluating their reasoning performances. Results showed that the intervention groups performed better than the control group in the syllogistic reasoning task. Moreover, there were no significant differences in the scores of NFC between the intervention groups and control group in the pretest, while the scores of NFC of the intervention groups were significantly higher than those of the control group in the posttest. Mediation analysis revealed that NFC mediated the effect of cognitive LA on reasoning performances among the elderly. We concluded that participating in cognitive LA represent a potential avenue for enhancing reasoning performances among older adults by boosting their cognitive motivation.
... It is scored on a 30-point scale with higher scores indicative of superior cognitive function. The optimal cut-off scores for screening cognitive impairment based on the subject's level of education are as follows: 19 points for those with 6 or fewer years of education, 22 points for those with 7-12 years of education, and 24 points for those with more than 12 years of education [16]. In this study, the duration for patients to complete the MoCA scale was approximately 15 minutes. ...
Background: Cognitive impairment (CI) is a common complication in chronic low back pain (CLBP) patients, and its progression increases the risk of dementia. However, there is currently a lack of predictive indicators for CLBP-CI. Previous studies have shown that routine blood indexes have predictive value for Alzheimer’s disease, but their relationship with CLBP-CI remains unclear. This study aims to explore the correlation between routine blood indexes and provide evidence of disparities in chronic pain and cognitive impairment between two groups of individuals with low back pain, as well as establish the foundation for longitudinal experimental studies aimed at developing effective interventions for cognitive impairment in individuals with chronic low back pain. Methods: This cross-sectional study was conducted at West China Hospital, Sichuan University. The Montreal Cognitive Assessment (MoCA) was conducted to divide patients into the CLBP-CI or CLBP-nCI group. Statistical analysis was performed to examine the differences between chronic low back pain patients with cognitive impairment and those without cognitive impairment. All statistical tests were conducted at a significance level of α=0.05 for two-sided testing. Results: The prevalence of chronic low back pain with cognitive impairment in this study demonstrates age-related disparities, with a higher prevalence observed among older individuals (P=0.009). A statistically significant difference in white blood cell count was observed between individuals with chronic low back pain and cognitive impairment (P=0.004). Conclusion: Age and white blood cell count may serve as influential factors in the development of chronic low back pain with cognitive impairment. This finding can aid healthcare professionals in implementing early intervention and treatment for individuals experiencing this condition.
... Our participants predominantly engaged in activities such as interacting with friends, playing cognitively stimulating games (e.g., Mahjong), and participating in sports or social clubs, suggesting that the positive effects of social participation may be largely attributed to these activities. The following are possible interpretations for these effects: (a) Participating in socially-focused activities (such as chatting with friends) may help older adults find meaning in life, maintain social connections and positive attitudes towards aging, feel a sense of usefulness, and ultimately benefit cognitive function (Herzog et al., 1998); (b) participating in cognitivelyfocused social activities such as playing mahjong, chess or cards is highly intellectually demanding (Cheng et al., 2006), involving the coordination and of a variety of cognitive abilities, including attention, working memory, reasoning, and calculation (Tyndall et al., 2018). These abilities are repeatedly trained during gameplay, which may maintain or even improve the cognitive function of older adults (Tyndall et al., 2018); (c) Participating in physically focused social activities, such as playing sports, may be associated with a higher level of neurogenesis, such as peripheral vascular endothelial growth factor in the hippocampus (Rich et al., 2017). ...
Objectives
Based on the “linked lives” tenant of the life course perspective, this longitudinal study aims to examine the actor and partner effects of social participation on cognitive function in older Chinese couples.
Methods
A total of 1,706 couples aged over 60 were included in the final analyses. Social participation was measured using two questions regarding types of activities and frequency. Cognitive function was measured using a combination of memory, orientation, visuoconstruction, attention, and calculation. The lagged-dependent APIM was used to model the dyadic associations between social participation and cognitive function.
Results
The time-averaged actor effects of both husbands’ and wives’ social participation on their own cognitive function were significant (p < .001 for both). The time-averaged partner effect of husbands’ social participation on wives’ cognitive function was significant (p < .001) but the reverse—the effect of wives’ social participation on husbands’ cognitive function—was not (p = .381). The time-specific actor and partner effects were not significant (p > .05 for all).
Discussion
Our findings indicate an asymmetrical pattern of actor–partner interdependence, where husbands’ social participation may affect their wives’ cognitive function on average, but wives’ social participation does not affect their husbands’ cognitive function. Clinical practitioners should invite both partners, especially husbands, to participate in social participation interventions to facilitate crossover benefits for wives. Moreover, policymakers should build more facilities to encourage older couples to engage in social activities to prevent cognitive decline.
... 10 Several other pieces of evidence support the beneficial role of playing Mahjong in cognitive stimulation in older patients and people with cognitive impairment. 11,12 Playing cards not only causes cognitive stimulation but also enhances social engagement. 7 In recent research involving children between seven and 12 years of age, it was found that modern board games and card games improve cognitive flexibility, response inhibition, and, to some extent, the working memory domain. ...
Cognitive remediation is an effective modality of therapeutic intervention that has beneficial roles in various neurocognitive disorders, traumatic brain injury, and cognitive impairments associated with several neurological and psychiatric disorders.1 Cognitive remediation techniques have significantly evolved in the past several decades regarding the underlying principle, the process by which it is being delivered (online or offline), and the settings where it is being carried out (clinic-based or home-based). Most cognitive remediation or cognitive training procedures require expert guidance and are expensive.2, 3 However, researchers developed several techniques that require minimum expertise supervision and are cost-effective (e.g., grain sorting task). Researchers attempted to use standard playing cards for their possible role in cognitive stimulation.4 As playing cards are popular among people across the globe and people remember the colors, patterns, and concepts related to playing cards due to their likability,4 it can be innovatively used for cognitive remediation for various disorders with neurocognitive impairment. This article focuses on exploring the utility of playing cards as a tool for cost-effective cognitive remediation. Existing research on the use of playing cards for various cognitive stimulation purposes is highly heterogeneous in terms of the type of cards used, the techniques used to engage individuals in the tasks, and the explanatory models used to explain the process.4–7 Despite the heterogeneity, they have several conceptual similarities (social engagement, cognitive domains targeted, familiarity of card-playing task with the population engaged), which can help conduct similar card-based future research.
... Moreover, the effect of social participation on cognitive function in Chinese societies is also examined empirically. Cheng and Chan conducted a study among 62 elderly people with mild cognitive impairment and found that playing mah-jongg can improve the cognitive function of older adults [13]. Hsu used the data from a longitudinal survey of middle-aged and older people (aged 45 and above) in Taiwan and found that compared with social activities inside the family, participation in social activities outside the family can ameliorate the cognitive function of middle-and old-aged people as compared with social activities inside the family [14]. ...
Background
This study makes an effort to examine the impact of home and community-based services on maintaining cognitive function and understand the mediating effect of social participation on the relationship of community services and older adults’ cognitive function in China.
Method
The empirical data comes from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). A total of 38,582 (person-time) respondents were gathered for this study. The two-way fixed effects regression model is used to estimate the associations between independent variables, mediating variables and cognitive ability after controlling for socio-demographic, family responsibility, and time variables.
Result
This study has confirmed that participating in daily and social activities is associated with the cognitive functions of Chinese older adults. Social participation can stimulate cognition. Active participation in outdoor activities, doing housework or taking care of kids, daily playing cards or mah-jong , reading books and newspapers, watching TV, and listening to the radio can significantly promote the cognitive ability of older adults. In addition, the findings have indicated the importance of community services for older adults. This study shows personal daily care services, legal aid services, health education services, as well as dealing with family and neighborhood disputes have a positive effect on maintaining older adults’ cognitive functions. Meanwhile, the provision of door-to-door medical services hurts their cognitive functions. This study also illustrates that community-based services can increase the level of older adults’ social participation, and then enhance their level of cognitive function.
Conclusion
This study can inform service provision agencies to develop targeted programs to support older adults’ continued engagement.
... In addition, some studies have also shown that stimulating intelligence more frequently (such as cards, chess, mahjong, and crossword puzzles) was related to reducing the risk of dementia [17][18][19] and there may be a dose-response relationship. The reason why these stimulating intellectual games can reduce the risk of dementia may be that playing cards and chess, which involves attention, reasoning, memory, and initiative in cognitive fields, is a powerful and comprehensive stimulating activity for the brain [20,21]. ...
Background
With the increase in age, the probability of cognitive impairment in the older people is increasing. More and more evidence shows that participating in leisure activities, especially chess and cards, is beneficial to the cognition and mental state of the older people. But the evidence for causal inference is limited. There is a need to conduct a fully powered randomized controlled trial (RCT) and long-term follow-up to test the effectiveness of intervention measures in improving cognitive function and mental state. This paper describes the methodology of a cluster RCT designed to determine the effect of chess and cards leisure activities on the cognitive function of the older people over 60 years old.
Methods/design
A cluster RCT consisting of 8 clusters will be conducted in four regions of Ningxia, China (Helan, Litong, Qingtongxia, and Shapotou). Clusters will be randomly assigned to the advocacy intervention group, which is also delivered with free leisure activities tools (chess and cards), or the control group. A baseline survey will be conducted before the intervention. A mid-term and final survey will be carried out twelve and twenty-four months after the intervention, respectively. The primary outcome is a change in cognitive function, and the secondary outcomes are changes in anxiety, depression, and loneliness.
Discussion
The results of this RCT will be helpful to (1) confirm the effectiveness of chess and cards leisure activities in improving the cognitive function of the older people over 60 years old; (2) determine the relationship between the frequency and duration of chess and cards leisure activities and cognitive function; (3) provide evidence of promoting participation in leisure activities through education campaigns and free provision of chess and cards tools; and (4) provide valuable information for successful aging.
