title: Leisure activity and cognitive decline in incident Alzheimer disease.
abstract: BACKGROUND
  High rates of leisure activity have been associated with reduced risk of Alzheimer disease (AD).
  
  
  OBJECTIVE
  To determine whether prediagnosis leisure activity modifies the rate of cognitive decline in patients with AD.
  
  
  METHODS
  Inception cohort followed up longitudinally for a mean of 5.3 years (up to 13.9 years).
  
  
  METHODS
  Urban community.
  
  
  METHODS
  A total of 283 patients with incident AD (mean age, 79 years; 56.2% Hispanic and 31.1% African American).
  
  
  METHODS
  Change in a composite cognitive score from diagnosis on and during the entire study follow-up.
  
  
  RESULTS
  In multivariate-adjusted generalized estimating equation models of postdiagnosis change (n = 133), each leisure activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P = .17). In models expanded to include cognitive change during study follow-up, including evaluations before and after diagnosis (n = 283), each activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P = .03). The association was strongest for intellectual activities.
  
  
  CONCLUSIONS
  Greater participation in prediagnosis leisure activities, especially intellectual activities, was associated with faster cognitive decline, supporting the hypothesis that the disease course in AD may vary as a function of cognitive reserve.
authors: Gertrude H Sergievsky Center, Columbia University Medical Center, New York, NY 10032, USA.
authors: Elizabeth P
authors: EP
authors: Helzner
authors: Nikolaos
authors: N
authors: Scarmeas
authors: Stephanie
authors: S
authors: Cosentino
authors: Florence
authors: F
authors: Portet
authors: Yaakov
authors: Y
authors: Stern
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000523:psychology*; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007899:Leisure Activities / Q000523:psychology*; D008297:Male; D008959:Models, Neurological; D011379:Prognosis