The Influence of Health Concern on the Relationship between Lifestyle Activities and Cognition in the Elderly
The aim of this study was to examine the effect of health concern on lifestyle activities, such as physical, mental, social activity (PA, MA, or SA), and cognition in the elderly. The subjects were divided into 4 groups. We developed health concern and activity model (HCA) based on the responses to HC and the 3 activities. Group 1 comprised subjects with “little or no HC” and “no” activity, group 2 comprised subjects with “much HC” but “no” activity, group 3 comprised subjects with “little or no HC” but engaged in 1 or more activities, and group 4 comprised subjects with “much HC” and engaged in at least 1 activity. Data were obtained from 3157 subjects aged 60 years and above. Cognitive function was assessed by the Korean version of the Mini-Mental State Examination (K-MMSE). A cross-sectional, factorial design was used in which the K-MMSE score was the dependent variable, with physical, mental, and social activity as one factor and health concern as the other. Analysis of covariance revealed significant differences in the K-MMSE score between all 4 groups. Group 2, with only concern had the lowest K-MMSE score. Group 1 showed higher K-MMSE score than group 2 but it was lower than group 3. Group 4 had the highest K-MMSE score among the 4 groups (Group 2<Group 1<Group 3< Group 4, p<0.001). In the non-cognitive impairment (NCI) group, with K-MMSE score greater than or equal to 18, only group 4 showed significantly higher K-MMSE score (p<0.001). The other groups showed no significant differences. In the cognitive impairment (CI) group, the K-MMSE score of group 3 and 4 were significantly higher than group 1 and 2. There were no significant differences in K-MMSE score between group 3 and group 4. K-MMSE scores of group 1 and group 2 showed no significant differences. Multiple regression analysis showed that PA, MA, and SA were all associated with cognition after adjustment for age, sex, educational level, current smoking, and current alcohol consumption for all subjects (p < 0.001, p = 0.001, p < 0.001 for PA, MA, and SA, respectively). In the NCI group PA, MA, and SA were all associated with cognition (p = 0.001, p < 0.05, p = 0.037 for PA, MA, and SA, respectively). In the CI group, only SA was associated with cognition (p < 0.001). The results suggest that having HC has a positive influence on cognition in the elderly when the subjects are engaged in physical, mental, or social activities. Only having HC, engagement in activities with no HC, or having none of the above, seems to be not enough in keeping cognition healthy, especially in the NCI group. In the CI group, engagement in activities is the common positive factor. Having HC did not have a significant influence on cognition in the CI group. Among the activities all three activities had positive association with cognition in the NCI group and only SA was associated with cognition in the CI group. The results may support the evidence that when there is capacity in the cognitive reserve, all of the activities are beneficial. But, with adequate HC, it is even better.
Physical activity, Mental activity, Social activity, Health concern, K-MMSE
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