High rates of leisure activity have been associated with reduced risk of Alzheimer disease (AD).
To determine whether prediagnosis leisure activity modifies the rate of cognitive decline in patients with AD.
Inception cohort followed up longitudinally for a mean of 5.3 years (up to 13.9 years).
A total of 283 patients with incident AD (mean age, 79 years; 56.2% Hispanic and 31.1% African American).
Main Outcome Measures
Change in a composite cognitive score from diagnosis on and during the entire study follow-up.
In multivariate-adjusted generalized estimating equation models of postdiagnosis change (n = 133), each leisure activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P = .17). In models expanded to include cognitive change during study follow-up, including evaluations before and after diagnosis (n = 283), each activity was associated with an additional yearly decline of 0.005 of a z-score unit in cognitive score (P = .03). The association was strongest for intellectual activities.
Greater participation in prediagnosis leisure activities, especially intellectual activities, was associated with faster cognitive decline, supporting the hypothesis that the disease course in AD may vary as a function of cognitive reserve.