Education, leisure activities and cognitive and functional ability of Alzheimer's disease patients: A follow-up study

Sobral, Margarida; Paúl, Constança

doi:10.1590/S1980-57642013DN70200008

ABSTRACT

Education and participation in leisure activities appear to be highly relevant variables in Alzheimer's disease (AD) and usually form the basis of the Cognitive Reserve construct. Objective: [A] To determine the association between education, cognitive and functional ability of AD patients; [B] To determine the association between participation in leisure activities and cognitive and functional ability of AD patients; [C] To evaluate the association of education and participation in leisure activities in the course of AD. Methods: Functional and neuropsychological abilities of 120 outpatients with probable AD were evaluated at baseline, at 36 and 54 months. Data collected at baseline included socio-demographics, clinical variables, education and frequency of participation in leisure activities throughout life. All participants and/or caregivers answered the questionnaire, "Participation in leisure activities throughout life" while patients completed the MMSE, the Clinical Dementia Rating scale, neuropsychological tests from the Lisbon Screening for Dementia Assessment, Barthel Index and Lawton and Brody's Index. Results: AD patients with higher levels of education achieved better results on cognitive tests. The participants with higher participation in leisure activities exhibited better results on cognitive and functional tests than those with lower participation. The disease progression was linear and progressed similarly regardless of the level of education of participants. However, the results suggest a slower disease progression in patients with a higher level of participation in leisure activities throughout their lives. Conclusion: AD patients with high education and high participation in leisure activities may benefit from a slower cognitive and functional decline after diagnosis of AD.

Key words:
aging; Alzheimer's disease; education; leisure activities

RESUMO

Escolaridade e participação em actividades de lazer parecem ser variáveis muito relevantes na doença de Alzheimer (DA) e normalmente usadas no construto Reserva Cognitiva. Objetivo: [A] Conhecer a associação entre escolaridade, capacidades cognitivas e funcionais de doentes com DA; [B] Conhecer a associação entre participação em actividades de lazer e capacidades cogntivas e funcionais de doentes com DA; [C] Avaliar a associação da escolaridade e participação em actividades de lazer no curso da DA. Métodos: Foram avaliadas competências funcionais e neurospsicológicas de 120 doentes com provável DA na baseline, após 36 e 54 meses. Dados recolhidos na baseline incluíram variáveis socio-demográficas, clínicas, escolaridade e frequência da participação em actividades de lazer. Participantes ou/e cuidadores responderam ao questionário, "Participação em actividade de lazer ao longo da vida" e completaram o MMSE, CDR, provas da Bateria de Lisboa para Avaliação das Demências, índice de Barthel e índice Lawton e Brody. Resultados: Doentes com DA com níveis mais elevados de escolaridade obtiveram melhores resultados nas provas cognitivas. Participantes com níveis mais elevados de participação em actividades de lazer exibiram melhores resultados nos testes cognitivos e funcionais do que aqueles com níveis mais baixos de participação. A progressão da doença foi linear e progrediu de forma semelhante relativamente ao nível de escolaridade. No entanto, resultados sugerem uma mais lenta progressão da doença relativamente aos doentes com níveis mais elevados de participação em actividades de lazer. Conclusão: Doentes com DA com elevada escolaridade e alta participação em actividade de lazer podem beneficiar de um mais lento declínio cognitivo e funcional após o diagnóstico da DA.

Palavras-chave:
envelhecimento; doença de Alzheimer; escolaridade; actividades de lazer

