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Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial


Cheng, S. T., Chow, P. K., Song, Y. Q., Yu, E. C., Lam, J. H.


Int Psychogeriatr, Volume: 26, No.: 4, Pages.: 637-43

Year of Publication



BACKGROUND: To examine the effects of complex cognitive (mahjong) and physical (Tai Chi) activities on dementia severity in nursing home residents with dementia. METHODS: Cluster-randomized open-label controlled design. 110 residents were randomized by nursing home into three conditions: mahjong, Tai Chi, and simple handicrafts (control). Activities were conducted three times a week for 12 weeks. Clinical Dementia Rating (CDR) was taken at 0 (baseline), 3 (post-treatment), 6, and 9 months. The outcome measure was CDR sum-of-box, which is a composite measure of both cognitive and functional deterioration in dementia. RESULTS: Intent-to-treat analyses were performed using multilevel regression models. Apolipoprotein E epsilon4 allele and education were included as covariates. Neither treatments had effects on the cognitive and functional components of the CDR, but mahjong had a significant interaction with time on the CDR sum-of-box total, suggesting a slower rate of global deterioration in the mahjong group as compared with the control group. CONCLUSIONS: Mahjong led to a gradual improvement in global functioning and a slightly slower rate of dementia progression over time. The effect was generalized and was not specific to cognition or daily functioning.

Bibtex Citation

@article{Cheng_2014, doi = {10.1017/s1041610213002524}, url = {}, year = 2014, month = {jan}, publisher = {Cambridge University Press ({CUP})}, volume = {26}, number = {04}, pages = {637--643}, author = {Sheung-Tak Cheng and Pizza K. Chow and You-Qiang Song and Edwin C. S. Yu and John H. M. Lam}, title = {Can leisure activities slow dementia progression in nursing home residents? A cluster-randomized controlled trial}, journal = {Int. Psychogeriatr.} }


aged, alleles, apolipoproteins e, chi, cluster analysis, cognition, cognition disorders, dementia, disease progression, exercise, female, handcrafts, humans, leisure activities, male, neuropsychological tests, nursing homes, outcome assessment (health care), physiology, physiopathology, psychology, severity of illness index, tai, tai ji, therapy

Countries of Study

Hong Kong

Types of Dementia

Dementia (general / unspecified)

Types of Study

Randomised Controlled Trial

Type of Outcomes

ADLs/IADLs, Cognition


Nursing Homes

Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Adult safeguarding and abuse detection/prevention, Arts and Music Interventions (including Art and Music Therapy), Exercise (inc. dancing)