Chess practice as a protective factor in dementia

Chess is not only a game for the mind, but can also have a positive impact on mental health. This blog post is about how chess can help slow or even prevent dementia. Studies have shown that playing chess regularly can improve cognitive skills and strengthen memory. In this post, learn more about the connection between chess and dementia and how you can benefit from this fascinating game.

Dementia is a significant contributor to disability and dependency among the elderly population worldwide, resulting in physical, psychological, social, and economic consequences for those affected, caregivers, families, and societies.

However, there is little known about dementia protective factors and their potential benefits against disease decline in the diagnosed population. Cognitive stimulating activities appear to be protective factors against dementia, though there is limited scientific evidence confirming this, with most publications focusing on prevention in non-diagnosed people.

A scoping review was conducted to investigate whether chess practice could mitigate signs, deliver benefits, or improve cognitive capacities of individuals diagnosed with dementia through the available literature, and therefore act as a protective factor.

21 articles were selected after applying inclusion and exclusion criteria to twenty-one articles. The overall findings emphasize that chess has the potential to promote prevention in populations that have not been diagnosed, whereas limited evidence has been presented regarding individuals who have been diagnosed.

Nonetheless, certain authors propose its potential as a protective factor owing to its advantages and the evidence pertaining to the cognitive functions associated with the game.

Although chess is indirectly assumed to be a protective factor due to its cognitive benefits, more studies are needed to demonstrate, with strong evidence, whether chess could be a protective factor against dementia within the diagnosed population.

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"The World Health Organization (WHO) is a specialized agency of the United Nations that deals with international health issues. Its main goal is to enable everyone to have the highest possible level of health. WHO is committed to fighting disease, promoting healthy lifestyles and strengthening health systems. It issues guidelines and recommendations for the health policy of member countries and coordinates global health measures in emergency and crisis situations. The organization was founded in 1948 and is headquartered in Geneva, Switzerland."

The World Health Organization's 2015 report predicts that the number of people over 60 years will more than double between 2000 and 2050, according to the organization's projections. According to the worldwide Alzheimer's Associations, dementia, specifically Alzheimer's disease (AD), affects 47.5 million people worldwide, and every year, 7.7 million new cases are reported. The impact on caregivers, families, and societies is one of the main causes of disability and dependency among the older population. The first cause of dementia represents approximately 70% of all dementia cases, and dementia is a salient clinical feature.

As a result, the aging populations around the globe are more likely to encounter cognitive impairments, such as neurodegenerative illnesses. The lack of early-onset dementia detection strategies worldwide makes it crucial to identify factors that can positively influence the cognitive decline most commonly experienced by those diagnosed with dementia.

At this point, it is important to discuss the meaning of some terms used in published literature regarding our research topic, such as "prevention," "early diagnosis," and "protective factor."

Confusion is generated when these concepts are interpreted equally or as synonyms. All of these terms are related, and even though they refer to different things, they all point to distinct phases of the medical procedure in which diagnosis signifies the major turning point. To clarify this, we've used MeSH definitions as a guide.

Prevention

Prevention involves the treatment of individuals, especially those with risk factors for a disease, in order to avoid the occurrence of a disease.  The disease hasn't yet begun, or at the very least, it hasn't been discovered.

Early diagnosis:

Methods to determine in patients the nature of a disease or disorder at its early stage of progression are called early diagnosis. Early diagnosis generally improves the prognosis and treatment outcome.

Protective factor:

An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic is known to be associated with prevention or mitigation of a health-related condition considered important to prevent.

The previous concepts were more general, so the experts are assuming that a protective factor is a feature that could be related to prevention or even when the diagnosis is made (enhancing the mitigation of such a condition) and also in early detection.

The research question that emerged was, "Is chess a protective factor, and what are its advantages for people with dementia?"

Time/place confusion and memory loss are some of the symptoms of dementia. The brains of people with Alzheimer's disease have plaque and tangles, as well as protein accumulation between nerve cells and protein accumulation inside nerve cells. As people age, plaque and tangles tend to appear more frequently in those with AD.

The possibility of developing dementia, AD, and other debilitating mental illnesses is reduced by playing chess.

The New England Journal of Medicine reported that people over 75 who engaged in leisure activities, such as chess, were more likely to delay the onset of dementia than those who didn't play.

This study, which lasted five years and included almost 500 participants, indicates that involvement in at least ten mind-exercising activities per group, delays early onset of AD by nearly 1.5 years. Individuals who played board games were over 35 percent less likely to develop dementia than those who participated in board games only occasionally or even rarely. In fact, people over the age of 75 that partake in leisure activities such as chess that stimulate the brain were less likely to develop signs of dementia

There is little information about the benefits of chess after the disease has been identified and diagnosed. The results of studies show that chess stimulates specific regions of the brain, and this effect alters with the challenges a chess player encounters. We know that chess lends itself to a variety of complexity, ranging from various patterns to intricate calculations that energize players brains.