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REFERENCES

Instituto Nacional de Estatística. Censos 2011 - Resultados Provisórios [INE web site]. December, 2011. Available at: http://www.ine.pt
» http://www.ine.pt
Fratiglioni L, Launer LJ, Andersen K, et al. Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000;54 (suppl.5):S10-S15.
Lopes MA, Bottino CMC. Prevalência de demência em diversas regiões do Mundo. Análise dos estudos epidemiológicos de 1994 a 2000. Arq Neuropsiquiatr 2002;60:61-69.
Ziegler-Graham, K, Brookmever, R, Johnson, E, Arrighi, HM. Worldwide variation in the doubling time of Alzheimer's disease incidence rates. Alzheimers Dis 2008;4:316-323.
Breitner JC, Wyse BW, Anthony JC, et al. APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: The Cache County Study. Neurology 1999;53:321-331.
Ritchie K, Kildea D, Robine JM. The relationship between age and the prevalence of senile dementiia: a meta-analysis of recente data. Int J Epidemiol 1992;21:763-769.
Cummings JL. Alzheimer's Disease. New Engl J Med 2004;351:56-67.
Berr C, Wancata J, Ritchie, K. Prevalence of dementia in elderly in Europe. Eur Neuropsychopharmacol 2005;15:463-471.
Jalbert JJ, Daiello LA, Lapane K. Dementia of the Alzheimer Type. Epidemiol Rev 2008;30:15-34.
Sachdev P. Vascular Cognitive disorder. Int J Geriatric Psychiatr 1999;14:402-403.
Ikeda M, Hokoishi K, Maki N, et al. Increased prevalence of vascular dementia in Japan: a community-based epidemiological study. Neurology 2001;57:839-844
Siedlecki K, Stern Y, Reuben A, Sacco RL, Elkind MSV, Wright C. Construct validity of cognitive reserve in multiethnic cohort: The Northen Manhattan Study. J Int Neuropsychol Soc 2009;15:558-569.
Scarmeas N, Stern Y. Cognitive Reserve and Lifestyle. J Clin Exp Neuropsychol 2003;25:625-633.
Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc2002;8: 448-460.
Scarmeas N, Albert SM, Manly JJ, Stern Y. Education and rates of cognitive decline in incident Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006; 77:308-316.
Scarmeas N, Levy MD, Tang M-X, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's Disease. Neurology 2001;57:2236-2242.
Verghese J, Lipton RB, Katz MJ, et al. Leisure Activities and the Risk of Dementia in the Elderly. New Eng J Med 2003;348:2508-2516.
Scarmeas N, Stern Y. Cognitive Reserve: Implications for Diagnosis and Prevention of Alzheimer`s Disease. Curr Neurol Neurosci Rep 2004;4:374-380.
Karp A, Paillard-Borg S, Wang H-X, Silverstein M, Winblad B, Fratiglioni L. Mental, Physical and Social Components in Leisure Activities Equally Contribute to Decrease Dementia Risk. Dement Geriatr Cogn Disord 2006;21:65-73.
Paillard-Borg S, Fratiglioni L, Winblad B, Wang H-X. Leisure Activities in Late Life in Relation to Dementia Risk: Principal Component Analysis. Dement Geriatr Cogn Disord2009;28:136-144.
Stern C, Munn Z. Cognitive leisure activities and their role in preventing dementia: a systematic review. Int J Evid Based Healthc 2010;8:2-17.
Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol 2004;3:343-353.
Paykel ES, Brayne C, Huppert FA, Gill C, Barkley C, Gehlhaar E. Incidence of dementia in a population older than 75 years in the United Kingdon. Arch Gen Psychiatry 1994;51:325-332.
Graves AB, Larson EB, Edland SD. Prevalence of dementia and its subtypes in the Japanese American population of King County, Washington State: The Kame Project. Am J Epidemiol 1996;144:760-71.
Jorm AF, Rodgers B, Henderson AS, Korten AE, Jacomb PA, Christensen H. Occupation type as a predictor of cognitive decline and dementia in old age. Age Ageing 1998;27:477-483.
Helmer C, Letenneur L, Rouch I, et al. Occupation during life and risk of dementia in French elderly community residents. Neurol Neurosurg Psychiatry 2001;71:303-309.
Beelen MJ. Cognitive Reserve in Alzheimer's Disease: Implications for detection and prevention. JLGH 2009;4:94-100.
