Leisure Activities as Protective Factors Against Alzheimer's Disease : A Case-Control Study

Transcription

1 : *, 1 1 Leisure Activities as Protective Factors Against Alzheimer's Disease : A Case-Control Study Chang Wo n Won M.D., Duk L. Na, M.D. 1 and Hyun Rim Cho i M.D. Department of Family Medicine, Kyung Hee University College of Medicine, Seoul Korea Department of Neurology, Sungkyunkwan University School of Medicine, Seoul, Korea 1 Background : Regular participation in leisure activities has been found to be associated with better cognitive performance. Many Koreans play Korean card game, Baduk('Go'), and the Korean chess. For these activities specific for Koreans, there has been no study to show the association between the risk of dementia and these acitivities. Method : Eighty-two cases identified as affected by Alzheimer's disease were obtained, and two controls were individually matched to each case according to age( 5 years), sex, education level, and the area of residence. A structured questionnaire was administered to the surrogate of cases and controls, by four well-trained interviewers. Results : The age of the cases ranged between 54 and 87 years old. The cases did not differ from the controls with regard to education, occupation, religion, type of housing, home ownership, living space, smoking and drinking habits. In a conditional logistic regression analysis, hours per day spent for chores (odds ratio, 1.54; 95% confidence interval, ) were positively associated with Alzheimer's disease. In contrast, reading books(odds ratio, 0.10; 95% confidence interval, ) was negatively associated with Alzheimer's disease. statistical association was found with Korean card game, Baduk('Go'), or the Korean chess. Conclusions : Reading books is associated with a reduced risk of Alzheimer's disease, but not for Korean card game, 'Go', Korean chess. In contrast, doing chores is associated with a increased risk of Alzheimer's disease. Key Words: Alzheimer's disease, Protective factors, Leisure activities, Reading, Chores : , : : chunwon@khmc.or.kr * MSD %, 95.7% 1)

2 Chang Wo n Wo n. FLeisure activities as protective factors against Alzheimer's disease : A case- control study,. apolipoprotein E gene 2-4), 5), 6-11) 12,13), 13,14), 3,12), 14), 15), 16), ). NINCDS-ADRDA* probable diag- nosis 2 1),, 2, 18), Fabrigoule 7) 3,,,,,, 40 90,,. Bassuk 19), /,,,,,, 12.,.,,,,.,, ( 20) -,, ),,,,,,,,.,,, / ) 2,.,. 1. 1) ,. 2 ) ( 5 ), (,,

3 ( 1, 2, 4 ) 1 ). t- (, SAS for Windows Version 6.12,, ), conditional logistic regression,. (odds ratio) , ( ), ( ). 25.6%, 3 ) 74.4%. 15, /, ( 1). Table 1. De mog raphic c haracte ristics of s ubjects (%) Cases (N=82) Controls (N=164) P Age (mean±sd) Gender Male Female Area of residence Large city Small city Town (25.6) 61(74.4) 54(65.9) 16(19.5) 12(14.6) 42(25.6) 122(74.4) 104(63.4) 40(24.4) 20(12.2) *National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association

4 Chang Wo n Wo n. FLeisure activities as protective factors against Alzheimer's disease : A case- control study., ( ),,,,,,.. 10 ( / ), ( / ( ),, ), ( 2). Education ne Primary school Middle- High school College- Occupation Office work Business Profession Official/Teacher Farmer Other job ne Religion Christian Catholic Buddhist Confucian Others ne Type of housing Apartment House Home ownership One 's own Rent Living space(pyung ) Table 2. Soc ioec ono mic status of s ubjects Cases (N=82) * Controls (N=164) * P 17(20.7) 35(42.7) 17(20.7) 13(15.8) 3(3.7) 18(22.2) 5(6.2) 8(9.9) 15(18.5) 4(4.9) 28(34.6) 23(28.0) 10(12.2) 28(34.1) 1(1.2) 1(1.2) 19(23.2) 29(39.2) 45(60.8) 70(95.9) 3(4.1) 36(22.0) 65(39.7) 34(20.7) 29(17.6) 8(4.9) 26(15.9) 10(6.1) 13(7.9) 31(18.9) 8(4.9) 68(41.5) 51(31.1) 19(11.6) 57(34.8) 1(0.6) 1(0.6) 35(21.3) 66(40.7) 96(59.3) 130(89.7) 14(9.7) (%) * Stratum totals may not equal overall totals because some data were unavailable The job in which the subjects had been engaged for more than 10 years 1 pyung equals m