Paying attention to the cultural scope of our research topic, experts identified paucity in the evidence published about research conducted in those countries where chess is practiced traditionally, even detecting the lack of basic epidemiological investigations about dementia.

According to Kiejna et al., there is an urgent need for epidemiological studies in Eastern and Central Europe, as well as for greater coordination and uniformity of approaches to enhance the quality and comparability of epidemiological data to determine the prevalence rates of dementia in all EU nations. They were able to find few regional and country-specific epidemiological studies of various types (population-based, cohort, cross-sectional studies), conducted on different restricted population groups of patients (from neurological units, out-patients units, residential homes).

Most of the countries we considered didn't have any studies identified, and the ones we did find had a lot of different clinical and methodological variants. The prevalence rates of dementia in Eastern Europe are similar to those in Western Europe, according to the few studies published. Furthermore, in the case of a few Asian nations, the GO game, a sort of chess-like competition played in China, Japan, and Korea, has been shown to yield favorable outcomes for medically afflicted populations.

Individual differences in susceptibility to age-related brain changes and pathological changes are explained by cognitive reserve. The point at which cognitive functions begin to be affected will manifest later than it would for those with lower cognitive reserve.

Higher-education individuals have a lower chance of developing Alzheimer's disease, which means they will also be able to continue with their daily routines longer.

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The literature published to date shows that since leisure activities, such as chess, delay the onset of dementia symptoms, it is considered a protective factor against dementia, not only in preventing but also when the disease is diagnosed.

Furthermore, based on the existing literature, we investigate whether chess practice can yield advantages or enhance the cognitive abilities of individuals with dementia once the condition is confirmed, and whether it serves as a dementia-preventive agent at any point during the aging process.

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Effortful mental activity strengthens synaptic connections and stimulates the neurogenesis process. It promotes plastic changes in the brain, which help to reduce the symptoms of dementia.

The results support the recommendation that seniors should be encouraged to read, play board games like chess, and dance. These types of activities, as referred to by the literature, can enhance their quality of life and strengthen their cognitive functions.

The outcomes of this scoping review are presented through themes that emerged during analysis and exemplify the cognitive stimuli inherent in chess.

The Researchers conducted an analysis of the aforementioned studies by first categorizing them according to the cognitive functions of the chess game they were referring to, then focusing on the benefits of those functions, and finally focusing on the evidence reported regarding the diagnosed population.

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The majority of studies emphasize the advantages of prevention rather than focusing on the diagnosed population. Some authors, such as Scarmeas and Dowd, propose that engaging in leisure activities may reduce the risk of incident dementia, providing a reserve that may delay the onset of clinical manifestations of the disease.

Different follow-up studies suggest a relationship between the degree of leisure activity such as chess and the risk of developing dementia or AD.

The findings indicate that engaging in leisure activities such as reading, socializing with acquaintances, and engaging in enjoyable activities were notably associated with a decreased risk of dementia.

Therefore, chess could potentially be included in the same list. Furthermore, people with high mental activity levels have a 33% lower risk of developing AD.

A study conducted over a period of five years involving 488 participants demonstrated that engaging in at least 11 mental exercise activities per week, in comparison to a control group that engaged in 4 or fewer activities per week, significantly delayed the onset of dementia by 1.3 years.

Some studies have shown that older people who frequently engage in mentally stimulating activities have fewer possibilities to develop AD or experience cognitive decline. Being cognitively active may contribute to strengthening cognitive reserve and enhancing adaptation to age-related pathologic changes.

Dartigues et al. have observed that board game players have a 15% lower risk of developing dementia (95% confidence interval [CI] 0.74 to 0.99; p = 0.04).

After 20 years of follow-up, 830 cases of early stage dementia (27.8%) were observed.

Despite a significant reduction in the risk of dementia among board game players (p 0.001) following a three-year follow-up, 3% of board players developed dementia compared to 6% of non-players, 16% versus 27% after ten years, and 47% versus 58% after twenty years.

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"Healthy brain and brain with AD (left to right)"

Furthermore, when talking about neurodegenerative diseases and early detection, some studies focus on diagnosed populations while others concentrate on early onset. The pathological features of AD are most profound in the limbic system and temporal, frontal, and association neocortices, and basal forebrain areas involved in learning, memory, emotion, judgment, abstraction, language, and executive functions.

It has therefore been hypothesized that intellectual activities involving learning and memory would be most protective against the development of the disease. Among these activities, chess stands out as an activity gathering all these features. Short-term and long-term memory usage, as well as calculation and visual–spatial abilities and critical thinking are five cognitive areas, with are all covered by this easy to learn and practice mind sport.

