Sex and Life Stage Differences in the Association Between Cognitive Engagement and Cognitive Change

INTRODUCTION: Cognitively stimulating activity (CSA) is associated with cognitive health, but whether associations with cognitive change differ by life stage and sex remains unclear.

Methods

Data were drawn from Rush cohorts. Participants were 2,614 adults aged 65 years and older (1,965 females; 649 males). CSA during childhood, middle adulthood, and late life was classified using stage-specific pooled medians. Linear mixed-effects models examined global cognition and five domains, adjusting for age, education, and cognitive diagnosis. Sex-engagement-time interactions were tested with false discovery rate correction.

Results

Childhood engagement showed limited associations; only the working-memory sex-engagement-time interaction survived correction ({beta} = -0.014, qFDR=.047). Middle adulthood showed the strongest sex-dependent associations, with significant interactions for global cognition, episodic memory, semantic memory, processing speed, and visuospatial ability (qFDR [≤].017). Higher engagement was associated with more favorable global and visuospatial trajectories among females but more negative trajectories across several domains among males. In late life, only working memory showed a significant sex interaction ({beta} = 0.017, qFDR=.018). High engagement in childhood and middle adulthood followed by low late-life engagement was associated with more favorable global cognitive trajectories among females but less favorable trajectories among males compared with both consistently low and consistently high engagement (sex-pattern-time qFDR<.001).

Discussion

Associations between CSA and cognitive change varied by life stage and sex and were not uniformly favorable. The observational design limits causal interpretation.