The effects of perceived enjoyable activities on cognition in late-life

Previous research suggests that more involvement in various activities can help delay cognitive decline in older adults. Few studies have examined both the impact of frequency and perceived enjoyment of different types of activities on cognition. This study analyzed the relationship between frequency and pleasure of activities and cognition by running correlations using the five different subscales of the California Older Person’s Pleasant Events Schedule (COPPES) and a battery of cognitive tests (Block Design, Animal Naming, Boston Naming Test, Trails A, Trails B, CVLT-LDFR, & Digit Span). It was hypothesized that higher frequency as well as higher level of enjoyment of activities would be positively correlated with cognitive functioning in older adults. The hypotheses were partially supported. Consistent with the hypotheses, there were significant positive correlations between BNT and both Relaxing Frequency and Pleasure, Contemplating Pleasure, Being Effective Pleasure, and both Doing Frequency and Pleasure. Also consistent with the hypotheses, there were significant negative correlations between Trails B and Being Effective Frequency as well as both Doing Frequency and Pleasure. These results imply that higher frequency as well as more enjoyment of certain types of activities may have a positive impact on cognition in later life. FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 3 Due to advances in medicine and related sciences, longevity continues to increase, and the number of people ages 65 and older continues to grow. As people age, cognition, and other physical and health factors, begins to decline. There are many different areas of cognition that have been shown to decline in late-life, including executive functioning (Raz & Rodrigue, 2006), verbal fluency (Elgamal, Roy, & Sharratt), processing speed (Salthouse, 2000), attention and working memory (Cavanaugh, 1998), naming (Albert, Heller, &Milberg, 1988), and verbal learning and memory (Lamar, Resnick, & Zonderman, 2003). In recent years, there has been an increased interest in identifying ways to sustain higher cognitive functioning in older adults. Without any way to decrease the effects of genetic susceptibility to dementias, other possible factors of delayed cognitive decline are being explored. This effect of various types of activity level on cognition has been shown to decrease the possibility of decline in late-life. One study investigated the role of general activity (i.e., reading a newspaper, doing physical activity, participating in hobbies, etc.) on cognitive performance in a community sample of elderly people. They took into account the influence of variables that have been shown to be predictive of cognitive performance such as gender, sensory functioning, health, education, and disability. They studied measures of fluid intelligence, crystallized intelligence, and FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 4 memory and found that higher activity levels (above a certain level of participation) positively influenced the level of cognitive performance using ANOVA (Christensen et al., 1996). In addition to general activity level, there are many different types of activities that have been shown to decrease the risk of cognitive decline and thus the risk of cognitive disorders in late-life. These include social involvement and activity, physical activity, non-physical leisure activity, and cognitively stimulating activities. The purpose of the current study is to explore the relationship between frequency as well as enjoyment of pleasant activities and cognition in later life. Social, Non-Physical Leisure, and Physical Activity Social activity, non-physical leisure activity (e.g. reading, playing music, singing in a choir, solving crossword puzzles), and physical activity are a few of the specific activities that research has shown may decrease the possibility of cognitive decline. One review performed a systematic analysis of published observational longitudinal studies that studied the effect of social network (quantity and quality), physical leisure, and nonphysical activity on cognition and dementia. These studies used a variety of cognitive assessments including tests of language, memory, visuospatial ability, verbal fluency, decline in cognitive functioning (memory, comprehension, and speed), and intelligence (verbal, nonverbal, and mechanical tasks) in order to test the relationship between social networks/activity, non-physical leisure activities, and physical activity on cognition. They concluded that more social, physical, and non-physical leisure activity protects against the onset of Alzheimer’s disease and dementia later in life (Fratiglioni, PaillardBorg, & FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 5 Winblad, 2004). In the sections below, three types of activity will be explored: leisure activity, social activity, and cognitively stimulating activity. Leisure Activity Leisure activities and their relationship to cognition are an important research area because they have been shown to help decrease the risk of Alzheimer’s and cognitive decline in late-life. One study analyzed the relationship between cognition and different types of leisure activities at baseline and again 20 years later. The activities that were included were political (e.g. delivering a speech at a meeting, participating in demonstrations), organizational (e.g. member of a political party, religious group, other organizations), mental (e.g. reading, hobbies), and physical activity (e.g. gardening, sports). Participants were random samples of the Swedish population who were 56-75 years of age at baseline. They found that there was a significant positive relationship between leisure activities and cognition at least 20 years later, which suggests that engaging in a range of activities may positively affect cognitive functioning in late-life (Käreholt, Lennartsson, Gatz, & Parker, 2010). Social Involvement Many studies show that social involvement leads to a decreased risk of cognitive decline. One article provided an overview of epidemiological research that linked different aspects of the social environment such as social network, socioeconomic status, and community-level social characteristics to differences in risks of morbidity and mortality in depressed and non-depressed older adults. They reported that older adults with more social ties and engagement at baseline were less likely to develop dementia or cognitive impairment during the follow-up (Seeman & Crimmins, 2001). Another study FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 6 examined whether a decrease in social support would lead to cognitive decline among older adults. Their results showed that a decline in social interaction over a one-year period was related to cognitive decline over the following year (Dickinson, Potter, Hybels, McQuoid, & Steffens, 2010). Cognitively Stimulating Activities Another type of activity that has been shown to lead to a decreased risk of cognitive decline is participation in cognitively stimulating activities. One longitudinal study wanted to test the hypothesis that individuals who were engaged in mentally stimulating activities (e.g. reading, listening to the radio, playing games such as cards or checkers, going to museums), may have a decreased risk of