Archer et al. studied the case of a chess player and highlighted the difficulties encountered in assessing patients with superior premorbid function in the early stages of Alzheimer's disease, and reveals the value of serial Magnetic Resonance Imaging (MRI) and neuropsychological assessment in detecting and monitoring early neurodegenerative diseases. Li et al. showed that the prevalence rate of dementia increased with age in Gushan, and concluded that factors as playing poker/chess more frequently, as well as taking good care of families tend to help reduce or postpone the development of dementia.

A study by Lin et al. confirms that “GO game” (a kind of Chinese chess game; over 5000 years old) can improve quality of AD patients. In fact, this kind of game involves the changes associated with many cognitive functions, including learning, abstract reasoning, and self-control, which facilitates cognitive behavioral therapy.

Another study, demonstrated that brain training needed for playing this kind of Chinese game causes structural changes that are particularly helpful, in terms of engaging in such foundational tasks as learning, abstract reasoning, problem solving and self-control.

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There is evidence that AD and good brain health have multiple factors, such as genetics or individual differences in cognitive reserve. Quality of sleep, anxiety or mood disorders, physical exercise, and a healthy diet are key factors in the AD approach.

Nonetheless, it cannot be overlooked that cognitive stimulation enhances mental well-being and safeguards against depression symptoms, both of which are crucial for the quality of life of AD patients.

Hence, certain studies indicate that engaging in intellectual pursuits during youth may serve as a safeguard against AD over time. Nonetheless, there is a limited amount of evidence regarding the measures that can be taken in the event of AD arising in later stages of life older people use different brain areas compared to younger people, even when they perform the same activity. This phenomenon facilitates the preservation of cognitive abilities throughout one's life.

Some studies have suggested that cognitive activities reduce the amyloid build up in the brain. There exists a hypothesis that suggests that the accumulation of amyloid may commence 7–10 years prior to the onset of AD symptoms. Due to this reason, it is possible that healthcare professionals may attempt to halt the progression of the disease, thereby preventing the manifestations of AD, such as memory loss.

Besides these factors, the ageing process also depends on physical, cognitive, and mental factors. A well-balanced diet, regular physical activity, and the management of any potential ailments during this stage are essential elements that can significantly impact the standard of living of an individual.

Cognitive factors, previous learning and educational level will be capital determining a predisposition to carry out these healthy behaviors.

According to certain studies, it has been demonstrated that engaging in mental activity can provide numerous advantages to an individual's health, which could be interpreted as enhancements in cognitive abilities.

It has been demonstrated that mind exercises, physical activity, and board games stimulate all six cognitive areas of the brain at the same time being a useful tool to reduce the impact of age on cognitive functions.

However, those studies do not support the idea that chess is a protective factor, but stress that it is a preventive one with positive benefits during the ageing process.

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There exists a second hypothesis that has been reported in epidemiological studies, namely that a correlation exists between elevated levels of leisure activities in old age and a lower rate of cognitive decline, as per the cognitive reserve theory.

People with a higher cognitive reserve have more efficient neuronal networks or are able to use alternative networks, which can delay the incidence of AD.

A subsequent analysis revealed that individuals who engaged solely in games experienced a reduction of 75% in their risk, whereas those who engaged in musical instruments experienced a reduction of 64% Crossword puzzle enthusiasts have a 38% lower risk.

Ultimately, Fritsch et al. have concluded that engaging in leisure activities aimed at enhancing cognitive stimulation is associated with a decreased likelihood of developing Alzheimer's disease. Individuals who engaged in a variety of mental activities had a lower likelihood of developing AD in comparison to those who engaged in a singular type.

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Despite the numerous advantages outlined throughout this review, and despite the limited data pertaining to their beneficial effects, the evidence currently lacking sufficient strength to infer a direct causal correlation or recommend one leisure activity over another.

Therefore, chess may be regarded as a protective factor against dementia and cognitive decline in elderly individuals, particularly due to its ability to enhance cognitive reserve. Nonetheless, it appears that engaging in skill-based activities rather than relying solely on general intelligence may prove to be more convenient, as its implementation appears to be less challenging in a population that exhibits distinct characteristics, such as individuals with dementia, where skill acquisition remains a viable option.

Given this perspective and current evidence, there is no doubt that more controlled trials are needed to assess the protective effect of cognitive activities on the risk of dementia, although even more for diagnosed populations.

These trials necessitate prolonged execution and evaluation of diverse variables to gain a comprehensive understanding of the impact of these factors on safeguarding dementia in the long run.

This effortful activity is recommended due to the inability to detect the disease in the early stages. Even the most recent evidence suggests that the disease manifests around 18 years after its onset. This could be a way to provide mental activities and exercise with their proper role in the AD and dementia approach and to set the starting point for their systematic implementation in prevention and treatment.

The practice of chess is a protective strategy against the development of dementia from a preventive perspective, and even though the evidence is weak to demonstrate its role as a protective factor, other evidence suggests that it may work as a protective factor.