Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial

Int Psychogeriatr. 2014 Apr;26(4):637-43. doi: 10.1017/S1041610213002524. Epub 2014 Jan 10.


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.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Alleles
  • Apolipoproteins E
  • Cluster Analysis
  • Cognition / physiology*
  • Cognition Disorders / physiopathology*
  • Dementia / physiopathology
  • Dementia / psychology
  • Dementia / therapy*
  • Disease Progression
  • Exercise / physiology
  • Female
  • Humans
  • Leisure Activities*
  • Male
  • Neuropsychological Tests
  • Nursing Homes
  • Outcome Assessment, Health Care
  • Severity of Illness Index
  • Tai Ji / psychology


  • Apolipoproteins E