What does it mean to be cognitively and socially active in the context of dementia risk reduction? An integrative review

The Lancet Commission on dementia prevention, intervention, and care recommends cognitive and social activities as protective against dementia risk in middle-aged and older adults. However, a lack of conceptual clarity makes it challenging to adequately assess these concepts in research and practice. Currently, a wide variety of measures are used, which complicates cross-study comparison and leads to fragmented evidence about protective effects. Using an integrative review, we analysed definitions across 43 academic and 37 grey records to formulate provisional definitions. We observed substantial heterogeneity in terminology to describe concepts and their attributes. Nine higher-order attributes were identified: interacting with others, cognitive functions, information processing, cognitive demand, novelty, personal control, purpose, quantitative aspects, and context. A main finding was the overlap between cognitive and social activities, as both inherently involve information processing and cognitive functions. Despite the overlap, they also had distinct attributes. Specifically, cognitive activities often involve novelty, while social activities involve interaction with others and often a sense of purpose. The findings indicate that currently available measurements over-rely on assessment of quantitative aspects such as frequency and duration, while neglecting the more subjective attributes such as perceived novelty, autonomy, and purpose. These provisional concepts support the development of measurement instructions and more comprehensive measurement instruments. Better measures allow for pinpointing what makes cognitive and social activities protective and may be useful to determine which participants could improve their activity engagement. This is essential for developing tailored interventions that effectively promote engagement in activities that foster healthy brain aging.