Wilson RS, Li Y, Aggarwal NT, et al. Education and the course of cognitive decline in Alzheimer. Neurology 2004;63:1193-1202.
LeCarret N, Auriacombe S, Letenneur L, Bergua V, Dartigues JF, Fabrigoule C. Influence of education on the pattern of cognitive deterioration in AD patients: the cognitive reserve hypothesis. Brain Cogn 2005;57:120-126.
Helzner E, Scarmeas N, Cosentino S, Portet F, Stern Y. Leisure Activity and Cognitive Decline in Incident Alzheimer Disease. Arch Neurol 2007;64:1749-1754.
Fritsch T, McClendon MJ, Smyth K, Ogrocki PK. Effects of educational attainment and occupational status on cognitive and functional decline in person with Alzheimer type dementia. Int Psychogeriatrics 2002;14:347-363.
Treiber K. Relationship of Cognitive Reserve and Decline in Alzheimer's Disease. A Population Study. All Graduate Theses and Dissertations 2010; Paper 574. http://digitalcommons.usu.edu/etd/574
» http://digitalcommons.usu.edu/etd/574
Katzman R, Brown T, Thal LJ, Fuld PA, Aronson M, Butters N. Comparison of rate of annual change of mental status score in four independent studies of patients with Alzheimer's disease. Ann Neurol 1988; 24:384-389.
Filley CM, Brownell HH, Albert ML. Education provides no protection against Alzheimer's disease. Neurology 1985;35:1781-1784.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (4thed. test revision). Washington DC: American Psychiatric Association; 2000.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
Folstein MF, Folstein SE, McHugh R. Mini-Mental State: A practical method for grading the cognitive state for patients for the clinician. J Psychiatr Res 1975;12: 189-198.
Hughes CP, Berg L, Danzinger LW, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.
Guerreiro MS, Botelho MA, Leitão O, CastroCaldas A, Garcia C. Avaliação Breve do Estado Mental. Adaptação Portuguesa do Mini Mental State Examination (MMSE) (Folstein, Folstein, McHugh, 1975). Lisboa: Grupo de Estudos de Envelhecimento Cerebral e Demências; 1994.
Garcia C. Doença de Alzheimer, problemas do diagnóstico clínico [Alzheimer'disease, difficulties in clinical diagnosis]. Dissertação de Doutoramento [PhD dissertation].Universidade de Lisboa. Faculdade de Medicina de Lisboa; 1984.
Graffar M. Une méthode de classification sociale d'échantillons de population. Courier 1956; 6:455.
Pordata [database online]. Francisco Manuel dos Santos Foundation, Available at: http://www.pordata.pt 2011.
» http://www.pordata.pt
Aevarsson O, Skoog I. A Longitudinal Population Study of the Mini-Mental State Examination in the Very Old: Relation to Dementia and Education. Dement Geriatr Cogn Disord2000;11:166-175.
Kilander L, Nyman H, Boberg M, Lithell H. Cognitive function, vascular risk factors and education. A cross-sectional study based on a cohort of 70-year- old men. J Intern Med 1997;242:313-321.
Albert MS, Jones K, Savage CR, et al. Predictors of cognitive change in older persons: MacArthur studies of successful aging. Psychol Aging 1995;10:578-589.
Ganguli M, Ratcliff G, Huff FJ, Kancel MJ. Effects of age, gender, and education on cognitive tests in a rurural elderly community sample: norms from the Monongahela Valley Independent Elders Survey. Neuroepidemiology 1991;10:42-52.
James BD, Wilson RS, Barnes LL, Bennett DA. Late-life Social Activity and Cognitive Decline in old Age. J Int Neuropsychol Soc2011;17:998-1005.
Teiber KA, Carlson MC, Corcoran, C, et al. Cognitive stimulation and cognitive and functional decline in Alzheimer's Disease: The cache county dementia progression Study. J Gerontol B Psychol Sci Soc Sci 2011;66:416-425.
Friedland RP, Fritsch T, Smyth KA, et al. Patients with Alzheimer's disease have reduced activities in midlife compared with healthy control-group members. Proc Natl Acad Sci USA 2001;98:3440-3445
Staff TR, Murray AD, Deary IJ, Whalley LJ. What provides cerebral reserve? Brain 2004;127:1191-1199.

