Cognitive leisure activity and incident dementia among older adults with diabetes: a 5-year prospective cohort study - 08/11/26

Doi : 10.1016/j.diabet.2026.101805

Yuma Hirano ^a,^⁎ , Takahiro Shimoda ^a, Chika Nakajima ^a, Ayuka Kawakami ^a, Yuto Nakashima ^a, Osamu Katayama ^a, Sho Nakakubo ^a, Kenji Harada ^a, Masanori Morikawa ^a, Ryo Yamaguchi ^a, Chiharu Nishijima ^a, Daiki Yamagiwa ^a, Fumio Sakimoto ^a, Soichiro Matsuda ^a, Daisuke Kakita ^a, Shinnosuke Nosaka ^a, Shoma Akaida ^a, Takuto Okuya ^a, Kanon Abe ^a, Kazuki Soma ^a, Seiya Tanaka ^b, Hiroyuki Shimada ^a,^c,^d

^a Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan

^b Innovation Center for Translational Research, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan

^c Department of Cognitive Function Research, Aging Research (Partnership field), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan

^d Medical Science Division, Department of Medical Sciences, Graduate School of Medicine, Science and Technology, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan

^⁎ Corresponding author. Yuma Hirano, Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430 Morioka-cho, Obu, Aichi 474-8511, Japan. Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology 7-430 Morioka-cho Obu Aichi 474-8511 Japan

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Highlights

•	Older adults with diabetes: more cognitive leisure activity, lower dementia risk.
•	Adjustment for physical activity did not materially alter the association.
•	Competing-risk and continuous-score analyses showed similar patterns.

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ABSTRACT

Aim

Exercise and physical activity are modifiable lifestyle factors for cognitive health, but whether cognitive leisure activity is also associated with dementia among older adults with diabetes is unclear. We examined its association with dementia incidence.

Methods

This 5-year prospective cohort included 779 adults aged ≥65 years with diabetes. Cognitive leisure activity was assessed using the cognitive activity scale and classified as lower (0–7 points) or higher (8–42 points). Incident dementia was identified from health and long-term care insurance records. Cox models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for relevant baseline factors; a further model also adjusted for moderate-to-vigorous physical activity (MVPA). Sensitivity analyses used Fine–Gray models with death as a competing event.

Results

During a median follow-up of 5.0 years (IQR, 5.0–5.0), 112 participants developed dementia. After multivariable adjustment, higher cognitive leisure activity was associated with a lower hazard of incident dementia (HR, 0.615; 95% CI, 0.414–0.913). After additional adjustment for MVPA, the association remained similar (HR, 0.624; 95% CI, 0.419–0.929). Findings were similar when cognitive leisure activity was modeled continuously. In competing-risk analyses, the subdistribution HR was 0.667 (95% CI, 0.455–0.977) after additional adjustment for MVPA.

Conclusion

Among older adults with diabetes, higher cognitive leisure activity was associated with lower 5-year dementia risk after accounting for baseline cognitive function, cardiometabolic factors, and measured physical activity, including walking in sensitivity analyses. Cognitive leisure activity may complement other lifestyle factors supporting cognitive health in this population.

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Keywords : cognitive function, cognitive leisure activity, dementia, diabetes, older adults, prospective cohort study