Cognitive Engagement and Dementia Risk: A Dose-Response Comparison of Nursing Home and Community Residents

This study examined the relationship between participation in cognitive activities (CA), the risk of Alzheimer's disease and related dementias (AD/ADRD), and the residential setting using Health and Retirement Study data from 2012 to 2020 (<i>n</i> = 18,111). A Cox proportional hazards regression model assessed risk factors. Findings revealed that residential setting significantly predicted dementia risk. Older adults living in nursing homes were 3.57 times more likely to develop AD/ADRD than those residing in the community (95% CI [2.23, 5.07]). Although both groups showed reduced risk with increased CA participation, community dwellers experienced a 12% risk reduction compared to only 2% among nursing home residents, even when both participated in cognitive activities three to four times per week. These results underscore the dual importance of engaging in cognitive activities and considering environmental context in mitigating AD/ADRD risk among older adults.