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Can a puzzle a day keep dementia at bay?

The National Poll of Healthy Aging conducted by the University of Michigan surveyed adults between the ages of 50 to 64 about their concern for developing dementia and the steps they are taking to reduce their risk [1]. Only 5% of respondents reported speaking with their doctor about strategies to minimize dementia risk, with most instead resorting to the use of brain puzzles and/or supplements in the hope that they can stave off dementia. While both the World Health Organization and Global Council on Brain Health have concluded that supplements are not effective for preventing dementia, numerous studies have reported associations between engaging in mentally stimulating activities and resistance to later cognitive decline. However, this does not imply that all types of brain games are equally effective or that they can actually prevent the eventual onset of dementia.

Computerized brain training games have become increasingly popular in recent years, but simple crossword puzzles and number puzzles is still the most common activities used by older adults. While speed of processing training was shown to provide long-lasting cognitive protection in the ACTIVE study [2], the long-term benefits associated with the general use of common mentally-stimulating activities in everyday life are less clear.

A recent observational study examined the association between cognition and word or number puzzle use in 19,078 cognitively healthy adults in the UK between the ages of 50 and 93 enrolled in the online PROTECT study on brain aging [34]. Cognitive function was assessed using 14 measures from two different battery assessments covering a range of cognitive functions including spatial working memory, verbal reasoning, reaction time, and attention. Participants were ranked into 6 groups according to their self-reported frequency of word or number puzzle use ranging from never to more than once per day.

Those who did word or number puzzles at least once a month showed significantly better performance across all cognitive domains compared to those who never used them, and measures of attention were highest in the people who did puzzles most frequently. Participants who did word puzzles had higher scores on measures of grammatical reasoning, while those who did number puzzles had higher scores on measures of executive functions, which include activities such as organizing and planning. Since the magnitude of overall cognitive improvement was similar for either type of puzzle, participating in a brain engaging activity on a regular basis may be more important than the specific type of activity.


Since this is an observational study, it did not determine cause and effect. It is not clear whether using puzzles can boost cognitive performance, or if people with higher baseline cognition are more likely to engage in mentally stimulating activities, such as solving puzzles. Another caveat is that the study did not determine whether there is a difference between people who have engaged in cognitively stimulating activities throughout their lives compared with those who started later in life.

The Bronx 20-year longitudinal Aging Study found that self-reported crossword puzzle use was associated with a 2.54 year delay in dementia onset [5], which suggests that similar to education, mentally stimulating activities may help delay the onset of symptoms, but on their own they cannot prevent dementia. However, in contrast to the use of supplements, there are no health risks associated with puzzle use. Therefore, brain puzzles may be considered as part of a more comprehensive dementia prevention program that also involves exercise and healthy eating.

  1. University of Michigan (2018) Thinking About Brain Health. National Poll on Healthy Aging.
  2. Willis SL, Tennstedt SL, Marsiske M et al. (2006) Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA 296, 2805-2814.
  3. Brooker H, Wesnes KA, Ballard C et al. (2018) An online investigation of the relationship between the frequency of word puzzle use and cognitive function in a large sample of older adultsInternational Journal of Geriatric Psychiatry
  4. Brooker H, Wesnes KA, Ballard C et al. (2019) The relationship between the frequency of number-puzzle use and baseline cognitive function in a large online sample of adults aged 50 and overInternational Journal of Geriatric Psychiatry

Pillai JA, Hall CB, Dickson DW et al. (2011) Association of crossword puzzle participation with memory decline in persons who develop dementiaJ Int Neuropsychol Soc 17, 1006-1013.

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