Trial registration
Chinese Clinical Trial Registry: ChiCTR2200066817. Registered on 19 December 2022.
... In multiple imputation analyses, we found that mahjong playing also associated lower incidence of cognitive frailty in our study. This suggests that cognitively stimulating activities with social interaction may improve executive, attention, verbal memory, and cognitive functions in older adults [49,50]. Additionally, sensitivity analyses with multiple imputation also revealed that low physical activity predicted cognitive frailty incidence, suggesting that cognitive frailty is modifiable [51], and future interventions targeted at improving cognitive frailty outcomes should include cognitive, physical, and social interaction domains. ...
Introduction:
Cognitive frailty is associated with higher risk of dementia and adverse health outcomes. However, multidimensional factors that influence cognitive frailty transitions are not known. We aim to investigate risk factors of incident cognitive frailty.
Methods:
Prospective cohort study participants were community-dwelling adults without dementia and other degenerative disorders and baseline and follow-up, including N=1054 participants aged ≥55 free of cognitive frailty at baseline, with complete baseline (March 6, 2009, to June 11, 2013) and follow-up data at 3-5 years later (January 16, 2013 to August 24, 2018). Incident cognitive frailty, defined by one or more criteria of the physical frailty phenotype and <26 of Mini-Mental State Examination (MMSE) score. Potential risk factors assessed at baseline included demographic, socioeconomic, medical, psychological and social factors, and biochemical markers. Data were analysed using Least Absolute Shrinkage Selection Operator (LASSO) multivariable logistic regression models.
Results:
A total of 51(4.8%) participants, including 21(3.5%) of the cognitively normal and physically robust participants, 20(4.7%) of the prefrail/frail only and 10(45.4%) of cognitively impaired only, transited to cognitive frailty at follow-up. Risk factors for transition to cognitive frailty were having eye problem (OR=2.6, 95%CI 1.24-5.43) and low HDL-cholesterol (OR=4.1, 95%CI 2.03-8.40), while protective factors for cognitive frailty transition were higher levels of education (OR=0.3, 95%CI 0.10-0.74) and participation in cognitive stimulating activities (OR=0.4, 95%CI 0.17-0.82).
Discussion/conclusion:
Multi-domain modifiable factors especially related to leisure activities predict cognitive frailty transition and may be targeted for prevention of dementia and associated adverse health outcomes.
... Recently, the effects of playing Mahjong on health, particularly on brain function, have been studied (Table 1). Mahjong has been shown to prevent depression in older adults (Tang et al., 2021), improve cognitive performance, such as verbal memory in patients with mild dementia (Cheng et al., 2006(Cheng et al., , 2014Qiu et al., 2019;Zhou et al., 2020;Ding et al., 2022), and improve higher brain functions, such as increased executive function (Zhang et al., 2020). Based on this improvement in executive function, Zang et al. concluded that Mahjong improved higher brain function by activating frontal lobe functions, such as concentration and anticipation. ...
This study investigated the effect of Mahjong, which is a table game played by three or four players and involves intellectual activity, on the intelligence quotient (IQ) of children. The participants were children between the age of 6 and 15 years, and their IQ was assessed immediately after enrolling in children's Mahjong classes and 1 year after the enrollment using the Wechsler Intelligence Scale for Children Fourth Edition (WISC-IV). Twenty children were included in the analysis. Their mean age at the time of the initial evaluation was 9 years and 6 months. In addition, we conducted a 1-year post-examination. The change in the IQ of this group was compared to that of a historical control group with a similar age range and test–retest interval. The mean overall full-scale IQ of the 20 children during the initial and post-1-year examinations was 106.05 and 113.75, respectively, and showed a statistically significant increase (p < 0.01). Based on the subscale index, the verbal comprehension index (VCI) and processing speed index (PSI) scores both showed a statistically significant increase from 100.6 to 106.75 and from 108.05 to 119.05 (p < 0.01), respectively. The PSI of the children included in the analysis showed a statistically significant increase compared to the historical control group. This study suggests that children who participate in Mahjong classes during their childhood have increased PSI scores of WISC-IV.
... Playing cards/ mahjong was found to have the therapeutic effects of preserving functioning or delaying decline in specific cognitive domains (Cheng et al., 2014) and decreasing the likelihood of becoming lonely (Teh and Tey, 2019). It has also been found to be a viable treatment option for dementia (Cheng et al., 2006) and is encouraged to be adopted into the routine for the elderly to prevent loneliness as well as to maintain cognitive abilities, especially for those living alone. However, it should be noted that playing cards/mahjong is a special kind of sedentary behavior. ...
Public parks are critical resources for physical activity (PA). Pocket parks within neighborhoods play an essential role in the elder’ daily life. A deep understanding of pocket park use and park-based PA for older adults supports the better design of outdoor spaces. Gender differences have been confirmed in previous studies. Indeed, it was observed that more males visit parks than females, and males are likely to be vigorously active. However, almost all the studies were conducted in western countries, and none has yet focused on the Chinese elderly. The main objective of this study is to investigate gender differences in park-based PA in the Chinese middle-aged and elderly population. In Zongbei Park (Chengdu, China), video recording is used from 07:00 a.m. to 07:00 p.m. to document numbers, gender, age group, and type of activity. Demographic variations of park use patterns and energy expenditure are analyzed. The study findings indicated that most users (92.05%) were middle-aged and elderly. Significant gender variations were found in the number of total and five types of activities (p < 0.01), respectively. Although more old males than females were observed in Zongbei Park, the total METs and mean METs per male were lower than females. A majority (65.66%) of the older adults were seen playing cards/mahjong. It will lead to a significant number of sedentary older adults. As China faces severe healthcare challenges due to the problem of aging, it becomes essential to construct age-friendly design pocket parks. More attention should be paid to address the park-based PA gender gap.
... Playing cards or mahjong is a highly intellectual and mental demanding task [21]. In China, it is a highly popular social entertainment program for older adults. ...
Cognitive decline in older adults is a major public health threat. This study aimed to explore the association of participation in cards or mahjong with cognitive function in older adults. A total of 7308 older adults were selected from the 2018 Chinese Longitudinal Healthy Longevity Survey. A modified Mini-Mental State Examination (MMSE) was used to assess cognitive function. The participants were classified according to the frequency of playing cards or mahjong into the “regularly” (R) group, “occasionally” (O) group, or “never” (N) group. The results showed that older persons in the R group and O group had better cognitive function than those in the N group. Specifically, significant differences were found in attention and calculation, language, and total MMSE score between the R group and the N group. However, significant differences were not observed for adults aged 60–69 years old. Regression analysis indicated that playing cards or mahjong, together with age, educational level, sex, marital status, and occupation before age 60 could explain the cognitive function. The findings suggest that there is an association between participation in cards or mahjong and cognitive function in the population of Chinese older adults, and that the frequency of participation plays an important role in the association.
... In addition, some elderly reported that there were too many pictures to remember, suggesting that future studies can be performed with a lesser number of pictures. The previous study shows that playing cards or mahjong has a significant positive effect on protecting cognitive functions in elderly individuals (21). Handicraft, calligraphy, and painting are also included in this intervention. ...
Background
In recent years, cognitive training has been one of the important non-pharmaceutical treatment methods that could delay cognitive decline and improve quality of life in the elderly. In different types of cognitive training, both the cognitive domains focused on and their training methods widely vary. This study aimed to explore the feasibility and engagement of multidomain cognitive training in Chinese community-dwelling healthy elderly.
Methods
Based on the cluster sampling method, a total of 151 healthy elderly, aged 70 or above, who lived in the neighborhoods in Shanghai met the inclusion criteria and agreed to participate in the study. Among them, 90 participants were assigned to the cognitive training group (intervention group), and 61 were assigned to the no cognitive training group (control group). Participants in the intervention group attended a 1-h multidomain cognitive training course twice a week for 12 weeks (total of 24 times), which targeted memory, reasoning, strategy-based problem-solving skills, etc. The control group did not receive any intervention.
Results
There was a significant increase in test scores of story recall (t = −8.61, p = 0.00) and Raven's Standard Progressive Matrices (RSPM) (t = −10.60, p = 0.00) after in-class interventions. The overall completion of homework was 77.78%. Fifty percent of the 90 participants completed self-training. The top three self-training methods were physical exercise, reading books and newspapers, and watching TV. The overall attendance rate of the intervention group was 76.14%, and more than 50% of them had an attendance rate of 77.8%. The attendance rate was positively correlated with years of education and baseline SF-36 (physical functioning, general health, vitality, and mental health) scores, whereas it was negatively correlated with baseline disease index and fatalism of personality indicators (p < 0.05).
Conclusion
The elderly with higher educational levels and better physical and psychological conditions had a higher engagement in multidomain cognitive training. The training course proved to be rational, feasible, and effective for community-scale application.
... Ratings reflect a 5-point scale from lowest to highest frequency: never (1), once or twice per month (2), once or twice per week (3), several times a week (4), every day or about every day (5). Responses are averaged across all items to provide the mean level of activity participation (i.e., CSA-Q mean) from 0 to 5. Several items, such as "using a computer" or "playing board games with others," have been associated with enhanced cognitive abilities (Cheng et al., 2006;Toril et al., 2014;Vujic, 2017). ...
