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BACKGROUND: While the significant association between leisure activities and frailty risk among older adults is well-established, the impact of integrated leisure activity scores and different categories of them on frailty trajectories over time remains unclear. METHODS: This study utilized longitudinal data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), which enrolled participants aged 65 years and older between 2002 and 2018. Frailty trajectories were derived using group-based trajectory modelling, and based on these trajectories, subjects were classified into various categories. Leisure activity was measured by integrated scores as well as three distinct categories: physically, cognitively, and socially stimulating activity. The effect of leisure activity on frailty trajectories was examined using multinomial logistic regression. RESULTS: By analysing data from 2,299 older adults, three frailty trajectories were identified: non-frail, moderate progressive, and high progressive. The results indicated that an increase in the score of integrated leisure activity was associated with 11% (odds ratio [OR] 0.89; 95% Confidence Interval [CI] 0.85-0.93) and 14% (OR 0.86; 95% CI 0.80-0.91) decrease in the likelihood of being in the moderate and high progressive frailty trajectories, respectively. Engaging in physically stimulating activity lowered the odds of belonging to the moderate and high progressive trajectory by 43% (OR 0.57; 95% CI 0.40-0.81; OR 0.57; 95% CI 0.36-0.92, respectively). Participation in socially stimulating activity showed a lower odd of being in the moderate progressive trajectory (OR 0.68; 95% CI 0.49-0.93) and the high progressive trajectory (OR, 0.61; 95% CI, 0.39-0.95). The effects of leisure activities on frailty trajectories were observed not to vary by age, education level and retirement status. CONCLUSIONS: This study suggests that older adults should be encouraged to increase both the amount and variety of their leisure activities. Physically stimulating activities should be considered the primary choice, followed by socially and cognitively stimulating activities.

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Multifactorial lifestyle approaches could be more effective than a single factor for maintaining cognitive function. This study investigated the association of combining cognitively stimulating leisure activities (CSLAs), including puzzles, quizzes, and cognitive training games, with intake of long-chain polyunsaturated fatty acids (LCPUFAs), including docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA), and arachidonic acid (ARA), on cognitive function in the older Japanese individuals without dementia. Participants were community-dwelling Japanese individuals without a self-reported history of dementia (n = 906, aged 60-88 years) from datasets of a 2-year longitudinal study (baseline: 2006-2008 and follow-up: 2008-2010). CSLA engagement and LCPUFA intake were divided into high and low groups according to frequency (≥once/week and

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The current study revisits the urban/rural quality of life (QOL) disparity among the older adults in China. It aims to test the potential leisure activity mechanism. Data for this study come from the 2011 and 2014 wave of Chinese Longitudinal Healthy Longevity Survey (CLHLS). Sample is restricted to the respondents who are 65 years old and older who are alive for both waves. Ordered logistic regression model is used to test the relationship between QOL and urban/rural residency. Mediation test is used to investigate the mediation effect of leisure activities. Findings from the analysis show that urban older adults have higher QOL, as well as higher frequency of participating leisure activities compare to their rural counterparts. Results also show that leisure activities, especially the cognitive stimulation activities mediate the relationship between urban/rural residency and QOL. The current study adds the role of leisure activities as an intervening variable between urban/rural residency and QOL among older adults in China. Policy application to reduce the QOL disparity through leisure activities is also discussed.

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BACKGROUND: Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients. OBJECTIVE: This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy. METHODS: This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients' and relatives' experiences of the treatment. RESULTS: This study started in March 2022 and the recruitment is expected to close in August 2024. CONCLUSIONS: This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity. TRIAL REGISTRATION: ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56315.

