Independent, joint, and temporal associations of social, intellectual, and physical leisure activities with cognitive decline in older Chinese adults: a longitudinal analysis from CHARLS

It remains unclear whether engaging in different types of leisure activities leads to cognitive decline and whether participation in multidomains offers additional benefits among older Chinese adults. We analyzed 6,847 participants aged ≥ 60 years from four waves (2011–2018) of the China Health and Retirement Longitudinal Study, with a mean follow-up of 6.1 years. Leisure activities were categorized as social, intellectual, or physical. Linear mixed-effects models examined associations between baseline activity and cognitive change. Random-intercept cross-lagged panel models assessed temporal directionality. Multilevel structural equation models evaluated mediation by depressive symptoms and social support. Higher baseline frequency of each activity domain was independently associated with slower cognitive decline after mutual adjustment, with the strongest association for intellectual activities (β = 0.046 points/year per additional day/week, 95% CI 0.023–0.069), followed by social (β = 0.028, 95% CI 0.011–0.045) and physical activities (β = 0.024, 95% CI 0.009–0.039). Compared with no moderate-level activity, engagement in one, two, and three domains was associated with progressively slower decline (β = 0.043, 0.078, and 0.098 points/year, respectively; all P < 0.001). Within-person increases in leisure activity predicted better subsequent cognitive performance, whereas reverse paths from cognition to later activity were weak and nonsignificant. Depressive symptoms and social support jointly accounted for 37.6%–39.0% of the observed associations in statistical mediation analyses. Greater leisure engagement, particularly across multiple domains, was associated with slower cognitive decline in older Chinese adults. These findings support the potential of low-cost multidomain leisure activities as promising candidate factors worthy of further investigation in future intervention studies aimed at mitigating cognitive decline.