An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia

Objective To explore the effect of an activity treatment-mahjong-on the cognitive functioning of persons with mild-to-moderate dementia. Method Participants were 62 older persons (M-age = 83.94, SD = 7.58) who met DSM-IV diagnosis of any dementia condition, had an initial Mini-Mental State Examination (MMSE) score <= 24, and were able to play, yet not having played mahjong for the past six months. They were randomly assigned to play either twice (n = 33) or four times (n = 29) a week over a 16-week duration. Digit forward span, digit forward sequence, verbal memory and MMSE were measured at baseline, post-test and I-month follow-up. Results Regardless of frequency of playing, mahjong produced consistent gains across all cognitive performance measures. It had large effect sizes on digit forward memory (1.0-1.4 for both span and sequence), moderate-to-large effect sizes on verbal memory (0.5-0.9), and a moderate effect size on MMSE (around 0.6). The effects lasted after mahjong had been withdrawn for a month, suggesting that constant practice is not necessary to achieve therapeutic effect once an initial threshold is attained. Conclusion Mahjong is a viable treatment option for dementia. Because mahjong therapy basically does not require professional supervision and can be implemented as widely as space allows at a given time, the potential benefits of integrating mahjong into the daily routines of an institution are enormous vis-a-vis minimal, if any, cost to the institution. Copyright (c) 2006 John Wiley & Sons, Ltd.