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OBJECTIVE: This study explores the impact of leisure activity and the association between childhood starvation and the risk of diabetes in older Chinese adults. DESIGN: Prospective cohort study based on the Chinese Longitudinal Healthy Longevity Study (CLHLS), a nationwide cohort study in China. SETTING AND PARTICIPANTS: A total of 4637 older adults aged ≥65 years, all with documented diabetes history, experiences of childhood starvation, and participation in leisure activities were recruited. METHODS: Childhood starvation exposure was assessed via self-reported responses from a structured questionnaire. The leisure activities were measured by 9 distinctive components and categorized into 3 distinct categories: productive activity, recreational activity, and sedentary activity. Diabetes status was determined by self-reported, physician-diagnosed cases during the follow-up period. Nonparametric survival models were employed for analysis. RESULTS: Over an average follow-up period of 4.3 years, 215 of 4637 participants (4.6%) reported a confirmed diagnosis of diabetes. Nonparametric survival models showed that those reporting childhood starvation had a higher risk of late-life diabetes [hazard ratio (HR) 1.72, 95% CI 1.21-2.44]. Engaging in productive activity (HR 0.90, 95% CI 0.83-0.99) and recreational activity (HR 0.88, 95% CI 0.77-1.00) was linked with a reduced risk of late-life diabetes. Sedentary activity did not show a significant effect. Further analysis highlighted the interactions effects of leisure activities on diabetes risk across different demographic and historical exposure subgroups. CONCLUSIONS AND IMPLICATIONS: Engaging in productive and recreational leisure activities was inversely associated with the risk of diabetes in older adults who experienced childhood starvation. Promoting such activities could be beneficial in mitigating long-term diabetes risk related to early-life nutritional deficiencies.

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Background: In order to lessen the burden of Alzheimer's disease (AD), timely and efficient management and intervention methods for mild cognitive impairment (MCI) are crucial. MCI is seen as a transitional stage between normal aging and dementia. Although sarcopenia is an important risk factor for MCI, it is unclear what factors mediates and regulates the brain-muscle communication. Our objective was to investigate the indirect moderating effects of sleep duration and leisure activity on depressive symptoms, sarcopenia and MCI. Method: Panel data from the 2015 China Health and Retirement Longitudinal Study (CHARLS) database was used in this investigation. we used Bootstrap sampling to determine the relationship between sleep duration, leisure activity, depressive symptoms, sarcopenia, and MCI in mediation and indirect moderation models. The outcome measurements were odds ratio (OR) and confidence interval (CI). Result: After adjusting for confounding variables, we discovered that sarcopenia and its traits, such as handgrip strength, gait speed, standing test, and muscle mass, were significantly correlated with MCI. Second, the results implied that depressive symptoms played a role in modulating the link between physical function, muscle strength, and MCI. This moderating effect was impacted by short sleep duration and moderate to high levels of leisure activities. Conclusion: We discovered that MCI was highly correlated not only with physical function and muscle strength but also with depressed symptoms, which acted as a partially mediating factor in this connection. Handgrip strength, gait speed, and standing test mediated the correction of MCI caused by depression symptoms. Importantly, leisure activities and sleep duration had indirect moderating effects on the above associations, and future management policies should take these factors into account.

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BACKGROUND: During the COVID-19 pandemic, medical workers were concerned about the care of their children or family members and the impact of being separated from them. This increased stress could harm the relationship between nurses and patients. This study assessed how medical workers' parental role may affect burnout during such a high-stress period. METHODS: This cross-sectional observational study was carried out in 2021 during the COVID-19 pandemic. The client burnout (CB) scale of the Copenhagen Burnout Inventory, the Nordic Musculoskeletal Questionnaire, and a demographic questionnaire were used. Statistical methods such as the t-test, one-way ANOVA, and univariable/multiple linear regression were applied. RESULTS: A total of 612 nurses were included in this study. The likely risk factors of CB were identified and the parenthood effect was found to be associated with reduced CB. The parental role and leisure activity with family and friends on CB were found to have an impact. Engaging in leisure activity with family and playing the role of a parent diligently will help relieve nurses' burnout from frequent contact with patients and their families, thus lowering the risk of clinical burnout. CONCLUSION: The parental role, family/friends relationships, and a complex work environment associated with nurses' burnout during the COVID-19 pandemic. This finding allows us to re-examine the importance of family life and parent-child relationships in high-stress work environments.

