Pro and Con: Do Cognitive-Enhancing Activities Prevent Dementia?

In a series of debates at the 2016 American Academy of Neurology annual meeting, expert physicians debated current and controversial issues in neuroscience. David S. Knopman, MD, FAAN, Professor of Neurology, Alzheimer’s Disease Research Center, Mayo Clinic, Rochester, MN, advocated for the benefits of cognitive-enhancing activities; Kaycee M. Sink, MD, MAS, Medical Director, Kulynych Memory Assessment Clinic, Wake Forest Baptist Medical Center, Winston-Salem, NC, contended that there is a lack of controlled studies to guide clinical recommendations.

Pro: Mentally Stimulating Activities Reduce Dementia Risk

A variety of mentally stimulating activities may carry benefit in reducing the risk for dementia. “It doesn’t have to be expensive, but it should be socially engaging,” said Dr Knopman, who stressed that lifelong participation in these activities is key.

Relevant types of socially engaging activities include crafts, book clubs, faith-based discussion groups, games, and proprietary computer activities, although the benefit of the latter remains controversial.

“As far as your patients are concerned, emphasizing social participation is really important….More important, it keeps them away from passive television watching or other socially isolating things,” said Dr Knopman.

Although it is never too late to start, participation in these types of activities undoubtedly goes back to childhood and early education, Dr Knopman said. “One of the key points is that this involves lifelong engagement. It isn’t something that starts de novo at age 75.”

According to Dr Knopman, learning new routines may be more important than engagement in one narrowly defined activity.

Con: Cognitive-Enhancing Activities Do Not Prevent Dementia

Although observational studies have shown that some cognitive activities, including board games, reading, and playing an instrument, are associated with lower incidence of dementia, no randomized controlled data are available to guide clinical recommendations, Dr Sink argued.

“The observational data are certainly supportive, but they’re fraught with confounding factors that limit our conclusions. No matter how well we control for things statistically, we’re never going to be able to really answer this question without a randomized controlled trial,” she reiterated.

“There’s nothing that we know of that prevents dementia. If there was, we’d all be doing it,” Dr Sink added. Instead, she recommends that patients save their money and skip the brain-training applications.

“I usually tell patients to limit their time in the 2D world, and instead be in the 3D world. Do something that’s way more stimulating than sitting in front of a screen—go engage with people, play with your grandkids, build LEGO sets, etc,” she emphasized.

Although the observational evidence is certainly encouraging, there is not enough evidence to recommend cognitively enhancing activities for the prevention of dementia on a guideline or policy level, Dr Sink said. However, the benefits of such activities far outweigh the harms.

“It may not help, but it’s certainly not going to hurt, so of course I tell my patients to continue to stay active cognitively,” she concluded.