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The effects of participation in leisure activities on neuropsychiatric symptoms of persons with cognitive impairment: a cross-sectional study


Chiu, Y. C., Huang, C. Y., Kolanowski, A. M., Huang, H. L., Shyu, Y. L., Lee, S. H., Lin, C. R., Hsu, W. C.


Int J Nurs Stud, Volume: 50, No.: 10, Pages.: 1314-25

Year of Publication



BACKGROUND: People with cognitive impairment have been shown to engage in few structured activities. During periods of unoccupied time or boredom, these patients most likely manifest neuropsychiatric symptoms. OBJECTIVE: The purposes of this study were to (1) describe the leisure-activity indicators (variety in leisure activities, appraisal of each activity’s restorative function, and leisure dysfunction, i.e. failure to appreciate the importance of restorative aspects of leisure activity), of community-dwelling older Taiwanese adults with cognitive impairment, and (2) explore the relationships between these indicators and neuropsychiatric symptoms in this population. DESIGN: Cross-sectional. SETTING: Memory disorder and geriatric psychiatric clinics of two hospitals in northern Taiwan. PARTICIPANTS: Patient-family caregiver dyads (N=60). METHOD: Patients’ dementia severity, based on Clinical Dementia Rating scores, was 0.5-2.0. Family caregivers completed the Chinese Neuropsychiatric Inventory to assess patients’ behavioral problems and the Restorative Activity Questionnaire to assess patients’ participation in leisure activities, restorative experience, and leisure dysfunction. RESULTS: On average, patients participated in approximately five individual leisure activities, but very few group leisure activities. The top three leisure activities were watching TV, taking a walk, and talking to relatives and friends. The leisure activities in which participants least commonly engaged were fishing, attending cultural exhibitions, and chess/card playing. All leisure-activity indicators were significantly correlated with disease stage, global cognitive function, and neuropsychiatric symptoms. Two leisure-activity indicators (leisure dysfunction and restorative experiences) were significantly correlated with depressive symptoms. Only leisure dysfunction significantly and consistently predicted neuropsychiatric symptoms. CONCLUSION: These results can be used by home health or community health nurses to design tailored leisure-activity plans for improving the care quality of patients with cognitive impairment. Health professionals can develop leisure-education programmes to emphasize the value of leisure pursuit and to modify attitudes toward participating in leisure activities. Finally, parks and recreational agencies may re-examine their services and facilities to meet the increasing needs of this population.

Bibtex Citation

@article{Chiu_2013, doi = {10.1016/j.ijnurstu.2013.01.002}, url = {}, year = 2013, month = {oct}, publisher = {Elsevier {BV}}, volume = {50}, number = {10}, pages = {1314--1325}, author = {Yi-Chen Chiu and Chien-Ying Huang and Ann M. Kolanowski and Hsiu-Li Huang and Yeaing (Lotus) Shyu and Shu-Hwa Lee and Ching-Rong Lin and Wen-Chuin Hsu}, title = {The effects of participation in leisure activities on neuropsychiatric symptoms of persons with cognitive impairment: A cross-sectional study}, journal = {International Journal of Nursing Studies} }


1115, aged, aged, 80 and over, cognition disorders, female, humans, male, neuropsychological tests, psychology, recreation, surveys and questionnaires

Countries of Study


Types of Dementia

Dementia (general / unspecified), Mild Cognitive Impairment (MCI)

Types of Study

Correlation Study (also known as Ecological Study)

Type of Outcomes

Behaviour, Cognition, Depression and Anxiety



Type of Interventions

Non-pharmacological Treatment