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OBJECTIVE: To examine the bi-directorial association between diversified leisure activity participation and cognitive function over a 7-year period. METHODS: Data analyzed was from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a large-scale longitudinal national study. The baseline survey was conducted in 2011 with follow-up every three years. We traced a total of 2718 participants over a period of 7 years. We used adjusted random intercept cross-lagged panel models (RI-CLPMs) to examine the bi-directorial associations between diversified leisure activity participation and cognitive function. RESULTS: We observed bi-directorial associations between diversity of leisure activity and cognitive function across waves at the between-person and within-person levels. The adjusted random intercept cross-lagged panel models fitted the data appropriately, and the 3-year cross-lagged effects of prior diversified leisure activity participation on cognitive function (ß = 0.058, p < 0.01) and cognitive function on subsequent diversified leisure activity participation (ß = 0.047, p < 0.05) were significant. The results remained after adjusting the model for baseline sex, age, educational level, marital status and current residence, the number of chronic diseases, ADL, depressive symptoms, sleep quality, smoking, and drinking. CONCLUSION: This study suggests that a reciprocal causality relationship between diversified leisure activity participation and cognitive function, indicating a "positive circle" that further promotes cognition over time.

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Purpose: This study used the Taiwan Longitudinal Study in Aging from 1996 to 2011 to investigate the effects of diabetes, hypertension, and healthy living behaviors of those aged over 50 years on the survival status in Taiwan. Methods: Among the 5,131 participants aged 50 years and above in the 1996 survey were included in this study. Cox's proportional hazards model was used to examine the incidence of diabetes, hypertension, and related mortality risk in those aged over 50 years. Results: After adjusting for age, gender, education level, diabetes, hypertension, health behavior, and leisure activity, results from the Cox model show that the elderly without diabetes have a lower mortality risk than those with diabetes. Regular exercise was associated with a lower risk of mortality. The hazard ratios of elderly with regular exercise were 0.78 (95 % CI: 0.64-0.96) for two times a week or less, 0.81 (95 % CI: 0.69-0.96) for 3-5 times a week, and 0.84 (95 % CI: 0.77-0.93) for 6 + times a week, respectively. On the other hand, leisure activity positively reduces mortality risk. For example, the hazard ratios of the elderly with watching TV and reading were 0.63 (95 % CI: 0.55-0.72) and 0.80 (95 % CI: 0.72-0.89), respectively. Moreover, smoking can increase mortality risk 23 % whether the elderly are with diabetes or hypertension or not. Conclusions: Regarding preventing and controlling chronic diseases in the future, continuously encouraging improvement in health behavior and engaging in leisure activities for the middle-aged and over should be considered essential markers.

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Background: This study delves into the complex interaction between leisure activities and cognitive function in older people with disabilities, with a particular emphasis on the moderating influence of depression. Despite the well-documented cognitive benefits of leisure activities among the older people, the intricate relationship between depression and the association between leisure activities and cognitive function in this specific demographic has been rarely reported. Methods: Drawing on data from the 2017-2018 Chinese Longitudinal Healthy Longevity Survey (CLHLS), this study meticulously examined a cohort of 713 participants aged 65-89 years. We constructed a moderation model to examine the impact of leisure activity on cognitive function in older people with disabilities, with depression levels as a moderating variable. Results: We found a positive association between engagement in leisure activities and cognitive function, highlighting the potential cognitive advantages associated with leisure engagement among disabled older people. However, the present analysis also reveals a significant moderation effect of depression on this relationship, shedding light on the nuanced nature of this association. Specifically, elevated levels of depression emerge as a critical moderator, attenuating the otherwise favorable impact of leisure activities on cognitive function among older people contending with disabilities. Conclusion: In conclusion, the findings provide a compelling rationale for tailored interventions that comprehensively target both leisure activity engagement and concurrent depression management, effectively fostering improvements in cognitive function among the cohort of disabled older people.