Late-life participation in cognitively stimulating activities is thought to contribute to an individual’s cognitive reserve and thus protect against cognitive decline, yet its association with clinical markers of neurodegeneration is not well established. To investigate, we developed a 13-item self-report “cognitively stimulating activities” questionnaire (CSA-Q), which was completed by a community sample of 269 older adults (>50 years) at risk of dementia. Participants met criteria for Mild Cognitive Impairment (MCI) and were classified as amnestic (aMCI; n = 93) or non-amnestic (naMCI; n = 176). Weighted CSA-Q dimensions were calculated for activity intensity, mental engagement and social engagement via a panel of 23 inter-raters. The CSA-Q mean and its dimensions were examined in relation to: (a) demographics (age, sex), (b) cognitive reserve proxies (years of education, premorbid IQ), (c) neuropsychological markers across cognitive domains of executive function, processing speed, learning, and memory storage, and (d) neuroimaging markers (left and right hippocampal volume). Analyses were conducted for all MCI, as well as for aMCI and naMCI sub-types. The CSA-Q was found to have concurrent validity with cognitive reserve proxies. Among all MCI, the CSA-Q dimensions of intensity and mental engagement had moderate associations with left hippocampal volume, but not with neuropsychological performance. For naMCI, the CSA-Q had moderate associations with left hippocampal volume, and small associations with aspects of executive functioning and processing speed. No equivalent associations emerged for the aMCI subtype. Our findings show that the CSA-Q may be particularly useful for older adults with non-amnestic cognitive deficits.
... With the underlying mechanism not fully comprehended, we speculate that different types of SP stimulate different parts of the brain with unique functions [31]. For instance, playing mah-jong requires attention and memory [32], and one' s fine motor movement and eye-hand coordination may be improved when playing mah-jong [33], which could contribute to enhancing brain function regarding digit forward and verbal memory [34]. This is similar for Internet use, which consists of novel and complex mental processes for older adults, especially requiring memory [15]. ...
Background Social Participation (SP) is known to benefit cognitive function. However, whether the positive relationship holds across different types of SP and dimensions of cognitive function, and whether the statement stays true in middle- and oldaged Chinese have not been investigated. The present study aimed to understand the current patterns of SP and cognitive function in China’s context, and therefore, explore the associations between cognitive function and SP at different levels from various aspects.
Methods A total of 7973 community residents aged 45 years and older were selected from the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). A fixed effects analysis was used to explore the association between changes in SP (diversity, frequency, and type) and that in cognitive function (memory and mental status) over a four-year period.
Results Changing from no SP to more variety (β = 0.377, 95% confidence interval (CI) = 0.192-0.562 for 1 type, β = 0.703, 95% CI = 0.470-0.937 for ≥2 types) or higher frequency
(β = 0.235, 95% CI = 0.007-0.462 for not regularly, β = 0.604, 95% CI = 0.411-0.798) of SP was associated with improvements in cognitive function. Playing mah-jong and using Internet were associated with improved memory but not with mental status. Sports and volunteering were associated with improved mental status but not with memory. The same pattern was observed in men and in women.
Conclusions The study confirmed that more diversity and higher frequency of SP was associated with improved cognitive function, whereas reminded policymakers to consider cultural context when developing target strategies to improve cognitive function.
... It can also protect against the worsening of mental health, and thus decrease the likelihood of becoming lonely (Aartsen & Jylh€ a, 2011). Playing mahjong has also been found to be a viable treatment option for dementia (Cheng, Chan, & Yu, 2006). Participating in the activity can maintain cognitive abilities or delay cognitive decline in older persons suffering from dementia (Cheng & Chow, 2011;Cheng et al., 2014). ...
This study examined three types of leisure activities (playing cards/mahjong, watching TV/listening to the radio, and participation in social activities) among the older segment of the Chinese population, and the effects of these activities in preventing the feelings of loneliness. Data came from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), conducted in 2005, 2008, and 2011. The males, those who were educated, the young-old (aged between 65 and 74 years), urban dwellers, and living in institutions were more likely to participate in all three activities frequently. Frequent or occasional participation in these three activities was negatively associated with feelings of loneliness. The longitudinal study from 2005 to 2011 showed that respondents who frequently played cards/mahjong at baseline were less likely to feel persistent loneliness at the end of the 2011 wave. Instead, frequently watching TV/listening to the radio in 2008 was associated with lower odds in feeling persistent loneliness at the end of 2011. Hence, active participation in playing cards/mahjong and TV/radio entertainment can be effective treatment intervention against persistent loneliness among older Chinese. For the Chinese, a leisure activity steeped in a nation's culture and heritage, such as playing mahjong, may be used as an intervention strategy to prevent and alleviate chronic loneliness among older adults.
... For instance, hobby clubs in prior literature were often referred to painting or music (Nummela et al., 2008;Tomioka et al., 2017), which are much less popular amongst middle-and old-aged Chinese. Instead, mah-jong ("麻 将" in Chinese) is one of the most popular hobbies in China's context and other Asian ethnic groups (Cheng et al., 2006). Similarly, voluntary work investigated in prior studies (Turner et al., 1999) mainly focused on formal voluntary work such as joining non-profit organisations (Bourassa et al., 2017), whereas Chinese, especially the senior, tend to carry out informal voluntary activities such as helping others without compensation. ...
The potential benefit of social participation (SP) to one's mental health has been widely acknowledged. Nevertheless, the specific type and amount of SP that is associated with improved depressive symptoms in middle- and old-aged Chinese awaits further investigation. This study aimed to understand the patterns of depression and SP by comparing urban vs rural China, and according to which, measure the associations between changes in SP and that in depressive symptoms. A total of 10,988 community residents aged 45 years and above were selected from wave 1 (2011), wave 2 (2013), and wave 4 (2015) of the China Health and Retirement Longitudinal Study (CHARLS), a nationally representative survey. The fixed-effects analysis was used to explore the association between the changes in diversity, frequency, and type of SP and the changes in depressive symptoms. The results indicated that rural respondents suffered from a significantly higher risk of depression and took less SP than their urban counterparts. Transitioning from no SP to 1 or more types of SP or to a once a week or higher frequency was associated with a decline in depressive symptoms. For urban respondents, playing mah-jong or cards and joining sports or social clubs predicted a decline in depressive symptoms. For rural residents, interacting with friends regularly was associated with fewer depressive symptoms. In conclusion, more diverse and higher frequency of SP was associated with better mental health, while the social significance of SP varied across different types of SP and between rural and urban areas. © 2019 Elsevier Ltd
... The reported RCTs found just focused on one leisure activity. It has been reported that Mahjong [194][195][196], Taichi [194,197], or video games requiring physical activity [198] can preserve functioning or delay the decline in certain cognitive domains, even in people with significant cognitive impairment. Such cognitive activities may thus be effective non-drug treatments for cognitively impaired patients. ...
Alzheimer’s disease (AD) is characterized by decreased neuronal activity and atrophy, while hyperactivity of neurons seems to make them resistant to aging and neurodegeneration, a phenomenon which we have paraphrased as ‘use it or lose it’. Our hypothesis proposes that (1) during their functioning, neurons are damaged; (2) accumulation of damage that is not repaired is the basis of aging; (3) the vulnerability to AD is determined by the genetic background and the balance between the amount of damage and the efficiency of repair, and (4) by stimulating the brain, repair mechanisms are stimulated and cognitive reserve is increased, resulting in a decreased rate of aging and risk for AD. Environmental stimulating factors such as bilingualism/multilingualism, education, occupation, musical experience, physical exercise, and leisure activities have been reported to reduce the risk of dementia and decrease the rate of cognitive decline, although methodological problems are present.
... Existing literature is even more limited for those with dementia (Bahar-Fuchs, Clare & Woods, 2013), as many individuals may find these techniques too challenging. Cognitive stimulation strategies (more related to environmental enrichment), such as playing Mahjong (a popular Chinese game) or practicing tai chi, have been found to be better tolerated and beneficial for this population (Cheng et al., 2014; Cheng, Chan & Yu, 2006; Mapelli, Di Rosa, Nocita & Sava, 2013). However, preliminary findings suggest that computerized cognitive rehabilitation can at least benefit short-term memory in individuals with moderate to severe dementia (Mate-Kole et al., 2007). ...
The role of neuroplasticity, or the brain’s ability to modify neural processes as a result of environmental changes, is crucial to normal memory functioning. Furthermore, this capacity of the central nervous system to adapt is essential for healthy aging and for recovery following trauma or disease states. In this chapter, we identify the synaptic and structural mechanisms that drive plasticity, as well as describe the purported processes responsible for short- and long-term memory. We then review the literature regarding the role of neuroplasticity in the aging brain and in recovery following various types of injury (e.g., traumatic brain injury and stroke). Particular focus is placed on the implications of lifestyle factors, such as diet, exercise, and environmental enrichment, and formal cognitive training or rehabilitation strategies as potential methods for facilitating neuroplasticity and maintaining healthy memory functioning.
... Further, family and community support are of paramount importance for the elderly with brain disorders. Accordingly, emerging evidence supports positive effects of social interventions such as playing mahjong and practicing Taichi, on brain health although further large-scale studies are warranted (Cheng et al., 2006;Wei et al., 2013). ...
China is encountering formidable healthcare challenges brought about by the problem of aging. By 2050, there will be 400 million Chinese citizens aged 65+, 150 million of whom will be 80+. The undesirable consequences of the one-child policy, rural-to-urban migration, and expansion of the population of 'empty nest' elders are eroding the traditional family care of the elders, further exacerbating the burden borne by the current public healthcare system. The challenges of geriatric care demand prompt attention by proposing strategies for improvement in several key areas. Major diseases of the elderly that need more attention include chronic non-communicable diseases and mental health disorders. We suggest the establishment of a home care-dominated geriatric care system, and a proactive role for researchers on aging in reforming geriatric care through policy dialogs. We propose ideas for preparation of the impending aging burden and the creation of a nurturing environment conducive to healthy aging in China.
