Cognitive Activity and Onset Age of Incident Alzheimer Disease Dementia

Neurology. 2021 Aug 31;97(9):e922-e929. doi: 10.1212/WNL.0000000000012388. Epub 2021 Jul 14.


Objective: To test the hypothesis that higher level of cognitive activity predicts older age at dementia onset in Alzheimer disease (AD) dementia.

Methods: As part of a longitudinal cohort study, 1,903 older persons without dementia at enrollment reported their frequency of participation in cognitively stimulating activities. They had annual clinical evaluations to diagnose dementia and AD, and the deceased underwent neuropathologic examination. In analyses, we assessed the relation of baseline cognitive activity to age at diagnosis of incident AD dementia and to postmortem markers of AD and other dementias.

Results: During a mean of 6.8 years of follow-up, 457 individuals were diagnosed with incident AD at a mean age of 88.6 (SD 6.4, range 64.1-106.5) years. In an extended accelerated failure time model, higher level of baseline cognitive activity (mean 3.2, SD 0.7) was associated with older age at AD dementia onset (estimate 0.026; 95% confidence interval 0.013-0.039). Low cognitive activity (score 2.1, 10th percentile) was associated with a mean onset age of 88.6 years compared to a mean onset age of 93.6 years associated with high cognitive activity (score 4.0, 90th percentile). Results were comparable in subsequent analyses that adjusted for potentially confounding factors. In 695 participants who died and underwent a neuropathologic examination, cognitive activity was unrelated to postmortem markers of AD and other dementias.

Conclusion: A cognitively active lifestyle in old age may delay the onset of dementia in AD by as much as 5 years.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age of Onset*
  • Aged
  • Aged, 80 and over
  • Alzheimer Disease / epidemiology*
  • Cognition*
  • Cohort Studies
  • Female
  • Humans
  • Life Style*
  • Longitudinal Studies
  • Male
  • Middle Aged