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BACKGROUND: Existing studies have shown a correlation between leisure activities and depressive symptoms in older adults, but the direction of the longitudinal relationship is inconsistent. This study used an autoregressive cross-lagged model to examine the longitudinal relationship between leisure activity participation and geriatric depression. METHODS: A total of 7,138 participants aged 60 years or older from the 2nd to the 4th wave of the China Health and Retirement Longitudinal Study (CHARLS) were analysed. RESULTS: First, present depressive symptoms were significantly associated with future depressive symptoms (ß2013-2015 = .893, p < .001; ß2015-2018 = .946, p < .001), and the same rule applied to leisure activities (ß2013-2015 = .402, p < .001; ß2015-2018 = .404, p < .001). Second, current depressive symptoms negatively predicted future leisure activities (ß2013-2015 = -.071, p < .001; ß2015-2018 = -.085, p < .001), but the inverse relationship was not statistically significant (ß2013-2015 = -.003, p > .05; ß2015-2018 = -.003, p > .05). CONCLUSION: These findings underscore the importance of interventions targeting depressive symptoms to potentially enhance engagement in leisure activities among older adults. The results contribute to the understanding of the complex dynamics between mental health and lifestyle choices in older populations, highlighting the potential of proactive mental health interventions to improve overall well-being.

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Several studies suggest that leisure activities enhance well-being. In line with this perspective, a recent study indicates that augmenting indoor leisure activities to compensate for diminished outdoor pursuits could sustain or enhance well-being during the COVID-19 pandemic. The present study was designed to identify personality traits that predict such behavioral shifts in indoor versus outdoor leisure activities during the pandemic. The present study included 657 participants (Mage = 41.08) and measured 12 personality traits that a previous study reported were associated with health-protective behaviors during COVID-19. Our findings indicate that the rise in indoor leisure activities correlated with prosocial tendencies toward family and friends/acquaintances (but not strangers), self-centered interest, resilience, and Big Five personality traits. Conversely, the decline in outdoor activities was linked solely to prosociality toward family and friends/acquaintances. Further interaction analysis uncovered that prosocial tendencies toward close relations predicted increased indoor activities as an alternative to outdoor engagements. We concluded that prosociality promoted behavioral changes that significantly prevented infections in intimate others, and it could maintain personal well-being during the COVID-19 pandemic by facilitating behavior change.

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BACKGROUND: Data analysis was conducted on 20 years (1999-2019) of the Korean Time Use Survey (KTUS) to identify differences and characteristics among each types by extracting latent clusters of weekend leisure activities. METHODS: Using data from the KTUS, we classified weekend leisure time activities into 6 distinct categories. To identify the latent clusters for each year's KTUS data, we utilized latent profile analysis (LPA). Furthermore, independent samples t-tests and one-way ANOVA were conducted to investigate the characteristics of each latent cluster. RESULTS: As a result of leisure time analysis by survey period, media use accounted for the largest share in all three age groups. The results of the LPA, which included media, sports, culture, and tourism, revealed that the distribution of leisure time for these activities was lower throughout the entire study period. CONCLUSION: Based on the results of this study, it is recommended to explore constructive leisure activities and to develop policy measures to promote the domestic leisure industry and leisure consumption.

