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Mediation analysis of leisure activities on the association between cognitive function and mortality: a longitudinal study of 42,942 Chinese adults 65 years and older
Xingxing Chen, Wenfan Wu, Xian Zhang, Tingxi Long, Wenyu Zhu, Rundong Hu, Xurui Jin, Lijing L. Yan, Yao Yao
Epidemiol Health. 2022;44:e2022112.   Published online November 27, 2022
DOI: https://doi.org/10.4178/epih.e2022112
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  • 3 Web of Science
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AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
Previous studies have established associations of cognitive function and leisure activities with mortality. This study aimed to evaluate whether leisure activities causally mediate these associations.
METHODS
This longitudinal study included 42,246 participants aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey. The Mini-Mental State Examination and a self-reported scale were used to measure cognitive status and leisure activities, respectively. We examined the associations of cognitive function and leisure activities with mortality using Cox proportional hazards models. Causal mediation analysis was used to assess whether leisure activities mediated the association between cognitive function and mortality.
RESULTS
Cognitive function and leisure activities were inversely associated with mortality. Leisure activities accounted for 28.3% (95% confidence interval [CI], 25.6 to 31.1) of the total effect of cognitive function and mortality. A higher mediated proportion (PM) was observed for physical leisure activities (PM, 20.1%; 95% CI, 18.0 to 22.3) than for social leisure activities (PM, 17.7%; 95% CI, 15.7 to 19.7). The mediating effect was higher among participants at younger ages (PM, 41.5%; 95% CI, 21.3 to 65.4), those with higher education levels (PM, 30.5%; 95% CI, 25.3 to 36.2), and residents of rural China (PM, 42.5%; 95% CI, 25.4 to 62.5).
CONCLUSIONS
Cognitive function was associated with inverse mortality. Leisure activities significantly mediated this association. Participation in leisure activities at the early stages of mild cognitive impairment could reduce the risk of mortality, which has a major impact on interventional strategies for healthy aging.
Summary
Key Message
Both cognitive function and leisure activities were associated with inverse mortality. Leisure activities were an important mediator of the association between cognitive function and mortality. A planned intervention for leisure activities, at an early stage of mild cognitive impairment, could promote health outcomes and optimally reduce the risk of mortality.

Citations

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  • Cognitive performance and all-cause mortality in community dwellers of Amerindian ancestry living in rural Ecuador: A population-based, longitudinal prospective study
    Oscar H. Del Brutto, Denisse A. Rumbea, Aldo F. Costa, Maitri Patel, Mark J. Sedler, Robertino M. Mera
    Clinical Neurology and Neurosurgery.2024; 236: 108053.     CrossRef
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    The Lancet Healthy Longevity.2023; 4(10): e535.     CrossRef
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Factors affecting cognitive function according to gender in community-dwelling elderly individuals
Miwon Kim, Jeong-Mo Park
Epidemiol Health. 2017;39:e2017054.   Published online November 15, 2017
DOI: https://doi.org/10.4178/epih.e2017054
  • 13,688 View
  • 292 Download
  • 34 Web of Science
  • 33 Crossref
AbstractAbstract AbstractSummary PDFSupplementary Material
Abstract
OBJECTIVES
This study aimed to identify the factors affecting the cognitive function of elderly people in a community by gender.
METHODS
We obtained 4,878 secondary data of people aged ≥65 years in 2016 at a dementia prevention center in Gyeyang-gu, Incheon. Data were obtained through Mini-Mental Status Examination optimized for screening dementia and a questionnaire. The data were statistically analyzed using analysis of variance, analysis of covariance, and hierarchical regression.
RESULTS
There were significant differences in cognitive function according to gender, and the differences were significant even when age was controlled, but gender differences disappeared when education was controlled. Age, education, social activities, number of comorbid diseases, and alcohol drinking affected cognitive function through interaction with gender, but interaction with gender disappeared when education was controlled. Regression analysis showed that depression, cohabitant, social activities etc., had a significant impact on both men and women under controlled education and age. In men, the effect of social activities was greater than that of women, and hyperlipidemia had the effect only in women.
CONCLUSIONS
The differences in gender-related cognitive functions were due to differences in gender education period. The period of education is considered to have a great influence on cognitive function in relation to the economic level, occupation, and social activity.
Summary
Korean summary
연구결과 성별에 따른 인지기능의 차이는 성별 교육기간의 차이에서 기인된 것으로 확인되었다. 또한 연령, 교육, 사회활동, 동거인, 질병수, 음주가 성별과의 상호작용을 통해 인지기능에 영향을 미쳤으나 교육을 통제 하였을 때 성별과의 상호작용이 사라져 이들 변수들과 성별의 상호작용에 교육이 관련됨을 확인하였다. 회귀 분석결과 교육과 연령을 통제한 상태에서 우울, 동거인, 사회 활동 등 인지기능에 영향을 미치는 요인들이 남녀가 동일하였다.

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The Effect of Vitamin Supplementation on Cognitive Function in the Elderly.
Sam Soon Lee, Byung Yeol Chun, Sang Soon Kim
Korean J Epidemiol. 2000;22(1):32-41.
  • 5,338 View
  • 14 Download
AbstractAbstract PDF
Abstract
OBJECTIVES
To estimate the effects of an oral vitamin supplementation on cognitive function in the elderly, 254 elderly people(experiment group) who were received an oral vitamin supplement for one-year was compared with 292 elderly who were treated as the control group in Koje city during the study period(from February 1997 to March 1998).
METHODS
The cognitive function was tested by mini-mental state examination Korea(MMSE-K). Multiple regression analysis was done to control other confounding variables such as gender, age, educational level, smoking, alcohol, a past 15-day medical history, satisfaction for living cost, family number, cognitive function of the baseline survey.
RESULTS
In the baseline survey, the prevalence of cognitive impairment was 31%(mild impairment 12.5% and severe impairment 18.5%). There was a significant difference(0.76) in cognitive change in the elderly between two groups, 0.68 improved in the experiment group and 0.08 worsen in the control group(p<0.01). In multiple regression analysis, the significant variables were an oral vitamin supplementation, a past 15-day medical history, family number, cognitive function of baseline survey(p<0.05). The improvement of cognitive function was observed in those who do not have a past 15-day medical history, have a large family number, and have a low cognitive function of the baseline survey.
CONCLUSIONS
It appears that an oral vitamin supplementation was effective in improving the cognitive function in the elderly and more effective in the cases with abnormal cognitive function.
Summary

Epidemiol Health : Epidemiology and Health