| ObjectivePopulation ageing has become one of the most significant social problems in China,and diseases like cognitive impairments have consistently aroused public awareness for not only affecting individuals' quality of life but also imposing substantial financial burdens on society.Consequently,paying attention to multi-domain cognition among the elderly at an early stage is of considerable importance to the public.In this study,we aimed to understand the role of leisure activity in multi-domain cognition,particularly how their interactions with education and area affect the multi-dimensional cognition in order to obtain the optimal factors to the specific population with specific kinds of decline in cognitive domains,and then to guide individual intervention and improve their cognition among older people.MethodsA cross-sectional study was conducted on registered 'residents in Xiamen aged over 60 years by multi-stage sampling from July to October in 2016.Face-to-face interview was performed with standardized operating progress and identical questionnaire to collect the data.The Montreal Cognitive Assessment(MoCA)was used to measure general cognition and six specific sub-domains.Leisure activity(including TV watching,reading,smartphone use,social activity,exercise)were self-reported.Age,gender,area,education,marital status,smoking,drinking,hypertension,diabetes,and depression were considered as covariates.We then performed ordinal logistic regression to detect the associations between leisure activity and general cognition and the six sub-domains,and furtherly,added the product term of leisure activity and education/area in the same model to explore their interactive effect on the multi-dimensional cognition.ResultsA total of 3,230 respondents were interviewed,of whom 3,061(94.77%)were provided valid responses with a mean age of 70.12±7.80 years.51.29%of them were men and the mean MoCA score was 18.65±6.43 points.Ordinal logistic regression analysis showed that modest reading(0-3.5h/w),smartphone use,and social activity engagement contributed to a better cognition in general.For the elderly who received low education or lived in rural area,modest TV watching(2-4h/d)and reading,smartphone use could significantly enhance their general cognition;smartphone use and social activity engagement were beneficial to cognition among those who lived in cities;for the highly educated,even modest TV watching or excessive reading(>3.5h/w)were inversely associated with general cognition.The most beneficial way for memory(OR=1.35),language was doing exercise more than 4 days and reading 0 to 3.5 hours weekly,respectively,while using 2+ functions of smartphone was the optimal factor improving visuospatial(OR=1.88),executive(OR=2.33)and attention(OR=1.72).Different leisure activities played different roles in different groups.Takewatching 0-2 hours TV per day as the reference,compared with the lowly educated,the highly educated risked their executive functions with>2 hours TV watching daily(P<0.01)while compared to citizens,people living in rural area benefited their language ability from watching more than 4 hours(P<0.05).Similar interactions also appeared in the reading,smartphone use with some subdomain cognition,respectively.However,there was no significant interaction between education and social activity engagement or exercise.Attention(P<0.05)and visuospatial(P<0.05)benefited from exercise 1-4 days weekly among who living in rural area in contrast with urban residents.ConclusionsThis study contributes to the literature as the first study to describe leisure activity in relation to multi-domain cognitive functions,especially their interaction with education and area on them.In conclusion,the present results suggested that:1)The general cognition of older people in Xiamen was not satisfied;2)Leisure activityplayed different role in specific cognitive functions,concretely,modest reading,smartphone use,and social activity engagement contributed to a better cognition in general.In terms of specific cognitive domain,the most beneficial way for maintaining memory and language were adequate exercise and modest reading,respectively,while for improving visuospatial and executive ability and attention was using smartphone;3)For the elderly with a low education level,leisure activities such as TV watching,smartphone use,and reading could enhance multiple domains of cognition;for old adults with a high education level,a less sedentary lifestyle involving engaging in more exercise,avoiding excessive TV watching and reading was beneficial;and for the moderately educated elderly,modest reading was a good way to improve general cognition.Likely,cognitively benefited way for the rural residents was TV watching,reading,and smartphone use while more social engagement and less sedentary lifestyle was for the urban inhabitants;4)Interaction between education/area and leisure activity on multi-dimensional cognition did exist,which indicated that individual intervention specific to population and cognitive domain was needed. |
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