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PURPOSE: The impact of psychological factors on the incidence of hepatocellular carcinoma (HCC) in humans remains unclear. Mendelian randomization (MR) study is a novel approach aimed at unbiased detection of causal effects. Therefore, we conducted a two-sample MR to determine if there is a causal relationship between psychological distress (PD), participation in leisure/social activities of religious groups (LARG), and HCC. METHODS: The genetic summary data of exposures and outcome were retrieved from genome-wide association studies (GWAS). We used PD and LARG as exposures and HCC as outcome. Five MR methods were used to investigate the causal relationship between PD, LARG, and HCC. The result of inverse variance weighted (IVW) method was deemed as principal result. Besides, we performed a comprehensive sensitivity analysis to verify the robustness of the results. RESULTS: The IVW results showed that PD [odds ratio (OR) 1.006, 95% confidence interval (CI) 1.000-1.011, P = 0.033] and LARG (OR 0.994, 95% CI 0.988-1.000, P = 0.035) were causally associated with the incidence of HCC. Sensitivity analysis did not identify any bias in the results. CONCLUSION: PD turned out to be a mild risk factor for HCC. In contrast, LARG is a protective factor for HCC. Therefore, it is highly recommended that people with PD are seeking positive leisure activities such as participation in formal religious social activities, which may help them reduce the risk of HCC.

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Physical activity (PA) has been shown to be related to physical and mental health. Yet there are few studies on how the frequency of PA relates to health and a healthy lifestyle. We aimed to investigate how the frequency of different PAs is associated with the following health indicators: body mass index (BMI), substance consumption, physical health, and mental health. We focused on three types of PA: (1) medium- to high-intensity aerobic exercise; (2) low- to medium-intensity relaxing exercise; and (3) outdoor leisure PA. A total of 9617 volunteers, aged 19 to 81, participated in the study. The relationships between the frequencies of the three types of PA and health-related and sociodemographic factors were analyzed using multinomial logistic regression. We found that women more frequently engaged in PA type 2, and men in types 1 and 3. A higher frequency of PA was associated with lower BMI and less or no smoking behavior; higher education (PAs 1 and 3); higher age (PAs 2 and 3); better physical health (PAs 1 and 3); and better mental health (PA 3). In conclusion, higher frequency of different PAs was significantly associated with better physical and mental health, less smoking, higher age, and a higher level of education.

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BACKGROUND: The purpose of this study was to investigate the longitudinal relationship between different levels of cognitively stimulating leisure activity (CSLA) participation and different levels of positive and negative affect among older adults with mild cognitive impairment (MCI). METHODS: Using a repeated-measured multivariate analysis of covariance (RM-MANCOVA), this study analyzed the Health and Retirement Study (HRS) data from 2012 to 2020 (N = 5932). RESULTS: The results presented the following. (a) The high CSLA group showed higher positive affect and lower negative affect than the mid and low groups. Also, the mid-CSLA group presented higher positive affect and lower negative affect than the low CSLA group. (b) Both positive and negative affect showed significant differences between years and indicated a continuously declining slope year by year without exceptions. (c) The high CSLA group not only presented higher positive affect and lower negative affect during the period but also solely showed a rebounding feature in the declining slope on both emotions. CONCLUSIONS: The findings of this study provide valuable support for the design and implementation of CSLA participation programs and clinical guidelines for older adults with MCI. The results highlight the importance of determining the optimal level of CSLA engagement that is required to promote emotional health and cognitive function in this population. Healthcare professionals and clinical practitioners can leverage the insights gained from this study to develop and deliver effective CSLA interventions tailored to the specific needs and capacities of older adults with MCI.