Copyright © 2015 Elsevier B.V. All rights reserved.
... The benefi ts of therapeutic recreation have been shown through numerous studies that reference a vast array of improvements to persons living with dementia and their overall quality of life. Specifi cally, therapeutic recreation seeks to improve areas of total well-being including (a) cognition (Cheng, Chan, & Yu, 2006 ;Wise, 2002 ); (b) physical ability (Arkin, 1999 ); (c) social ability (Richeson & Neill, 2004 ); (d) emotional stability (Buettner & Fitzsimmons, 2004 ;Buetter, Fitzsimmons, & Atav, 2006 ); (e) sensory stimulation (Bittman et al., 2004 ); and (f) spiritual wellness (Trevitt & MacKinlay, 2006 ). Interventions to achieve improved quality of life are provided by professionally trained individuals who understand the importance of continual assessment, goal setting, interventions, and evaluation (Hare & Frisby, 1989 ). Rehabilitation through therapeutic recreation provides persons living with dementia an opportunity to attain their goals and improve their quality of life through individualized interventions of recreation and leisure (Wang, 2007 ). ...
... Mahjong is a fourplayer gambling game which originated in China and is played in Chinese communities across the World [50]. Studies suggest that, Mahjong is especially popular with women and the older generation [51,52,53], and there is some evidence to show that participation can prevent mental deterioration associated with old-age [54]. The game has strong cultural roots with many Chinese learning the game at a very young age, usually through exposure to gameplay by family and friends. ...
Objective
This study aimed to (i) examine the prevalence and types of gambling, (ii) establish prevalence of ‘pathological’ gambling, (iii) explore the correlates of gambling, and (iv) establish psychiatric and physical comorbidity in a sample of older adult gamblers (≥ 60 years) in contrast to younger gamblers in a representative population sample in Singapore.
Method
This paper reports the results of a secondary analysis of data from a representative community survey of 6616 participants, of which 2252 had engaged in gambling activities at least once in their lifetime.
Results
48.9% of older adults reported lifetime gambling. Older gamblers were more likely to be males, married or widowed (vs. never married), with pre-primary, primary and secondary education (vs. university), economically inactive (vs. employed) and had personal annual income of SGD 19,999 and below (vs. SGD 50,000 and above). Older gamblers had significantly higher rates of betting on horses, playing numbers or betting on lotteries, and playing Mahjong. After adjusting for demographic variables in multiple logistic regression analyses, gamblers aged 60 years and older had significantly lower odds of having pathological gambling than those in the younger age group (OR = 0.4). Older gamblers had significantly higher odds of having diabetes (OR = 3.2), hypertension (OR = 4.9), and any comorbid chronic physical condition assessed in this study.
Conclusions
For the majority of older adults, gambling remains a recreational activity that is entertaining and a way of socialization. However, one must remain cognizant of the possible risks for some to develop disordered gambling.
... As the 1-10 RPE scale is modified to make it easy to use, it is likely that individuals with AD could more reliably use it. In addition, there might be a difference in RPE validity for different exercise programs such as aerobic exercise versus brain exercises like Mahjong (Cheng, Chan, & Yu, 2006) or aerobic exercise versus Taiji (Li et al., 2014). However, the concurrent validity between the modified 1-10 Borg RPE scale and HR has not been tested in AD, and no studies have evaluated the utility of RPE across different exercise programs. ...
Standardized methods for prescribing and monitoring exercise intensity are needed to advance exercise research in Alzheimer's disease (AD). The purpose of this study was to evaluate the concurrent validity of a modified 1–10 Rating of Perceived Exertion (RPE) scale against heart rate (HR) in older adults with mild-to-moderate AD (N = 8, age 77–87 years). RPE and HR were assessed every 5 min during each exercise session with 3,988 data pairs. Pearson and Spearman correlations and mixed models for correlated data were used for analysis. Results show the correlation between RPE and HR and between RPE and change in HR from resting was −.11 (SE = .15) and −.31 (SE = .17), respectively. The proportions of variance explained by RPE overall, RPE within participant, and RPE within session were only 4.0, 5.3, and 6.7%, respectively. We conclude that the modified 1–10 RPE scale did not show concurrent validity to HR, with large between-individual variability.
... In our study, 18% of participants reported that they played mahjong at least several times a month, which is consistent with rates reported in studies of Chinese older adults in Hong Kong and Singapore (11,23). Mahjong's popularity among Chinese groups may in part be due to its proven effect in preserving and improving older adults' cognition function (25), as mahjong requires brain exercises such as remembering rules, identifying winning strategies, calculating the odds, and observing other players. ...
Background:
Social engagement is a key indicator of older adults' later life quality and health status, but few studies have comprehensively examined social engagement patterns of U.S. Chinese older adults. This study assesses social engagement patterns among U.S. Chinese older adults.
Methods:
Data were collected by the Population Study of Chinese Elderly project, a cross-sectional population-based study of 3,159 U.S. Chinese older adults aged 60 and older in the greater Chicago area. Social engagement patterns were examined with a list of 16 social engagement activity related questions. Analysis of variance and Pearson or Spearman correlation coefficients were used to examine correlations between sociodemographic and health characteristics and social engagement.
Results:
Age was negatively associated with social engagement actives for Chinese older adults. Although education had a significant positive correlation on older adults' participation in social engagement activities, income did not show any significant correlation. Perceived health status and quality of life were also positively correlated with social engagement. Chinese older adults were more likely to visit community centers than any other social or cultural venues.
Conclusions:
This study highlights the important role community centers play in the lives of Chinese older adults. Further, longitudinal studies are also necessary to understand the predictors and outcomes of social engagement levels among Chinese older adults.
... having digit forward and verbal memory deficits) maintained improvements for at least a month. 23 Cultural relevance should therefore be taken into account when promoting cognitive activities to the elderly. ...
Background. Activity theory stresses the positive linkage of activity and quality of life (QOL) in individuals. This study aimed to explore the association between leisure participation and health-related QOL (HrQOL) of community-dwelling elders in Hong Kong. Methods. A cross-sectional study was conducted over a 3-month period beginning August 2006. Persons aged 65 years or older were randomly selected from elderly health centres. Telephone interviews were then conducted by trained professionals. HrQOL was measured using Short Form-12 version 2. Subjects were asked about their participation in 18 types of leisure activities grouped in 4 categories, namely: recreational, cognitive, social, and productive. Frequency of such participation was measured on a 5-point scale. Its association with sociodemographic variables was examined using regression analysis. Results. 269 participants completed the interview (response rate=77%). The most common daily leisure activities were watching television (99%), listening to the radio/music (57%) and reading (57%). Cognitive and social activities were positively associated with the physical and mental domains of HrQOL. Higher levels of participation in cognitive activity were associated with better physical functioning (p<0.05, 95% CI=0.144 to 1.667), role physical (p<0.05, 95% CI=0.047 to 1.594) and mental health (p<0.05, 95% CI=0.001 to 0.937). Participation in social activity was associated with better physical functioning (p<0.05, 95% CI=0.211 to 1.918). On the contrary, participation in recreational activity was only marginally related to social functioning (p=0.055, 95% CI= -1.89 to 0.02), role emotion (p=0.059, 95% CI= -1.27 to 0.02), and mental health (p=0.053, 95% CI= -1.26 to 0.01). Participation in productive activity was negatively associated with general health (p<0.05, 95% CI= -1.569 to -0.049). Conclusion. From a primary care perspective, expanding the repertoire of leisure activities, in particular, cognitive and social activities, may contribute to better HrQOL for the elderly living in the community. Longitudinal studies are recommended to further examine the causal relationship of leisure participation and HrQOL.
Background
Considering the significance of self-reported social participation in the context of depression, patterns of social engagement may influence the onset and progression of depressive disorders. This study aimed to elucidate the relationship between social behaviors and depressive symptoms.
Methods
Utilizing data from the China Health and Retirement Longitudinal Study (CHARLS) over a nine-year span, we enrolled 9415 participants without depression in 2011 and monitored them for depressive symptoms until 2020. Baseline data included ten items related to social activities. We investigated the correlation between these social activity-related items, their major patterns, and the emergence of depressive symptoms, alongside varying depressive trajectories.
Results
Individual analysis of social activity-related items demonstrated significant correlations with a decreased risk of developing new depressive symptoms and adverse depressive trajectories. Pattern analysis indicated that a higher level of engagement in activities such as frequent interactions with friends (odds ratio [OR] = 0.79, 95% confidence interval [CI] 0.70–0.89), participation in diverse societal activities (OR = 0.70, CI 0.62–0.80), and a combined pattern of internet use and friend interactions (OR = 0.60, CI 0.41–0.79) was associated with a lower risk of depression onset. Compared to individuals categorized in the societal isolation group, those with a higher adherence to these activity patterns exhibited a decreased risk of developing unfavorable depressive trajectories (ORs = 0.39 to 0.83).
Conclusions
Patterns of social engagement, particularly frequent interactions with friends, participation in a variety of societal activities, and the combined use of the internet with friend interactions, were inversely related to the risk of depression onset and worsening depressive trajectories. These findings emphasize that promoting social participation activities can serve as practical intervention tools to prevent depression, providing a foundation for strengthening public health policies aimed at fostering social connectivity and reducing the burden of depressive disorders.
Background
Gender influences cardiovascular disease (CVD) through norms, social relations, roles and behaviours. This study identified gender-specific aspects of socialisation associated with CVD.