Publication Dates

Publication in this collection
Apr-Jun 2013

History

Received
28 Dec 2012
Accepted
18 Apr 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Instituto Nacional de Estatística. Censos 2011 - Resultados Provisórios [INE web site]. December, 2011. Available at: http://www.ine.pt
» http://www.ine.pt

[2] Fratiglioni L, Launer LJ, Andersen K, et al. Incidence of dementia and major subtypes in Europe: A collaborative study of population-based cohorts. Neurologic Diseases in the Elderly Research Group. Neurology 2000;54 (suppl.5):S10-S15.

[3] Lopes MA, Bottino CMC. Prevalência de demência em diversas regiões do Mundo. Análise dos estudos epidemiológicos de 1994 a 2000. Arq Neuropsiquiatr 2002;60:61-69.

[4] Ziegler-Graham, K, Brookmever, R, Johnson, E, Arrighi, HM. Worldwide variation in the doubling time of Alzheimer's disease incidence rates. Alzheimers Dis 2008;4:316-323.

[5] Breitner JC, Wyse BW, Anthony JC, et al. APOE-epsilon4 count predicts age when prevalence of AD increases, then declines: The Cache County Study. Neurology 1999;53:321-331.

[6] Ritchie K, Kildea D, Robine JM. The relationship between age and the prevalence of senile dementiia: a meta-analysis of recente data. Int J Epidemiol 1992;21:763-769.

[7] Cummings JL. Alzheimer's Disease. New Engl J Med 2004;351:56-67.

[8] Berr C, Wancata J, Ritchie, K. Prevalence of dementia in elderly in Europe. Eur Neuropsychopharmacol 2005;15:463-471.

[9] Jalbert JJ, Daiello LA, Lapane K. Dementia of the Alzheimer Type. Epidemiol Rev 2008;30:15-34.

[10] Sachdev P. Vascular Cognitive disorder. Int J Geriatric Psychiatr 1999;14:402-403.

[11] Ikeda M, Hokoishi K, Maki N, et al. Increased prevalence of vascular dementia in Japan: a community-based epidemiological study. Neurology 2001;57:839-844

[12] Siedlecki K, Stern Y, Reuben A, Sacco RL, Elkind MSV, Wright C. Construct validity of cognitive reserve in multiethnic cohort: The Northen Manhattan Study. J Int Neuropsychol Soc 2009;15:558-569.

[13] Scarmeas N, Stern Y. Cognitive Reserve and Lifestyle. J Clin Exp Neuropsychol 2003;25:625-633.

[14] Stern Y. What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc2002;8: 448-460.

[15] Scarmeas N, Albert SM, Manly JJ, Stern Y. Education and rates of cognitive decline in incident Alzheimer's disease. J Neurol Neurosurg Psychiatry 2006; 77:308-316.

[16] Scarmeas N, Levy MD, Tang M-X, Manly J, Stern Y. Influence of leisure activity on the incidence of Alzheimer's Disease. Neurology 2001;57:2236-2242.

[17] Verghese J, Lipton RB, Katz MJ, et al. Leisure Activities and the Risk of Dementia in the Elderly. New Eng J Med 2003;348:2508-2516.

[18] Scarmeas N, Stern Y. Cognitive Reserve: Implications for Diagnosis and Prevention of Alzheimer`s Disease. Curr Neurol Neurosci Rep 2004;4:374-380.

[19] Karp A, Paillard-Borg S, Wang H-X, Silverstein M, Winblad B, Fratiglioni L. Mental, Physical and Social Components in Leisure Activities Equally Contribute to Decrease Dementia Risk. Dement Geriatr Cogn Disord 2006;21:65-73.

[20] Paillard-Borg S, Fratiglioni L, Winblad B, Wang H-X. Leisure Activities in Late Life in Relation to Dementia Risk: Principal Component Analysis. Dement Geriatr Cogn Disord2009;28:136-144.

[21] Stern C, Munn Z. Cognitive leisure activities and their role in preventing dementia: a systematic review. Int J Evid Based Healthc 2010;8:2-17.

[22] Fratiglioni L, Paillard-Borg S, Winblad B. An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurol 2004;3:343-353.

[23] Paykel ES, Brayne C, Huppert FA, Gill C, Barkley C, Gehlhaar E. Incidence of dementia in a population older than 75 years in the United Kingdon. Arch Gen Psychiatry 1994;51:325-332.

[24] Graves AB, Larson EB, Edland SD. Prevalence of dementia and its subtypes in the Japanese American population of King County, Washington State: The Kame Project. Am J Epidemiol 1996;144:760-71.

[25] Jorm AF, Rodgers B, Henderson AS, Korten AE, Jacomb PA, Christensen H. Occupation type as a predictor of cognitive decline and dementia in old age. Age Ageing 1998;27:477-483.

[26] Helmer C, Letenneur L, Rouch I, et al. Occupation during life and risk of dementia in French elderly community residents. Neurol Neurosurg Psychiatry 2001;71:303-309.

[27] Beelen MJ. Cognitive Reserve in Alzheimer's Disease: Implications for detection and prevention. JLGH 2009;4:94-100.

[28] Wilson RS, Li Y, Aggarwal NT, et al. Education and the course of cognitive decline in Alzheimer. Neurology 2004;63:1193-1202.