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INTRODUCTION: National data reveal that the age-adjusted prevalence of leisure-time physical inactivity is higher among Blacks and Hispanics compared with Whites. However, these estimates do not consider nonleisure physical activity (PA). Also, race/ethnicity in these findings may by confounded by socioeconomic status disparities in PA. Here, we examine racial/ethnic differences in multiple measures of PA within a lower socioeconomic status sample. METHODS: Participants in the current cross-sectional study (n = 1526 adults, aged ≥ 18 y) were recruited from Supplemental Nutrition Assistance Program-Education classes (nutrition education classes that target low-income people) in Texas. Self-report data were obtained using survey questionnaires in spring and fall 2018. PA outcomes of 4 different intensities were assessed: mean daily time spent walking, engaging in moderate and vigorous PA, and sitting. Additional PA-related measures included use and awareness of community PA resources. Linear regression models examined racial/ethnic differences in the 4 PA outcomes after adjusting for participant gender, age, household composition measures, and various socioeconomic status measures. RESULTS: In this low-income sample, Hispanic and Black participants spent 6 to 9 more minutes per day walking and engaging in moderate and vigorous PA compared with White/other participants (P < .05 for each measure). Conversely, White/other participants reported spending 82 more minutes sitting per day than Black and Hispanic participants (P < .01). Overall, Black participants were most likely to utilize community PA resources and report ease of engaging in exercise. DISCUSSION: Together, these results reveal greater engagement in PA by racial/ethnic minorities in low-income communities compared with Whites. Our results have implications for tailoring PA programming to these communities.

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Objetivos: investigar desde la Ciencia de la Ocupación la influencia del contexto en el equilibrio ocupacional de mujeres mayores de la ciudad de Puerto Montt. Métodos: metodología cualitativa, transversal, la población corresponde a ocho personas adultas mayores que habitan en la Provincia de Llanquihue; cuatro pertenecen a una agrupación de personas adultas mayores de zona rural y cuatro residen en zona urbana, seleccionadas aleatoriamente. Resultados: dentro de los resultados generales, se observa que, los relatos están enmarcados principalmente en cuatro categorías: equilibrio ocupacional, ocupaciones, satisfacción personal y bienestar. Conclusiones: existen diferencias en el concepto de equilibrio ocupacional de adultas mayores residentes en ambas zonas, viéndose afectado por la salud, limitando la participación en ocupaciones. Las residentes en zona rural perciben mayor equilibrio ocupacional en comparación con las de zona urbana, destacando satisfacción con la vida, estrechamente relacionada con la maternidad.(AU)

Objective: To investigate, from the perspective of Occupational Science, the influence of context on the occupational balance of older women in the city of Puerto Montt. Methods: Qualitative, cross-sectional methodology. The sample consists of 8 older women residing in the Llanquihue province: 4 belong to an Association of Aged Females from a rural area, and 4 reside in an urban area, randomly selected. Results: Within the general results, the findings are mainly categorized into four themes: occupational balance, occupations, personal satisfaction, and well-being. Conclusions: Differences exist in the concept of occupational balance among older women residing in both areas, influenced by health conditions that limit participation in occupations. Residents in rural areas perceive greater occupational balance compared to those in urban areas, with a notable emphasis on life satisfaction, closely linked to motherhood.(AU)

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Objetivos: explorar el conocimiento sobre terapia ocupacional en la escuela, desde la perspectiva de terapeutas ocupacionales pediátricos, para poder identificar fortalezas y debilidades y proponer acciones futuras de desarrollo. Métodos: as personas participantes se reclutaron por muestreo no-probabilístico de conveniencia y bola de nieve, a través de colegios y asociaciones profesionales. Noventa y dos participantes superaron el cribado inicial y se seleccionaron para analizar sus respuestas. Resultados: veintinueve participantes (31,5%) trabajan en las escuelas y sesenta y tres (68,5%) tienen relación con colegios, pero no trabajan en educación. Cuentan con excelente formación en enfoques individuales, y se centran preferentemente en abordar dificultades sensoriales y motoras. El 35,9% (n=33) están involucrados en algún proyecto educativo, financiado principalmente por cada escuela. La mayoría posee escasa formación sobre enfoques actuales de terapia ocupacional escolar, respaldados por la evidencia, y creen necesario impulsar el desarrollo de esta área en España. Conclusiones: este estudio muestra que se requiere formación específica sobre terapia ocupacional escolar en España y ulteriores cambios legislativos. Además, es preciso aclarar las funciones del (de la) terapeuta ocupacional en la escuela y los modelos de prestación de servicios en los contextos educativos, para comprender cómo contrastan con los enfoques clínicos tradicionales.(AU)