Methods
A longitudinal study was conducted, involving 9936 (5,231 women and 4705 men) initially healthy, community-dwelling Australians aged 70 years or more from the ASPirin in Reducing Events in the Elderly (ASPREE) study and ASPREE Longitudinal Study of Older Persons, with a median follow-up time of 6.4 years. Variable categorisation, variable selection (using machine learning (ML) models; Elastic Net and extreme gradient boosting) and Cox-regression were employed separately by binary gender to identity socialisation factors (n=25 considered) associated with CVD.
Results
Different socialisation factors were identified using the ML models. In the Cox model, for both genders, being married/partnered was associated with a reduced risk of CVD (men: HR 0.76, 95% CI 0.60 to 0.96; women: HR 0.67, 95% CI 0.58 to 0.95). For men, having 3–8 relatives they felt close to and could call on for help (HR 0.76, 95% CI 0.58 to 0.99; reference <3 relatives), having 3–8 relatives they felt at ease talking with about private matters (HR 0.70, 95% CI 0.55 to 0.90; reference <3 relatives) or playing games such as chess or cards (HR 0.82, 95% CI 0.67 to 1.00) was associated with reduced risk of CVD. For women, living with others (HR 0.71, 95% CI 0.55 to 0.91) or having ≥3 friends they felt at ease talking with about private matters (HR 0.74, 95% CI 0.58 to 0.95; reference <3 friends) was associated with a lower risk of CVD.
Conclusions
This study demonstrates the need to prioritise gender-specific social factors to improve cardiovascular health in older adults.
Objective: The mahjong game is known for stimulating cognitive skills and improving thephysical and mental functioning of particularly the elderly population. This study discusses howthe mahjong game is extended from leisure and entertainment to improving the physical, mentaland cognitive health of the elderly. Methodology: The study utilized a qualitative and explorativeresearch design to examine the impact of mahjong activities on physical, cognitive and mentalstates of the elderly in China. The data was collected through both primary and secondary sources.Being empirical in nature, the study findings were analyzed through sorting techniques andcontent analysis, categorizing the impact into physical, cognitive and mental impacts. Results:The study found out severe impacts of the mahjong game on nervous system, cardiovascularsystem, nervous systems and digestive tract of the elderly. The study also evaluated the cognitiveand emotional abilities of the elderly in some cases like dementia and depression, mahjong isreported to have positive effects. Conclusion: Elderly people should adjust the arrangement ofrecreational mahjong activities according to their conditions. The findings of this article wouldbe beneficial and serve as a reference to future mahjong-related research. It may also be usedtherapeutically to treat emotional problems and poor coordination skills among the elderly.
This study examined the relationship of playing mahjong with smoking and alcohol consumption behaviors among Chinese older adults. We used a large and nationally representative dataset, the 8th wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Older adults who were 65 years old or above were included in the final analysis sample (n = 10,954). Multivariable logistic regressions were used to examine the associations of playing mahjong with current and former smoking/alcohol consumption status. Additionally, we used negative binomial and multiple linear regressions to investigate the number of cigarettes smoked per day and the amount of alcohol consumed per day. Compared with older adults who did not play mahjong, those who played mahjong at least once per month were more likely to report both current and prior smoking/alcohol consumption habits (all p < 0.05). The sub-analysis revealed that older adults who played mahjong at least once per week tended to smoke more cigarettes per day (all p < 0.05) than those who did not play mahjong at all. When public health practitioners advocate for the health benefits of playing mahjong, they should also consider its associations with smoking/alcohol consumption behaviors among Chinese older adults.
Background
Traditional board games can entail significant skills encompassing several cognitive functions across different domains. Therefore, they may potentially represent effective cognitive interventions in the aging population with or without Alzheimer’s disease or other types of dementia.
Objective
We aimed at verifying the hypothesis that traditional board games can prevent or slow down cognitive decline, through a systematic review on traditional board games and dementia.
Methods
We searched five databases with tailored search strings. We included studies assessing the impact of board games on elderly subjects at risk of or suffering from cognitive impairment, or subjects with cognitive impairment irrespective of age. Studies where the effect of board games was not separated by cards or other games were excluded. A meta-analysis was performed for specific cognitive and non-cognitive outcomes.
Results
Board games improved mental function, as measured by Montreal Cognitive Assessment (p = 0.003) and Mini-Mental State Examination (p = 0.02). Ska and Go improved Trail Making Test –A, while Mahjong improved executive functions. There was no consistent effect across different games on Digit Span or Categorical Fluency. Chess improved quality of life measured with the WHO-QoL-OLD scale (p < 0.00001). Mahjong temporarily improved depressive symptoms. Go increased BDNF levels and left middle temporal gyrus and bilateral putamen metabolism.
Conclusions
Traditional board games may slow global cognitive decline and improve the quality of life in elderly subjects. Different games have varying impacts on specific cognitive domains, possibly mediated by functional and biological factors.
Key messages ‐ For people with mild‐to‐moderate dementia, cognitive stimulation probably leads to small benefits in cognition (the general ability to think and remember). ‐ We found a range of other probable benefits, including improved well‐being, mood and day‐to‐day abilities, but benefits were generally slight and, especially for cognition and well‐being, varied greatly between studies. ‐ Most studies evaluated group cognitive stimulation. Future studies should try to clarify the effects of individual cognitive stimulation, assess how often group sessions should take place to have the best effect, and identify who benefits most from cognitive stimulation. What is dementia? Dementia is an umbrella term for numerous brain disorders. Alzheimer’s disease is the most common of these. People of all ages can develop dementia, but most often it occurs in later life. People with dementia typically experience a decline in their cognitive abilities, which can impair memory, thinking, language and practical skills. These problems usually worsen over time and can lead to isolation, upset and distress for the person with dementia and those providing care and support. Cognitive stimulation Cognitive stimulation (CS) is a form of 'mental exercise' developed specifically to help people with dementia. It involves a wide range of activities aiming to stimulate thinking and memory generally, including discussion of past and present events and topics of interest, word games, puzzles, music and creative practical activities. Usually delivered by trained staff working with a small group of people with dementia for around 45 minutes twice‐weekly, it can also be provided on a one‐to‐one basis. Some programmes have trained family carers to provide CS to their relative. What did we want to find out? We wanted to find out if CS was better for people living with dementia than usual care or unstructured social activities to improve: ‐ cognitive abilities (including memory, thinking and language skills) ‐ well‐being and mood ‐ day‐to‐day abilities ‐ distress and upset for the person with dementia and/or carers We also wanted to find out if family carers experienced any changes associated with the person with dementia receiving CS or if there were any unwanted effects. What did we do?We searched for studies that looked at group or individual CS compared with usual care or unstructured social activity in people living with dementia. We compared and summarised the results of the studies and rated our confidence in the evidence, based on factors such as study methods and sizes. What did we find? We found 37 studies involving 2766 participants with mild or moderate dementia and an average age of 79 years. The biggest study involved 356 participants, the smallest 13. The studies were conducted in 17 countries from five continents, with most in Europe. Fewer than half (16) included participants living in care homes or hospitals. The length of the trials varied from four weeks to two years. Sessions per week varied from one to six. The overall number of sessions varied from eight to 520. Most studies lasted for around 10 weeks, with around 20 sessions. Most studies offered CS in groups, with just eight examining individual CS. Main results No negative effects were reported. We found that CS probably results in a small benefit to cognition at the end of the course of sessions compared with usual care/unstructured activities. This benefit equates roughly to a six‐month delay in the cognitive decline usually expected in mild‐to‐moderate dementia. We found preliminary evidence suggesting that cognition benefited more when group sessions occurred twice weekly or more (rather than once weekly) and that benefits were greater in studies where participants’ dementia at the outset was of mild severity. We also found that participants improved on measures of communication and social interaction and showed slight benefits in day‐to‐day activities and in their own ratings of their mood. There is probably also a slight improvement in participants’ well‐being and in experiences that are upsetting and distressing for people with dementia and carers. We found CS probably made little or no difference to carers' mood or anxiety. What are the limitations of the evidence? Our confidence in the evidence is only moderate because of concerns about differences in results between studies. We cannot be certain of the exact reasons for these differences, but we noted that studies varied in: • the way CS was delivered (individually, in groups, using an app) and the programme of activities included • who delivered the programme (trained professionals, care workers, family carers) • the frequency of sessions (1 per week to 5 per week) • the duration of the programme (from 4 weeks to 1 or 2 years) • the type(s) of dementia with which participants were diagnosed and the severity of the dementia • whether participants lived in care homes and hospitals or in their own homes We were unable to examine as many of these sources of potential difference as would have been desirable because of the relatively small number of studies reflecting each aspect. How up‐to‐date is this evidence? This review updates our previous review from 2012, with evidence up‐to‐date to March 2022.
Short Commentary titled: Elderly for Dementia - “Mahjong”
Leisure activities, particularly physically and cognitively stimulating leisure activities, mitigate cognitive decline. The present study aimed to examine the relationship between mahjong playing, leisure physical activity, and mild cognitive impairment (MCI). Older adults with and without MCI were recruited ( n = 489, healthy group; and n = 187, MCI group). The regression results showed that years of mahjong playing (odds ratio = 0.595, 95% confidence interval [0.376, 0.961], p = .032) and physical activity (odds ratio = 0.572, 95% confidence interval [0.381, 0.849], p = .012) were associated with reduced odds of having MCI after adjusting for a series of covariates. Leisure physical activity and mahjong playing interacted with each other and produced combined effects on the odds of having MCI. Combined cognitive and physical interventions may produce larger benefits on cognition than either intervention alone.
Objectives
The aim of this study was to assess the effectiveness of a cognitive intervention based on modern board and card games.