[29] LeCarret N, Auriacombe S, Letenneur L, Bergua V, Dartigues JF, Fabrigoule C. Influence of education on the pattern of cognitive deterioration in AD patients: the cognitive reserve hypothesis. Brain Cogn 2005;57:120-126.

[30] Helzner E, Scarmeas N, Cosentino S, Portet F, Stern Y. Leisure Activity and Cognitive Decline in Incident Alzheimer Disease. Arch Neurol 2007;64:1749-1754.

[31] Fritsch T, McClendon MJ, Smyth K, Ogrocki PK. Effects of educational attainment and occupational status on cognitive and functional decline in person with Alzheimer type dementia. Int Psychogeriatrics 2002;14:347-363.

[32] Treiber K. Relationship of Cognitive Reserve and Decline in Alzheimer's Disease. A Population Study. All Graduate Theses and Dissertations 2010; Paper 574. http://digitalcommons.usu.edu/etd/574
» http://digitalcommons.usu.edu/etd/574

[33] Katzman R, Brown T, Thal LJ, Fuld PA, Aronson M, Butters N. Comparison of rate of annual change of mental status score in four independent studies of patients with Alzheimer's disease. Ann Neurol 1988; 24:384-389.

[34] Filley CM, Brownell HH, Albert ML. Education provides no protection against Alzheimer's disease. Neurology 1985;35:1781-1784.

[35] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (4thed. test revision). Washington DC: American Psychiatric Association; 2000.

[36] McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[37] Folstein MF, Folstein SE, McHugh R. Mini-Mental State: A practical method for grading the cognitive state for patients for the clinician. J Psychiatr Res 1975;12: 189-198.

[38] Hughes CP, Berg L, Danzinger LW, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J Psychiatry 1982;140:566-572.

[39] Guerreiro MS, Botelho MA, Leitão O, CastroCaldas A, Garcia C. Avaliação Breve do Estado Mental. Adaptação Portuguesa do Mini Mental State Examination (MMSE) (Folstein, Folstein, McHugh, 1975). Lisboa: Grupo de Estudos de Envelhecimento Cerebral e Demências; 1994.

[40] Garcia C. Doença de Alzheimer, problemas do diagnóstico clínico [Alzheimer'disease, difficulties in clinical diagnosis]. Dissertação de Doutoramento [PhD dissertation].Universidade de Lisboa. Faculdade de Medicina de Lisboa; 1984.

[41] Graffar M. Une méthode de classification sociale d'échantillons de population. Courier 1956; 6:455.

[42] Pordata [database online]. Francisco Manuel dos Santos Foundation, Available at: http://www.pordata.pt 2011.
» http://www.pordata.pt

[43] Aevarsson O, Skoog I. A Longitudinal Population Study of the Mini-Mental State Examination in the Very Old: Relation to Dementia and Education. Dement Geriatr Cogn Disord2000;11:166-175.

[44] Kilander L, Nyman H, Boberg M, Lithell H. Cognitive function, vascular risk factors and education. A cross-sectional study based on a cohort of 70-year- old men. J Intern Med 1997;242:313-321.

[45] Albert MS, Jones K, Savage CR, et al. Predictors of cognitive change in older persons: MacArthur studies of successful aging. Psychol Aging 1995;10:578-589.

[46] Ganguli M, Ratcliff G, Huff FJ, Kancel MJ. Effects of age, gender, and education on cognitive tests in a rurural elderly community sample: norms from the Monongahela Valley Independent Elders Survey. Neuroepidemiology 1991;10:42-52.

[47] James BD, Wilson RS, Barnes LL, Bennett DA. Late-life Social Activity and Cognitive Decline in old Age. J Int Neuropsychol Soc2011;17:998-1005.

[48] Teiber KA, Carlson MC, Corcoran, C, et al. Cognitive stimulation and cognitive and functional decline in Alzheimer's Disease: The cache county dementia progression Study. J Gerontol B Psychol Sci Soc Sci 2011;66:416-425.

[49] Friedland RP, Fritsch T, Smyth KA, et al. Patients with Alzheimer's disease have reduced activities in midlife compared with healthy control-group members. Proc Natl Acad Sci USA 2001;98:3440-3445

[50] Staff TR, Murray AD, Deary IJ, Whalley LJ. What provides cerebral reserve? Brain 2004;127:1191-1199.

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