Background Participation in leisure activities has been associated with a lower risk of dementia. It is unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia. We examined the frequency of participation in leisure activities and derived cognitive-activity and social activity scales and investigated dementia incidence over 15 years of follow-up in a representative sample of the English population.

Methods Data were 12,280 participants aged 50+ from the English Longitudinal Study of Ageing, free from dementia at their baseline assessments being either wave 1 (2002–2003), 3 (2006–2007), or 4 (2008–2009), and followed up until wave 8 (2016–2017). Leisure activities were derived using a standardised questionnaire derived by Nucci et al. and grouped into the cognitive and social type of leisure activities. Cox proportional hazards regression models were used to estimate the hazard ratios (HR) of dementia in relation to the cognitive and social type of leisure activities using the age of survival as the time metric.

Results During the follow-up period, 602 participants aged 56 to 99 developed dementia. Medium (HR 0.79, 95% CI 0.65–0.94, p=0.013) and higher levels (HR 0.62, 95% CI 0.46–0.83, p=0.002) of engagement in cognitive leisure activities were associated with a lower risk of dementia by survival age in a model adjusted for sex and marital status. Further adjustment for wealth explained the association with medium level, but not with higher cognitive engagement (HR 0.72, 95% CI 0.53–0.98, p=0.036). Further subsequent adjustment for CHD, stroke, hypertension did not substantially modify these associations. An independent analysis of the engagement in the social type of leisure activities showed a similar pattern with protection for higher levels of engagement (HR 0.75, 95% CI 0.63–0.90, p=0.002) in a model adjusted for sex and marital status. However, further adjustment for the overall wealth has explained this association.

Conclusion This study showed a reduced risk of dementia for individuals with a higher level of engagement in cognitively stimulating activities such as reading, playing computer games, visiting art and museums contributing to a multifaceted level of leisure activities, that may preserve cognitive reserve until later in life and hinting to the psychosocial paradigm.