Abstract
Prevention of neurocognitive disorders is currently one of the greatest unmet medical challenges. The cognitive effects of solving jigsaw puzzles (JPs) have not been studied so far, despite its frequent use as a leisure activity in all age cohorts worldwide. This study aimed at closing this gap between a lack of science and a frequent real-world use by investigating the cognitive abilities recruited by JP as well as the cognitive benefits of lifetime and 30-day JP experience. A total of 100 cognitively healthy adults (≥50 years of age) were randomized to either a 30-day home-based JP intervention (≥1 h/day) plus four sessions of cognitive health counseling (JP group) or four sessions of cognitive health counseling only (counseling group). We measured global visuospatial cognition by averaging the scores of eight z-standardized visuospatial cognitive abilities (perception, constructional praxis, mental rotation, speed, flexibility, working memory, reasoning, and episodic memory). JP skill was assessed with an untrained 40 piece JP and lifetime JP experience with retrospective self-report. JP skill was associated with all assessed cognitive abilities (rs ≥ 0.45, ps < 0.001), and global visuospatial cognition (r = 0.80 [95% CI: 0.72–0.86], p < 0.001). Lifetime JP experience was associated with global visuospatial cognition, even after accounting for other risk and protective factors (β = 0.34 [95% CI: 0.18–0.50], p < 0.001). The JP group connected on average 3589 pieces in 49 h. Compared to the counseling group, they improved in JP skill (Cohen’s d = 0.38 [95% CI: 0.21–0.54], p < 0.001), but not in global visuospatial cognition (Cohen’s d = -0.08, [CI: -0.27 to 0.10], p = 0.39). The amount of jigsaw puzzling was related to changes in global visuospatial cognition within the JP group, only after accounting for baseline performance (β = 0.33 [95% CI: 0.02–0.63], p = 0.03). In sum, our results indicate that jigsaw puzzling strongly engages multiple cognitive abilities and long-term, but not short-term JP experiences could relevantly benefit cognition.Trial Registration: ClinicalTrials.gov Identifier: NCT02667314
Highlights
Preventing cognitive decline in aging such as in mild cognitive impairment and dementia is one of the most relevant medical needs in our aging society (Winblad et al, 2016)
As protective factors found in observational designs are not manipulated and not necessarily causal (National Research Council and Institute of Medicine, 2009), we investigated the impact of a 30-day jigsaw puzzle (JP) intervention on visuospatial cognition in a randomized, assessorblinded, controlled clinical trial
Despite the lack of an effect of the JP intervention, compared to the counseling group, on visuospatial cognition, the dose– response analysis revealed an association of the change in global visuospatial cognition from pretest to posttest with the amount of jigsaw puzzling and with the number of connected JP pieces within the JP intervention, only after accounting for baseline performance to adjust for the regression-to-the-mean effect [β = 0.33, p = 0.03, and β = 0.43, p(Holm corrected) = 0.03, respectively, see Figure 5 and Supplementary Table S6]
Summary
Preventing cognitive decline in aging such as in mild cognitive impairment and dementia is one of the most relevant medical needs in our aging society (Winblad et al, 2016). Based on a cognitive task analysis, jigsaw puzzling may demand multiple cognitive abilities including visual perception (e.g., recognizing objects, patterns, and orientation of lines), constructional praxis (e.g., integrating visual and motor information to assemble pieces), mental rotation (e.g., mentally rotating piece’s orientation to fit them to other pieces), cognitive speed and visual scanning (e.g., sorting puzzle pieces), cognitive flexibility (e.g., switching attention between different strategies, between different puzzle pieces, and between puzzle shape, image, and color), perceptual reasoning (e.g., integrating different perceptual information to develop strategies and plans how to solve the puzzle), and working and episodic memory (e.g., keeping the association between spatial location and visual patterns/images of puzzle pieces in working memory and long-term memory) As another potential active ingredient, engaging in jigsaw puzzling could serve to cope with stressors by regulating distressing emotions (Hutchinson et al, 2003). We aimed at revealing a dose-response relationship between the amount of jigsaw puzzling and visuospatial cognitive improvement within the JP group
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