Objective: This study aimed to explore current school-based occupational therapy practice in Spain from the perspective of paediatric occupational therapists, identify strengths and weaknesses, and propose future development actions. Methods: Through colleges and professional associations, participants were recruited by non-probabilistic convenience and snowball sampling. Ninety-two participants passed the initial screening question, and their responses were selected for analysis. Results: Twenty-nine participants (31.5%) work in schools, and sixty-three (68.5%) are related to schools but do not work in education. They have excellent training in individual approaches and preferentially focus on addressing sensory and motor concerns. Thirty-three respondents (35.9%) are involved in some educational projects financed mainly by each school. Most participants have little training on current evidence-based approaches to school-based occupational therapy. They believe it is necessary to promote the development of this area in Spain. Conclusions: This study shows that specific training in school-based occupational therapy in Spain is required in addition to legislative changes. Besides, the roles of the occupational therapist in schools and service delivery models in educational settings need to be clarified to understand how they contrast with traditional clinical approaches.(AU)

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INTRODUCTION: Cerebral small vessel disease (cSVD) is a growing epidemic that affects brain health and cognition. Therefore, a more profound understanding of the interplay between cSVD, brain atrophy, and cognition in healthy aging is of great importance. In this study, we examined the association between white matter hyperintensities (WMH) volume, number of lacunes, entorhinal cortex (EC) thickness, and declarative memory in cognitively healthy older adults over a seven-year period, controlling for possible confounding factors. Because there is no cure for cSVD to date, the neuroprotective potential of an active lifestyle has been suggested. Supporting evidence, however, is scarce. Therefore, a second objective of this study is to examine the relationship between leisure activities, cSVD, EC thickness, and declarative memory. METHODS: We used a longitudinal dataset, which consisted of five measurement time points of structural MRI and psychometric cognitive ability and survey data, collected from a sample of healthy older adults (baseline N = 231, age range: 64-87 years, age M = 70.8 years), to investigate associations between cSVD MRI markers, EC thickness and verbal and figural memory performance. Further, we computed physical, social, and cognitive leisure activity scores from survey-based assessments and examined their associations with brain structure and declarative memory. To provide more accurate estimates of the trajectories and cross-domain correlations, we applied latent growth curve models controlling for potential confounders. RESULTS: Less age-related thinning of the right (ß = 0.92, p<.05) and left EC (ß = 0.82, p<.05) was related to less declarative memory decline; and a thicker EC at baseline predicted less declarative memory loss (ß = 0.54, p<.05). Higher baseline levels of physical (ß = 0.24, p<.05), and social leisure activity (ß = 0.27, p<.01) predicted less thinning of right EC. No relation was found between WMH or lacunes and declarative memory or between leisure activity and declarative memory. Higher education was initially related to more physical activity (ß = 0.16, p<.05) and better declarative memory (ß = 0.23, p<.001), which, however, declined steeper in participants with higher education (ß = -.35, p<.05). Obese participants were less physically (ß = -.18, p<.01) and socially active (ß = -.13, p<.05) and had thinner left EC (ß = -.14, p<.05) at baseline. Antihypertensive medication use (ß = -.26, p<.05), and light-to-moderate alcohol consumption (ß = -.40, p<.001) were associated with a smaller increase in the number of lacunes whereas a larger increase in the number of lacunes was observed in current smokers (ß = 0.30, p<.05). CONCLUSIONS: Our results suggest complex relationships between cSVD MRI markers (total WMH, number of lacunes, right and left EC thickness), declarative memory, and confounding factors such as antihypertensive medication, obesity, and leisure activitiy. Thus, leisure activities and having good cognitive reserve counteracting this neurodegeneration. Several confounding factors seem to contribute to the extent or progression/decline of cSVD, which needs further investigation in the future. Since there is still no cure for cSVD, modifiable confounding factors should be studied more intensively in the future to maintain or promote brain health and thus cognitive abilities in older adults.

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