Methods
We conducted two two‐arm parallel‐group, randomized controlled trials. The first one (pilot study) was non‐blind. The second one (main study) was a double‐blind design. Participants (14 in a pilot study and 35 in the main study) were healthy older adults over 65 years old who were assisting to adult care institutions. In the pilot study, participants in the experimental group (n=6) played modern board and card games which activated cognitive processes; whereas the control group (n=6) was in the wait‐list condition. In the main study, participants in the experimental group (n=12) also played modern board and card games; whereas the control group (n=15) performed standardized paper‐and‐pencil cognitive tasks. Psychologists specialized in older‐people conducted all the interventions. In both studies, intervention sessions were bi‐weekly for 5 weeks. The outcomes of both studies were cognitive status and executive functioning, depressive symptomatology, and quality of life measures. All assessment and intervention sessions took place in their habitual centers.
Results
In the pilot study, participants in the games intervention showed a significant improvement in semantic verbal fluency. In the main study, both interventions showed significant improvements in phonemic verbal fluency. Whilst board and card games maintained motor impulsivity control, paper‐and‐pencil tasks improved speed in an inhibition task.
Conclusions
Modern board and card games could be an effective cognitive intervention to maintain some cognitive functions.
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Background: Mahjong is a four-player gambling game that originated in China. It is a very popular recreational hobby among land-lost Chinese peasants who have moved to the city due to urbanization. This study aims to identify the influencing factors of Mahjong playing behaviors and their effects on the health of land-lost peasants.
Method: A cross-sectional study was conducted in two districts of Chongqing (Southwest China), which is the first pilot area of the urban–rural integration in China. Researchers recruited 539 land-lost peasants to implement a self-report questionnaire survey. Logistic regression was conducted to identify the key factors associated with Mahjong playing behaviors.
Result: This study found that age is a crucial factor affecting the Mahjong playing behaviors of land-lost peasants. The middle-aged (30–49 years old) and elderly (>= 50 years old) are extremely prone to be problematic Mahjong players when compared with young people (18–29 years old). Moreover, people with a high monthly income are more likely to be problematic Mahjong players compared with those with a low monthly income. In addition, the high frequency of playing and long duration of sessions in the enclosed, smoky environment of Mahjong parlors introduce significant hazards to the health of land-lost peasants. However, Mahjong can help them build a social network, provide them with spiritual comfort, and ultimately integrate them into a new environment.
Conclusion: Therefore, we call for measures that can make Mahjong an activity for entertainment rather than gambling and reduce the adverse effects of Mahjong playing behaviors on the players’ health.
Scientific research on the benefits of the Mahjong card game and social activity for sleep remains limited among older adults in China, although these two leisure behaviors are common among Chinese older adults. This study aims to examine this topic of interest in a single research effort. Applying panel data from the Chinese Longitudinal Healthy Longevity Survey from 4718 participants, a nationally representative sample, multivariable logistic regressions were performed to investigate the effects of the Mahjong card game and social activity on quality of sleep and recommended hours of sleep duration daily (between 7 and 8 h of sleep) among Chinese older adults. Of the study sample, approximately 62% of older adults reported good quality of sleep, but only 38% of them slept within the recommended range. Non-gamers had lower odds of reporting good quality of sleep (adjusted odds ratio [AOR] = 0.75, 95% CI 0.62, 0.90, p < 0.01), compared with daily Mahjong card gamers. Participation of social activity was not associated with sleep quality. Less frequent participation in social activity was positively associated with recommended hours of sleep duration daily, but there was no significant difference between older adults who did not participate in social activity at all and those who participated daily. The study results suggest that playing the Mahjong card game is associated with better sleep quality among older adults. However, the effect of social activity on sleep-related measurements should be investigated further. The effect of social activity and sleep quality remains inconclusive.
The aims of this systematic review were to investigate what kind of cognitive leisure activities have been used in intervention studies targeting older adults, and whether these activities improve cognitive function or inhibit cognitive decline. Based on the PRISMA declaration, we searched keywords using three electronic databases: PubMed, PsycINFO and PsycARTICLES. Intervention studies involving cognitive leisure activities with cognitive assessments set as outcomes were included. We regarded cognitive leisure activities as activities for enjoyment or well‐being that cause intellectual stimulation (e.g. reading, playing board games). To investigate the influence of each activity on cognitive domains, multicomponent programs (e.g. combined music and art) were excluded. In total, 20 studies were included in the evaluation. Consequently, intervention studies related to arts, writing, board games, reading, handicrafts, a crossword puzzle and learning computer skills were identified. Of the 20 studies, 13 showed improvement in some cognitive domain. In 12 of these 13 studies, the intervention effects were not observed in a specific cognitive domain; rather, the intervention effects were observed across multiple cognitive domains and on working memory. The results of the present review suggest that cognitive function in older adults can be improved through cognitive leisure activity interventions. Activities related to learning new skills, that cause strong intellectual stimulation and that include communication elements were considered particularly effective tools. However, as the number of studies is small, more high‐quality research needs to be accumulated. Geriatr Gerontol Int 2019; ••: ••–••.
Through a case study of variations in the game of Mahjong differing from each other in terms of the extent of technological assistance involved, this article sheds light on questions of transmediality and technological specificity of games and play. It argues that while the variations in Mahjong can be described as sitting together in a family resemblance, the specificities of the technologies and the sociocultural contexts involved give rise to new kinds of playful practices that are not reducible to the “transmedial Mahjong” but whose understanding nevertheless necessitates knowledge of the rules and conventions of Mahjong. This not only casts critical light on how the “ludological” paradigm of game studies has defined its object of study but also prompts reconsideration of the role of technology when applying perspectives that emphasize the processual nature of games.
This article outlines how the provision of training for care home staff facilitates grading of activities to ensure they are appropriate to each resident's ability and interests. Boyd et al highlight how this reduces the risk of discouragement and hostility from residents
Approximately two thirds of people in care homes have a form of dementia (Alzheimer's Society, 2007). The majority of care home residents with dementia spend most of their time engaged in no activity at all, with unstructured time accounting for two thirds of their day (Lucero et al, 2001). Engagement in meaningful activity can change mood, behaviour and even cognition for the duration of the activity (Pulsford, 1997). Activities expand knowledge and provide a sense of meaning and accomplishment (Tappen, 1997). They facilitate socialisation and communication and enhance self-esteem (Wald, 1993). Finally, they provide physical, mental and emotional stimulation (Whitcomb, 1993). Therefore, failure to provide opportunities for therapeutic activities for persons with dementia is tantamount to abuse (Crump, 1991). The provision of training for care home staff facilitates grading of activities to ensure they are appropriate to each resident's ability and interests. It also reduces the risk of discouragement and hostility, experienced when activity breaks down (Pulsford, 1997).
The present and future of our society are shaped by an ever-increasing proportion of old and very old people. The Berlin Aging Study is one of the largest interdisciplinary efforts to explore old age and aging. Unique aspects of the Berlin Aging Study are the spectrum of scientific disciplines involved, the range of discipline-specific and interdisciplinary research topics, the focus on very old age (70 to over 100 years), and the empirical reference to a representative heterogenous urban population. The study's first cross-sectional findings on intellectual abilities, self and personality, social relationships, physical health, functional capacity, medical treatment, mental disorders such as depression and dementia, socioeconomic conditions, activities, everyday competence, subjective well-being, and gender differences are reported in depth in this book. The study was carried out in the context of the Berlin-Brandenburg Academy of Sciences study group on 'Aging and Social Development'. The authors primarily conduct their research at the Berlin Max Planck Institute for Human Development, the Free University of Berlin, and the Humboldt University, Berlin.
Examined whether or not cognitive decline in the elderly that has been reliably demonstrated over a 14-yr period can be reversed. 97 male and 132 female participants (aged 64–95 yrs) in a long-term longitudinal study were classified into those who had declined (
n = 122) and those who had remained stable (
n = 107) on the abilities of inductive reasoning and spatial orientation, based on their performances on the Primary Mental Ability Reasoning and Spatial Orientation Tests. Ss were assigned to 5-hr training programs on either ability in a pretest–posttest design that used Ss trained on 1 target ability as controls for those trained on the other. Results show that cognitive training techniques reliably reverse decline in spatial and reasoning ability documented over a 14-yr period in a substantial number of Ss. Training procedures also enhanced the performance of many Ss who had remained stable. Training improvement on spatial orientation was found to be greater for decliners than for those who remained stable and greater for females than for males. (36 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Frequent participation in cognitively stimulating activities has been hypothesized to reduce risk of Alzheimer disease (AD), but prospective data regarding an association are lacking.
To test the hypothesis that frequent participation in cognitive activities is associated with a reduced risk of AD.
Longitudinal cohort study with baseline evaluations performed between January 1994 and July 2001 and mean follow-up of 4.5 years.
A total of 801 older Catholic nuns, priests, and brothers without dementia at enrollment, recruited from 40 groups across the United States. At baseline, they rated frequency of participation in common cognitive activities (eg, reading a newspaper), from which a previously validated composite measure of cognitive activity frequency was derived.
Clinical diagnosis of AD by a board-certified neurologist using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria and change in global and specific measures of cognitive function, compared by cognitive activity score at baseline.
Baseline scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 (mean, 3.57; SD, 0.55), with higher scores indicating more frequent activity. During an average of 4.5 years of follow-up, 111 persons developed AD. In a proportional hazards model that controlled for age, sex, and education, a 1-point increase in cognitive activity score was associated with a 33% reduction in risk of AD (hazard ratio, 0.67; 95% confidence interval, 0.49-0.92). Results were comparable when persons with memory impairment at baseline were excluded and when terms for the apolipoprotein E epsilon4 allele and other medical conditions were added. In random-effects models that controlled for age, sex, education, and baseline level of cognitive function, a 1-point increase in cognitive activity was associated with reduced decline in global cognition (by 47%), working memory (by 60%), and perceptual speed (by 30%).