developing Alzheimer’s disease. In order to test this hypothesis, they used a variety of cognitive tests (e.g. Boston Naming Test, Verbal Fluency, line orientation) and found that the frequency of participation in mentally engaging activities was positively related to cognition (Wilson et al., 2002). Perceived Enjoyment of Activities and Cognition In addition to frequency of activities, this study is testing the relationship between level of enjoyment of an activity and cognition. There has not been much research done on the effect of enjoyment of activities on cognition; however, studies have shown that mood and cognition are highly correlated and that lower moods are correlated with lower enjoyment of activities. For example, there is a link between mood and cognition, and many studies have shown that lower mood is related to cognitive decline. One study using cognitively intact older adults with at least 60 years of age found that clinically meaningful depression and FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 7 persistently high depressive symptoms were associated with a higher rate of cognitive decline. Individuals with persistent depressive symptoms were found to have the highest level of cognitive decline especially in areas such as processing speed and global cognition, and tended to perform lower on baseline measures of processing speed, attention, and executive functioning (Köhler et al., 2010). Furthermore, one study looked at the relationship between mood and number of pleasant activities. The subjects belonged to one of three groups: depressed, psychiatric controls, and normal controls. They used the Pleasant Events Schedule to measure activity level and pleasantness and the Depression Adjective Check List to measure the subject’s mood and found that there is a significant positive relationship between pleasant activities and mood (Lewinsohn & Libet, 1972). To further study the effect of pleasant activities on mood and cognition, another study examined the relationship between pleasant events and depression in older adults. This study focused on the declining ability and desire of older persons with Alzheimer’s disease to participate in pleasant activities. To test their hypothesis that depressed Alzheimer’s patients will identify fewer events as enjoyable and show a lower frequency of pleasant events than non-depressed patients regardless of their cognitive level, the Pleasant Events Schedule-AD (PES-AD), the Mini Mental State Exam (to test cognitive functioning, MMSE), and the Hamilton Depression Rating Scale (HDRS) were used. They found that Alzheimer Disease outpatients with higher scores on the MMSE scored higher on the PES-AD, and those who scored higher on the HDRS scored lower on the PES-AD. Their results suggest 1) that depression is related to a reduction in enjoyable activities in Alzheimer’s patients regardless of cognitive functioning and 2) that subjects FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 8 with higher cognitive functioning participated in and enjoyed more activities (Logsdon & Teri, 1997). There has been a significant amount of research done on the relationship between different activities and cognition as well as the relationship between mood and cognition in later life. Research has also been published on activity level and frequency and enjoyment of pleasant activities in depressed older adults. However, to date there has been very little research published on the relationship between the frequency of perceived pleasant activities (social and non-physical leisure) as well as the individual’s perceived level of enjoyment of the activity and cognition in community-dwelling older adults who are able to live on their own. The current study attempts to remedy the lack of research in this area by examining the relationship between various activities, perceived level of enjoyment, and cognitive functioning. Based on the above literature review, it is hypothesized that there is a positive relationship between frequency of perceived pleasant activities and better cognitive functioning in later life. It is also hypothesized that there is a positive relationship between perceived level of enjoyment of an activity and cognition. Methods Participants This study was comprised of community-dwelling adults (N= 55) of at least 65 years of age. The study was initially designed to look at differences between musicians and non-musicians; however, for the purposes of the current study, the participants will not be separated into groups. Each participant was required to be able to independently complete a full written consent form. Participants with the presence of a mood (e.g. major depression or anxiety) or neurological (e.g. Alzheimer’s disease, Dementia, stroke) FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 9 disorder, who show significant cognitive impairment or psychoses, or cannot live independently, were excluded from the data. Participants were recruited through advertisements (e.g. flyers) in local media outlets and with the help of the community music program at the University of Louisville School of Music. Trained graduate and undergraduate psychology students administered the assessments on the University of Louisville’s Belknap campus or in the home of the participant. Compensation for participating in the study was that the participants were placed in a drawing for one of six $50 gift cards. Measures The cognitive test battery was designed to assess different cognitive domains that have been shown to decline with age (Raz & Rodigue, 2006). All measures chosen showed strong psychometric properties.  Trail Making Test: This is a task that measures executive functioning and processing speed. The participant must connect numbers (e.g., 1-2-3) or numbers and letters (e.g., 1-A-2-B) as quickly as they can in order (Arbuthnott & Frank, 2000; Sánchez-Cubillo et al., 2009).  Animal Naming: This test requires the participant to name as many animals as they can in 60 seconds and measures verbal fluency, which is the ability to produce unique words that belong to a category or begin with a certain letter (Ruff, Light, Parker, & Levin, 1996).  Digit Span: This test is part of the Wechsler Adult Intelligence Scale (WAIS-IV; Wechsler, Coalson, & Raiford, 2008) and measures processing FREQUENCY AND ENJOYMENT OF ACTIVITIES AND COGNITION 10 speed, attention, and working memory by requiring participants to repeat a progressively longer list of numbers.  Boston Naming Test (BNT): This test presents a series of pictures of items (e.g., bed, pencil, or pretzel) that the participant must name. This task also includes levels of cueing if the participant is having difficulty naming the item (Ferraro & Lowell, 2010).  California Verbal Learning Test (CVLT): This test measures verbal learning, as well as immediate, delayed, and recognition of verbal memory. During this test, a list of words is read several times for immediate recall and learning. After 20-30 minutes, participants must recall as many of the words as they can. Directly after delayed recall, forced recognition is used to assess recognition memory (Elwood, 1995; Woods, Delis, Scott, Kramer, & Holdnack, 2006).  WAIS-III Block Design: Visuospatial skill and processing speed is assessed with this task. The participant is required to match the picture that is shown to this with the blocks in front of them (Wechsler et al.,