Cognitively stimulating activities and risk of probable dementia or cognitive impairment in the English Longitudinal Study of Ageing. (December 2020)

• Record Type: Journal Article
• Authors: Williams, Benjamin David; Pendleton, Neil; Chandola, Tarani
• Is Part Of: SSM - population health. Volume 12(2020)
• Publication Date: 2020-12
• Subjects: Cognitive impairment -- Cognitively stimulating activity -- Dementia -- Marginal structural model -- ELSA -- Volunteering; Social medicine -- Periodicals; Medical anthropology -- Periodicals; Public health -- Periodicals; Psychology -- Periodicals; Medicine -- Periodicals; 362.105
• DOI: 10.1016/j.ssmph.2020.100656
• Languages: English
• ISSNs: 2352-8273

Abstract

Abstract: Objectives: To examine the association between cognitive stimulating activities (CSA) in later life (internet/email use, employment, volunteering, evening classes, social club membership and newspaper reading) and risk of cognitive impairment or dementia using marginal structural models to account for time-varying confounding affected by prior exposure. Methods: Data were used from the English Longitudinal Study of Ageing waves 1 (2002) to 7 (2014), a nationally representative sample of adults in England aged ≥50. Self-reported participation in CSAs were measured as binary exposures from waves 2 (2004) to 6 (2012), with final sample sizes between n = 3937 and n = 2530 for different CSAs. Baseline exposure and covariates were used to create inverse probability of treatment and censoring weights (IPTCW). IPTCW repeated measures Poisson and linear regression were used to estimate each CSAs effect on risk of probable cognitive impairment or dementia at wave 7 (defined as a score of ≤11/27 on a modified telephone interview for cognitive status (TICS-27)). Results were compared to standard regression adjustment. Results: Internet use at any wave (Risk ratios between 0.62 and 0.69) and volunteering in waves 3 to 6 (RRs between 0.516 and 0.633) were associated with reduced risk of cognitive impairment in IPTCW models. Standard estimates were similar for both internet use and volunteering. Newspaper reading (RR 95% Confidence interval 0.74–0.99) and social club membership (RR 95% CI 0.54–0.86) at wave 6 were significantly associated with risk of cognitive impairment in standard models, but not in the IPTCW models (RR 95% CI 0.82–1.11 and 0.60–1.08 respectively). Employment and evening classes were not associated with cognitive impairment in either model. Conclusions: We found that volunteering and internet use were associated with reduced risk of cognitive impairment. Associations between newspaper reading or social club membership and cognitive impairment may be due to time-varying confounding affected by prior exposure. Highlights: Confounding affected by past exposure is a problem in studies of cognitive function. We addressed this using inverse probability weighted marginal structural models. Volunteering and internet use were protective against cognitive impairment. Other cognitively stimulating activities were protective with standard regression. But these associations were non-significant in the marginal structural models.