These results suggest that frequent participation in cognitively stimulating activities is associated with reduced risk of AD.
Normative information on neuropsychological measures for Chinese people is scarce. This study addresses this inadequacy by providing norms on several tests, using a sample of 475 Cantonese-speaking Chinese aged from 13 to 46. Included are eight neuropsychological measures of attention, memory, and fluency, which provided an overview of some important neuropsychological functions along the verbal-nonverbal axis. Age, gender, and education were factors observed to have an effect on the test performance of these participants. This pattern is consistent with that reported in Western literature. These measures appear to be appropriate clinical instruments for use in Hong Kong Chinese society, although the usefulness of the current norms is limited to adolescents and, to a lesser extent, to young adults in that population. Also, because of possibly important differences in the linguistic and educational backgrounds of Hong Kong residents versus Chinese residents of other countries (including mainland China and North America), applicability of the current norms outside of Hong Kong is currently uncertain.
The use of latent growth models to examine influence on individual differences on ability level versus rate of change were examined for measures of fluid ability, memory, and perceptual speed in a sample of twins from the Swedish Adoption/Twin Study of Aging. Results indicated a larger amount of individual variation for average ability level (i.e., intercept) than rate of change (i.e., slope) for all three traits: Block Design, Thurstone's Picture Memory, and Symbol Digit. Generally, genetic influences were of greater importance to individual variation in ability level whereas variation for rate of change exhibited a larger environmental component. These findings support theories of increasing environmental influences with age. When genetic and environmental sources of covariation between educational attainment and pulmonary function with latent growth parameters were considered, the sources of covariation between the latent cognitive growth model parameters (i.e., intercept and slope) and both covariates were primarily genetic for ability level (intercepts) but environmental for rate of change (slopes). Such findings suggest that the forces important to timing or entry into cognitive decline may reflect stochastic processes or external environmental factors, primarily nonshared, that may differentially hasten cognitive decline in twins. These same forces may overlap with those that influence higher or lower educational attainment or those leading to better or worse pulmonary functioning.
Cognitive function in older adults is related to independent living and need for care. However, few studies have addressed whether improving cognitive functions might have short- or long-term effects on activities related to living independently.
To evaluate whether 3 cognitive training interventions improve mental abilities and daily functioning in older, independent-living adults.
Randomized, controlled, single-blind trial with recruitment conducted from March 1998 to October 1999 and 2-year follow-up through December 2001.
Volunteer sample of 2832 persons aged 65 to 94 years recruited from senior housing, community centers, and hospital/clinics in 6 metropolitan areas in the United States.
Participants were randomly assigned to 1 of 4 groups: 10-session group training for memory (verbal episodic memory; n = 711), or reasoning (ability to solve problems that follow a serial pattern; n = 705), or speed of processing (visual search and identification; n = 712); or a no-contact control group (n = 704). For the 3 treatment groups, 4-session booster training was offered to a 60% random sample 11 months later.
Cognitive function and cognitively demanding everyday functioning.
Thirty participants were incorrectly randomized and were excluded from the analysis. Each intervention improved the targeted cognitive ability compared with baseline, durable to 2 years (P<.001 for all). Eighty-seven percent of speed-, 74% of reasoning-, and 26% of memory-trained participants demonstrated reliable cognitive improvement immediately after the intervention period. Booster training enhanced training gains in speed (P<.001) and reasoning (P<.001) interventions (speed booster, 92%; no booster, 68%; reasoning booster, 72%; no booster, 49%), which were maintained at 2-year follow-up (P<.001 for both). No training effects on everyday functioning were detected at 2 years.
Results support the effectiveness and durability of the cognitive training interventions in improving targeted cognitive abilities. Training effects were of a magnitude equivalent to the amount of decline expected in elderly persons without dementia over 7- to 14-year intervals. Because of minimal functional decline across all groups, longer follow-up is likely required to observe training effects on everyday function.
Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia.
We examined the relation between leisure activities and the risk of dementia in a prospective cohort of 469 subjects older than 75 years of age who resided in the community and did not have dementia at base line. We examined the frequency of participation in leisure activities at enrollment and derived cognitive-activity and physical-activity scales in which the units of measure were activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities, with adjustment for age, sex, educational level, presence or absence of chronic medical illnesses, and base-line cognitive status.
Over a median follow-up period of 5.1 years, dementia developed in 124 subjects (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). Among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia. A one-point increment in the cognitive-activity score was significantly associated with a reduced risk of dementia (hazard ratio, 0.93 [95 percent confidence interval, 0.90 to 0.97]), but a one-point increment in the physical-activity score was not (hazard ratio, 1.00). The association with the cognitive-activity score persisted after the exclusion of the subjects with possible preclinical dementia at base line. Results were similar for Alzheimer's disease and vascular dementia. In linear mixed models, increased participation in cognitive activities at base line was associated with reduced rates of decline in memory.
Participation in leisure activities is associated with a reduced risk of dementia, even after adjustment for base-line cognitive status and after the exclusion of subjects with possible preclinical dementia. Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia.
Background: Although the risk of Alzheimer disease (AD) has been hypothesized to be lowered by frequent participation in cognitively stimulating activities, there is a lack of prospective data regarding such an association. Method: To determine whether frequent participation in cognitively stimulating activities does indeed reduce the risk for developing AD. this longitudinal cohort study assessed cognitive activity and presence of AD in 801 older Catholic nuns, priests, and brothers without dementia at enrollment who were recruited from 40 groups across the United States, At baseline assessments, which took place between January 1994 and July 2001, study subjects rated frequency of participation in common cognitive activities (e.g., reading a newspaper); a previously validated composite measure of cognitive activity frequency was derived from these ratings. Outcome measures included a clinical diagnosis of AD by a board-certified neurologist (using National Institute of Neurological and Communicative Disorders and Stroke/Alzheimer's Disease and Related Disorders Association criteria) and change at follow-up (mean =4.5 years after baseline) in global and specific measures of cognitive function. Results: At baseline, scores on the composite measure of cognitive activity ranged from 1.57 to 4.71 (mean ±SD = 3.57 ±0.55; higher scores indicate more frequent activity). 111 individuals developed AD between baseline and follow-up. A proportional hazards model that controlled for age, sex, and education found that a 1-point increase in cognitive activity score was associated with a 33% reduction in risk of AD (hazard ratio = 0.67; 95% confidence interval = 0.49 to 0.92). Comparable results were found when individuals with memory impairment at baseline were excluded and when terms for the apolipoprotein E ε4 allele and other medical conditions were added. A 1-point increase in cognitiveactivity was associated with a smaller decline in global cognition (by 47%), working memory (by 60%), and perceptual speed (by 30%) in random-effects models that controlled for age, sex, education, and baseline level of cognitive function. Conclusion: Frequent participation in cognitively stimulating activities may reduce risk of AD,.
Memory difficulties are a defining feature of Alzheimer's disease (AD), with significant implications for people with AD and family members. Interventions aimed at helping with memory difficulties, therefore, may be important in reducing excess disability and improving well-being. There is a long tradition of cognition-focused intervention in dementia care. In this review we offer broad definitions and descriptions of three approaches to cognition-focused intervention for people with dementia—cognitive stimulation, cognitive training and cognitive rehabilitation—and attempt to clarify the underlying concepts and assumptions associated with each. Cognitive training and cognitive rehabilitation are the main approaches used with people who have early-stage AD. We review a range of studies describing the implementation of these two approaches, and evaluate the evidence for their effectiveness. With regard to cognitive training, the evidence currently available does not provide a strong demonstration of efficacy, but findings must be viewed with caution due to methodological limitations. It is not possible at present to draw firm conclusions about the efficacy of individualised cognitive rehabilitation interventions for people with early-stage dementia, due to the lack of any randomised controlled trials (RCTs) in this area, although indications from single-case designs and small group studies are cautiously positive. Further research is required that takes account of the conceptual and methodological issues outlined here.
Summary Cognitive rehabilitation (CR) aims to enable people with cognitive impairments to achieve their optimum level of well-being by helping to reduce the functional disability resulting from damage to the brain. Central to this process is the collaborative identification of personally-meaningful goals and the development of interventions to address these goals. CR interventions draw upon a mixture of approaches aimed at restoration of function, implementation of compensatory strategies and environmental modification, and these can be integrated with approaches directed at dealing with the emotional responses to impairment and other psychosocial difficulties to provide an holistic rehabilitation framework. While initially developed primarily for people with non-progressive brain injury, this approach is equally applicable to people with progressive conditions such as Alzheimer's disease (AD). Although this work is still at a relatively early stage, the first randomised controlled trial has now been completed. This chapter reviews the application of the CR approach for people with AD and considers the evidence for its effectiveness. The available evidence suggests that CR has the potential to bring about changes in behaviour, enhance well-being and maintain involvement in daily life.
We present the first results of a cognitive stimulation programme for patients with dementia. Fifty-six subjects entered a study involving two parallel, randomized groups. Assessment was blind for the main criteria (neuropsychological tests). Twenty-nine patients were stimulated and were compared to 27 non-stimulated patients. The stimulated group attended 10 stimulation sessions over 5 weeks. Each group was assessed on the first and seventh week. Following stimulation, there was significant improvement of Mini-Mental State (MMS) scores (p < 0.01) and increased performance for the Word List Memory Test (one-tailed p = 0.09) in the Consortium to establish a Registry for Alzheimer's Disease (CERAD) battery. Verbal fluency remained unchanged. Stimulation tended to improve items of an additional battery (one-tailed p < 0.01). The composite sum of test scores showed a significant difference in favour of the stimulated group. These results were positively correlated with the initial MMS scores and negatively with education. The Activities of Daily Living (ADL) scale did not show a significant change. We concluded that global stimulation of cognitive functions improves certain parameters among demented outpatients.
