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To the Editor:
Rundek and Bennett1 comment on two new studies in the same issue2,3 that acknowledge the protective effect of complex mental activity on incident dementia based on observational studies, and conclude that the establishment of a causal link requires clinical trial. However, they are unconvinced that such a trial would be conclusive since observed benefits may be due to participation in activities over the entire lifetime, entailing an intervention over many years and considerable resources.
Our recent systematic review of this field4 suggests that their prediction may be overly pessimistic. Meta-analysis of 22 epidemiologic reports of education, occupation, and cognitive leisure activities showed that high mental activity levels resulted in a summary OR for incident dementia of 0.54 (CI: 0.49, 0.59). Six reports have focused on late-life cognitive activities, each finding a protective effect (OR 0.50, CI: 0.42, 0.61). …
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