title: Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial.
abstract: BACKGROUND
  To examine the effects of complex cognitive (mahjong) and physical (Tai Chi) activities on dementia severity in nursing home residents with dementia.
  
  
  METHODS
  Cluster-randomized open-label controlled design. 110 residents were randomized by nursing home into three conditions: mahjong, Tai Chi, and simple handicrafts (control). Activities were conducted three times a week for 12 weeks. Clinical Dementia Rating (CDR) was taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. The outcome measure was CDR sum-of-box, which is a composite measure of both cognitive and functional deterioration in dementia.
  
  
  RESULTS
  Intent-to-treat analyses were performed using multilevel regression models. Apolipoprotein E ε4 allele and education were included as covariates. Neither treatments had effects on the cognitive and functional components of the CDR, but mahjong had a significant interaction with time on the CDR sum-of-box total, suggesting a slower rate of global deterioration in the mahjong group as compared with the control group.
  
  
  CONCLUSIONS
  Mahjong led to a gradual improvement in global functioning and a slightly slower rate of dementia progression over time. The effect was generalized and was not specific to cognition or daily functioning.
authors.affiliation: Department of Psychological Studies, Hong Kong Institute of Education, Hong Kong.
authors.forename: Sheung-Tak
authors.initials: ST
authors.lastname: Cheng
authors.affiliation: Department of Psychological Studies, Hong Kong Institute of Education, Hong Kong.
authors.forename: Pizza K
authors.initials: PK
authors.lastname: Chow
authors.affiliation: Department of Biochemistry, University of Hong Kong, Hong Kong.
authors.forename: You-Qiang
authors.initials: YQ
authors.lastname: Song
authors.affiliation: Department of Psychogeriatrics, Kwai Chung Hospital, Hong Kong.
authors.forename: Edwin C S
authors.initials: EC
authors.lastname: Yu
authors.affiliation: Department of Psychological Studies, Hong Kong Institute of Education, Hong Kong.
authors.forename: John H M
authors.initials: JH
authors.lastname: Lam
mesh_terms: D000368:Aged; D000483:Alleles; D001057:Apolipoproteins E; D016000:Cluster Analysis; D003071:Cognition / Q000502:physiology*; D003072:Cognition Disorders / Q000503:physiopathology*; D003704:Dementia / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D018450:Disease Progression; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D007899:Leisure Activities; D008297:Male; D009483:Neuropsychological Tests; D009735:Nursing Homes; D017063:Outcome Assessment, Health Care; D012720:Severity of Illness Index; D026302:Tai Ji / Q000523:psychology
chemical_list: D001057:Apolipoproteins E