Examination of the range and limits of cognitive reserve capacity (plasticity) by means of cognitive training is proffered as a promising diagnostic strategy for the early (premorbid) identification of dementia, particularly Alzheimer's disease, in nonclinical populations. First data are presented from a sample of elderly independent-living people classified as healthy or at risk (beginning dementia) on the basis of a standardized psychiatric interview. Randomly assigned groups participated in a cognitive training program based on figural relations, a component of fluid intelligence. Stepwise regression analyses demonstrated that only healthy elderly profited from training and that only post-training scores predicted the psychiatric "at risk" diagnosis. The results hold promise for further development of testing-the-limits of individual differences in cognitive reserve capacity to identify premorbid states of dementia in nonclinical samples.
Synopsis
Mini-Mental State findings from an age 60+ random community sample ( N = 1681) indicate that score is related to education, age and race (but not sex) and to functional status, but not to selected aspects of physical or mental health. Adjustment for demographic characteristics, particularly education, is recommended lest cognitive impairment be overestimated.
In order to determine the meaning of cognitive impairment in community dwelling elderly, 3,481 adults were interviewed in their homes using the Mini-Mental State Examination. Ninety-six per cent of the population aged 18-64 scored 23 or higher, whereas 80 per cent of the population 65 and over scored 23 or higher. Individuals with low scores were suffering from a variety of psychiatric disorders including dementia. Thirty-three per cent of the elderly population scoring in the range of 0-23 had no diagnosable DSM-III condition. Prevalence of dementia from all causes was 6.1 per cent of the population over age 65. Two per cent of the population over age 65 were diagnosed as having Alzheimer's disease.
The use of visual imagery for overcoming memory loss was tested in a sample of community-living older people with evidence of senile dementia. These people were randomly assigned into one of three training conditions: didactic, in which imagery techniques were taught; problem-solving, which presented practical solutions for everyday difficulties; and a wait list. Caregivers of the dementia patients were also included in the groups. Although recall performance was somewhat improved for subjects in the didactic group, these gains seemed to have little practical value for caregivers.
The Geriatric Depression Scale (GDS) is a common screening tool for elderly depression in Hong Kong. This study aimed at (1) developing a standardized manual for the verbal administration and scoring of the GDS-SF, and (2) comparing the inter-rater reliability between the standardized and non-standardized verbal administration of GDS-SF. Two studies were reported. In Study 1, the process of developing the manual was described. In Study 2, we compared the inter-rater reliabilities of GDS-SF scores using the standardized verbal instructions and the traditional non-standardized administration. Results of Study 2 indicated that the standardized procedure in verbal administration and scoring improved the inter-rater reliabilities of GDS-SF.
Neurons are continually born from endogenous stem cells and added to the dentate gyrus throughout life, but adult hippocampal neurogenesis declines precipitously with age. Short-term exposure to an enriched environment leads to a striking increase in new neurons, along with a substantial improvement in behavioral performance. Could this plastic response be relevant for explaining the beneficial effects of leading "an active life" on brain function and pathology? Adult hippocampal neurogenesis in mice living in an enriched environment from the age of 10 to 20 months was fivefold higher than in controls. Relatively, the increase in neuronal phenotypes was entirely at the expense of newly generated astrocytes. This cellular plasticity occurred in the context of significant improvements of learning parameters, exploratory behavior, and locomotor activity. Enriched living mice also had a reduced lipofuscin load in the dentate gyrus, indicating decreased nonspecific age-dependent degeneration. Therefore, in mice signs of neuronal aging can be diminished by a sustained active and challenging life, even if this stimulation started only at medium age. Activity exerts not only an acute but also a sustained effect on brain plasticity.
Participation in cognitively stimulating activities is hypothesized to be associated with risk of AD, but knowledge about this association is limited.
A biracial community in Chicago was censused, persons aged 65 years and older were asked to participate in an interview, and 6,158 of 7,826 (79%) eligible persons did so. As part of the interview, persons rated current frequency of participation in seven cognitive activities (e.g., reading a newspaper) and nine physical activities (e.g., walking for exercise) from which composite measures of cognitive and physical activity frequency were derived. Four years later, 1,249 of those judged free of AD were sampled for a detailed clinical evaluation of incident disease and 842 (74% of those eligible) participated.
The composite measure of cognitive activity ranged from 1.28 to 4.71 (mean 3.30; SD 0.59), with higher scores indicating more frequent activity. A total of 139 persons met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for AD on clinical evaluation. In a logistic regression model adjusted for age, education, sex, race, and possession of the APOE epsilon4 allele, a one-point increase in cognitive activity score was associated with a 64% reduction in risk of incident AD (OR 0.36; 95% CI 0.20 to 0.65). By contrast, weekly hours of physical activity (mean 3.5; SD 5.1) was not related to disease risk (OR 1.04; 95% CI 0.98 to 1.10). Education was associated with risk of AD and a similar trend was present for occupation, but these effects were substantially reduced when cognitive activity was added to the model.
Frequency of participation in cognitively stimulating activities appears to be associated with risk of AD and may partially explain the association of educational and occupational attainment with disease risk.
A recent Cochrane review of reality orientation therapy identified the need for large, well-designed, multi-centre trials.
To test the hypothesis that cognitive stimulation therapy (CST) for older people with dementia would benefit cognition and quality of life.
A single-blind, multi-centre, randomised controlled trial recruited 201 older people with dementia. The main outcome measures were change in cognitive function and quality of life. An intention-to-treat analysis used analysis of covariance to control for potential variability in baseline measures.
One hundred and fifteen people were randomised within centres to the intervention group and 86 to the control group. At follow-up the intervention group had significantly improved relative to the control group on the Mini-Mental State Examination (P=0.044), the Alzheimer's Disease Assessment Scale - Cognition (ADAS-Cog) (P=0.014) and Quality of Life - Alzheimer's Disease scales (P=0.028). Using criteria of 4 points or more improvement on the ADAS-Cog the number needed to treat was 6 for the intervention group.
The results compare favourably with trials of drugs for dementia. CST groups may have worthwhile benefits for many people with dementia.
Neuropsychiatric symptoms of dementia are common and associated with poor outcomes for patients and caregivers. Although nonpharmacological interventions should be the first line of treatment, a wide variety of pharmacological agents are used in the management of neuropsychiatric symptoms; therefore, concise, current, evidence-based recommendations are needed.
To evaluate the efficacy of pharmacological agents used in the treatment of neuropsychiatric symptoms of dementia.
A systematic review of English-language articles published from 1966 to July 2004 using MEDLINE, the Cochrane Database of Systematic Reviews, and a manual search of bibliographies was conducted. Inclusion criteria were double-blind, placebo-controlled, randomized controlled trials (RCTs) or meta-analyses of any drug therapy for patients with dementia that included neuropsychiatric outcomes. Trials reporting only depression outcomes were excluded. Data on the inclusion criteria, patients, methods, results, and quality of each study were independently abstracted. Twenty-nine articles met inclusion criteria.
For typical antipsychotics, 2 meta-analyses and 2 RCTs were included. Generally, no difference among specific agents was found, efficacy was small at best, and adverse effects were common. Six RCTs with atypical antipsychotics were included; results showed modest, statistically significant efficacy of olanzapine and risperidone, with minimal adverse effects at lower doses. Atypical antipsychotics are associated with an increased risk of stroke. There have been no RCTs designed to directly compare the efficacy of typical and atypical antipsychotics. Five trials of antidepressants were included; results showed no efficacy for treating neuropsychiatric symptoms other than depression, with the exception of 1 study of citalopram. For mood stabilizers, 3 RCTs investigating valproate showed no efficacy. Two small RCTs of carbamazepine had conflicting results. Two meta-analyses and 6 RCTs of cholinesterase inhibitors generally showed small, although statistically significant, efficacy. Two RCTs of memantine also had conflicting results for treatment of neuropsychiatric symptoms.
Pharmacological therapies are not particularly effective for management of neuropsychiatric symptoms of dementia. Of the agents reviewed, the atypical antipsychotics risperidone and olanzapine currently have the best evidence for efficacy. However, the effects are modest and further complicated by an increased risk of stroke. Additional trials of cholinesterase inhibitors enrolling patients with high levels of neuropsychiatric symptoms may be warranted.
A recent randomised controlled trial on Cognitive Stimulation Therapy (CST) identified the need to evaluate its more long-term benefits for people with dementia. This study evaluates the effectiveness of a weekly maintenance CST programme for people with dementia in residential care.
Thirty-five people with dementia were included, following on from a seven-week twice-weekly study of CST. The maintenance CST sessions ran in two residential homes using a once a week programme of CST over an additional 16 weeks. Two control homes did not receive the maintenance intervention.
Using repeated measures ANOVAS, there was a continuous, significant improvement in cognitive function (MMSE) for those receiving MCST (CST+maintenance CST sessions) as compared to CST alone or no treatment (p = 0.012). There were no effects on quality of life, behaviour or communication following maintenance sessions. The initial cognitive improvements following CST were only sustained at follow-up when followed by the programme of maintenance CST sessions.
The cognitive benefits of CST can be maintained by weekly sessions for around 6 months. A large-scale, multi-centre maintenance CST trial is required to clarify potential longer-term benefits of maintenance CST for dementia.
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