Hui-Xin Wang, Ph.D Div. Geriatric Epidemiology Dept. NEUROTEC, Karolinska Institutet & Stockholm Gerontology Researc

1. Social and leisure activities in relation to dementia Hui-Xin Wang, Ph.D Div. Geriatric Epidemiology Dept. NEUROTEC, Karolinska Institutet & Stockholm Gerontology Research Center

2. Social and leisure activities in relation to dementia Findingsfrom Differentstudies Biological plausibility

3. Social and leisure activities in relation to dementia Findingsfromdifferent studies Social network Physical activities Mental activities

4. 20 15 10 5 0 Social network index Socialnetwork 1 The Kungsholmen Project Fratiglioni et al, Lancet 2000; 355:1315-1319 Relative risks (RR) for dementia Poor Limited Moderate Rich

5. Socialnetwork 2 PAQUID study Helmer et al, Neurology 1999;53:1953-58 Marital status RR for dementia Never married 1.9 (1.1-3.2) EPESE- New Haven cohort Bassuk et al, Ann Intern Med 1999;131:165 Social ties OR for cog decline 0 vs 5 1.9 (1.1- 3.2)

6. Socialnetwork 3 Possible explanations Instrumental support or mental stimulation

7. Mental activities 1 RR for dementia from follow-up studies Manhattan Study Scarmeas et al, Neurol. 2001;57:2236-42 Leisure activity 0.6 (0.5-0.8) PAQUID Study Fabrigoule et al, JAGS 1995;43:485-90 Travelling 0.5 (0.2-0.9) Knitting 0.5 (0.3-0.8) Gardening0.5 (0.3-0.9)

8. Mental activities 2 RR for dementia from follow-up studies The Kungsholmen Project Wang et al, Am J Epidemiol 2002,155:1081-7 Mental activities 0.7 (0.4-1.0) The Religious Order Study Wilson et al, JAMA 2002;287:742-8 Cognitive activity score0.7 (0.5-0.9) (1-point increase)

9. Social and leisure activities Wang et al, Am J Epidemiol 2022;155:1081-7 RR (95% CI) for dementia NO< Weekly Daily Mental Activity 10.8 (0.5-1.3) 0.6 (0.4-0.9) Social Activity 10.9 (0.5-1.4) 0.6 (0.4-0.9) ProductiveActivity10.8 (0.3-2.6) 0.6 (0.4-0.9)

10. Physical activities 1 Canadian Study of Health and Aging Laurin et al, Arch Neurol 2001;58: 498-504 OR for dementia None 1 Low 0.64 (0.41-1.02) Moderate 0.69 (0.50-0.95) High 0.63 (0.40-0.96)

11. Physical activities 2 The Kungsholmen Project Wang et al, Am J Epidemiol 2002; 155:1081-7 OR for dementia None 1 Weekly 0.97 (0.4-2.2) Daily 0.41 (0.1-1.3) 3 / 5 cross-sectional studies and 2 / 3 longitudinalstudies reported no association

12. Social and leisure activities in relation to dementia Biological plausibility Studies on other diseases Experimental studies

13. Studies on other diseases 1.Physical activity increases survival and protects against CVD(Bassey 2000)2.Psychosocial factors (depression and social support) are independent etiological and prognostic factors for CHD(Hemingway and Marmot, BMJ 1999)3.Social, productive, and cultural activities have a positive influence on survival(Bygren et al, BMJ 1996; Glass et al, BMJ 1999)

14. Experimental studies 1.Physical activity sustains CBF, and improves aerobic capacity (Laurin 2001)2.Enriched environment improves the plasticity and thickness of old rats’ cerebral cortex (Powell 1994)3.Poorsocial network affects the immune system(Seeman 1996)

15. Conclusions Most studies on the topic suport that social and leisure activities may decrease the risk of dementia However Data concerning this topic are limited. More longitudinal studies with better control ofconfounders and experimental data are necessary.