5 2. Smoking Smoker/ex- smoker Never Alcohol Drinker ndrinker Table 3. Smoking and drinking habits Cases (N=82) Controls (N=164) P 19(23.5) 62(76.5) 23(28.0) 59(72.0) 43(26.2) 121(73.8) 34(20.7) 130(79.3) (%) Table 4. Enjoying Ko rean card game, Baduk( 'Go '), o r Ko rean c hess (%) Cases (N=82) Controls (N=164) P Korean card game Yes* 29(37.7) 48(62.3) 63(38.7) 100(61.3) Go (Baduk) Yes* 5(6.3) 75(93.8) 11(6.7) 153(93.3) Korean chess Yes* 2(2.5) 78(97.5) 15(9.1) 149(90.9) * More than once per month 5 Conditional Logistic Regression Analysis,. ( 3)., ( 51, 150 ) %., (p=0.015). ( 7)., (,, (p=0.014), ) (p= (p=0.003)( 6) )

6 Chang Wo n Wo n. FLeisure activities as protective factors against Alzheimer's disease : A case- control study Table 5. Watching te levis ion, reading a news pape r, and reading books Watching television Yes Reading a newspaper Yes Reading books Yes Cases (N=82) Controls (N=164) P 69(84.1) 13(15.9) 39(47.6) 43(52.4) 24(30.0) 56(70.0) 146(90.7) 15( 9.3) 89(54.9) 73(45.1) 75(46.3) 87(53.7) (%) Tab le 6. Ho us e ho ld c ho res, knitting, getting a long with g randc hildre n Hours per day spent for household chores Cases (N=82) Controls (N=164) P 21(25.6) 14(17.1) 27(32.9) 7(8.5) 13(15.9) 55(33.5) 51(31.1) 43(26,2) 9( 5.5) 6( 3.7).(%) Knitting * Yes 38(65.5) 20(34.5) 88(73.3) 32(26.7) Days per week spent with grandchildren (55.4) 5( 7.7) 1( 1.5) 23(35.4) 69(47.6) 27(18.6) 1( 1.5) 49(33.8) * only the female subjects are included,, apolipoprotein E )

7 2. Table 7. Res ults of Co nditiona l Log istic Reg ress ion Ana lys is fo r Alzhe ime r's diseas e * Variable Adjusted Odds Ratio Lower CI Upper CI p- value Reading books Daily hours for houshold chores Enjoying Korean chess Enjoying Baduk('Go ') Korean card game * Matched analysis for variables of 51 cases with Alzheimer's disease and 150 age- sex- residenceeducation matched controls CI : 95% Confidence Interval significant at level 5%..,, 22),. 2.5% 9.1 % (recall bias).. Fabrigoule 7),..,., Fabrigoule 7).. Fabrigoule 7 23). 7)

8 Chang Wo n Wo n. FLeisure activities as protective factors against Alzheimer's disease : A case- control study., %., 25.6%, 74.4%.,. 1 ( / ),.,..,,. (p=0.030).. Ross 24) (p=0.014). 21%, 53%,. 4,. :.,. : , ( 5 ) : 54 87,,, ( / ), Conditional Logistic Regression Analysis. :.,. 1) ) Strittmatter WJ, Saunders AM, Schmechel D, Pericak-Vance M, Enghild J, Salvesen GS, et al. Apolipoprotein E: high avidity binding to - amyloid and increased frequency of type 4 allele in late-onset familial Alzheimer's disease. Proc Natl Acad Sci USA 1993;90:

9 2. 3) Kuusisto J, Koivisto K, Kervinen K, Mykkanen L, Helkala EL, Vanhanen M, et al. Association of apolipoprotein E phenotypes with late onset Alzheimer's disease: A population based study. BMJ 1994;309: ) Tsai M-S, Tangalos EG, Petersen RC, Smith GE, Schaid DJ, Kokemen E. apolipoprotein E: risk factor for Alzheimer's disease. Am J Hum Genet 1994;54: ) Katzman R, Kawas C. The epidemiology of dementia and Alzheimer disease. In: Alzheimer Disease. New York: Raven Press 1994: ) Amaducci LA, Fratiglioni L, Rocca WA, et al. Risk factors for clinically diagnosed Alzheimer's disease. Neurology 1986;36: ) Fabrigoule C, Letenneur L, Dartigues JF, Zarrouk M, Commenges M. Social and leisure activities and risk of dementia: A prospective longitudinal study. JAGS 1995;43: ) Shalat S, Seltzer B, Pidcock C, Baker EL. Risk factors for Alzheimer's disease: A case-control study. Neurology 1987;37: ) Graves AB, White E, Koepsell TD, Reifler BV, van Belle G, Larson EB, Raskind M. case-control study of Alzheimer's disease. Ann Neurol 1990; 28: ) Heyman A, Wilkinson WE, Stafford JA, Helms MJ, Sigmon AH, Weinberg T. Alzheimer's disease: A study of epidemiological aspects. Ann Neurol 1984;15: ) Broe GA, Henderson AS, Creasey H, McCusker E, Korten AE, Jorm AF, Longley W, Anthony JC. A case-control study of Alzheimer's disease in Australia. Neurology 1990 v;40: ) Stern Y, Gurland B, Tatemichi TK, Xin Tang M, Wilder D, Mayeux R. Incidence of education and occupation on the incidence of Alzheimer's disease. JAMA 1994;271: ) Evans DA, Hebert LE, Beckett LA, Scherr PA, Albert MS, Chown MJ, Pilgrim DM, Taylor JO. Education and other measures of socioeconomic status and risk of incident Alzheimer's disease in a defined population of older persons. Arch Neurol 1997;54: ) Fratiglioni L, Ahlbom A, Viitanen M, Winblad B. Risk factors for late onset Alzheimer's disease: A population based case-control study. Ann Neurol 1993;33: ) French LB, Schuman LM, Mortimer JA, Hutton JT, Boatman RA. A case-control study of dementia of the Alzheimer type. 16) Anderson K, Launer LJ, Ott A, Hoes AW, Breteler MMB, Hofman A. Do nonsteroidal antiinflammatory drugs decrease the risk of Alzheimer's disease? Neurology 1995;45: ) Paganini-Hill A, Henderson VW. Estrogen replacement therapy and risk of Alzheimer disease. Arch Intern Med 1996;156(28): ) Hultsch DF, Hammer M, Small BJ. Age differences in cognitive performance in later life: Relationship to self-reported health and activity life style. J Gerontol(Psychol Sci) 1993;48: ) Bassuk SS, Glass TA, Berkman LF. Social disengagement and incident cognitive decline in communitive-dwelling elderly persons. Ann Intern Med 1999;131: ),,,,, ;12(4):

10 Chang Wo n Wo n. FLeisure activities as protective factors against Alzheimer's disease : A case- control study 21) McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan E. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Servicies Task Force on Alzheimer's disease. Neurology 1984;34: ) Koh K, Ray R, Lee J, Nair A, Ho T, Ang PC. Dementia in elderly patients: Can the 3R mental stimulation programme improve mental status? Age and Ageing 1994;23: ) Linn RT, Wolf PA, Bachman, Knoefel JE, Cobb JL, Belanger AJ et al. The 'preclinical phase' of probable Alzheimer's disease: A 13-year prospective study of Framingham cohort. Arch Neurol 1995;52: ) Ross GW, Abott RD, Petrovitch H, Masaki KH, Murdaugh C, Trockman C, Curb JD, White LR. Frequency and characteristics of silent dementia among elderly Japanese-American men. JAMA 1997;12: