Ar Arts, ts, cul ultur tural eng ngagement, t, cogni gniti tion n & de dementi tia Dr Daisy Fancourt, Senior Research Fellow / Wellcome Research Fellow Psychobiology Group, Department of Behavioural Science & Health Institute of Epidemiology and Health Care, UCL d.fancourt@ucl.ac.uk
Connecting cultural engagement to health outcomes PSYCHOLOGICAL e.g. enhanced self-efficacy, coping COMPONENTS and emotional regulation • Aesthetic engagement PHYSIOLOGICAL Prevention • Involvement of the e.g. lower stress hormone imagination response, enhanced immune • Sensory activation function and higher cardiovascular Management reactivity • Evocation of emotion • Cognitive stimulation Treatment BEHAVIOURAL • Social interaction • Physical activity e.g. exercise, healthy diet, Health promotion acceptance of care and • Engagement with adherence to prescribed themes of health treatments, help-seeking • Interaction with behaviours and low healthcare settings alcohol/smoking/ drugs consumption
Cognitive Reserve Stern, Y. (2012). Cognitive reserve in ageing and Alzheimer's disease. The Lancet Neurology , 11 (11), 1006-1012.
Sample cohort design: Methodological approach • Baseline data e.g. random sampling of census • 10,000 participants Wave 0 • Data 2 years later • 9,500 participants Wave 1 • Data 2 years later • 8,800 participants Wave 2 • Data 2 years later • 8,100 participants + refreshment sample of 1,000 Wave 3 participants • Data 2 years later • 7,800 participants + 920 of the refreshment Wave 4 participants
Cultural engagement and cognitive decline Sample: 3,468 adults aged 50+ Timescale: Tracked for 10 years Activity: Visiting museums/galleries/exhibitions Going to the theatre/concert/opera Going to the cinema Covariates: •Sex | Age | Marital status | Ethnicity | Educational attainment •Employment status | Wealth | Occupation •Self-rated health | Eyesight | Hearing | Depression •Social network | having a hobby | using the internet | reading a daily newspaper •Engagement in civic or social activities (political groups, neighbourhood groups, church groups, charities, evening classes or arts or music classes, social clubs, sports clubs, other societies) Fancourt, D., Steptoe, A. (2018). Cultural engagement predicts changes in cognitive function in older adults over a 10 year period: Findings from the English Longitudinal Study of Ageing. Scientific Reports, 8 (1)
Cultural engagement and cognitive decline Memory 1.2 1 B coefficient (with standard error) 0.8 0.6 0.4 0.2 0 ] r r ] r r ] r r s e s e s e F a a F a a F a a h r h r h r E e e o E e e o E e e o t t t n m n m n m R y y R y y R y y o o o a a a a a a [ [ [ m m m r r r r o r o r o e e e e e e e e e c c w c c w c c w v y v y v y n i n i n i e l e l e l w e w e w e h h h o o o N f N f N f t t t t t t y n y n y n n r n r n r r o r o r o a o a o a o e e e M M M h e h e h e v v v t t t c E c E c E s s s n n n s s s O O O e e e L L L Gallery/museum Theatre/concert/opera Cinema Fancourt, D., Steptoe, A. (2018). Cultural engagement predicts changes in cognitive function in older adults over a 10 year period: Findings from the English Longitudinal Study of Ageing. Scientific Reports, 8 (1)
Cultural engagement and cognitive decline Semantic fluency 2.5 2 B coefficient (with standard error) 1.5 1 0.5 0 -0.5 r r r r r r ] s e ] s e ] s e F a F a F a a a a h r h r h r E e e o E e e o E e e o t t t n n n y y m y y m y y m R R R o o o a a a [ a [ a [ a m m m r r r r o r o r o e e e e e e e e e c c w c c w c c w v y v y v y n n n e i e i e i w e l w e l w e l h h h o o o N f N f N f t t t t t t n n n y y y n n n r r r r o r o r o a o a o a o e e e M M M h h h e v e v e v t t t E E E c c c s s s n n n s s s O O O e e e L L L Gallery/museum Theatre/concert/opera Cinema Fancourt, D., Steptoe, A. (2018). Cultural engagement predicts changes in cognitive function in older adults over a 10 year period: Findings from the English Longitudinal Study of Ageing. Scientific Reports, 8 (1)
Television and cognitive decline Memory Executive function 0.6 0.4 0.2 Beta coefficients with standard error 0 -0.2 -0.4 -0.6 -0.8 -1 -1.2 <2.5 hours/day 2.5-3.5 hours/day 3.5-4.5 hours/day 4.5-7 hours/day >7 hours/day Fancourt, D., & Steptoe, A. (2019). Television viewing and cognitive decline in older age: findings from the English Longitudinal Study of Ageing. Scientific reports, 9(1), 2851.
Museums and dementia incidence Sample: 3,946 adults aged 50+ Timescale: Tracked for 10 years Activity: Visiting museums, art galleries or exhibitions Dementia: 3.38+ score on IQCODE or self/informant-reported physician diagnosis Covariates: •Sex | Age | Marital status | Ethnicity | Educational attainment •Employment status | Wealth | Occupation •Depression | Eyesight | Hearing | Cardiovascular conditions •Community engagement (political groups, neighbourhood groups, church groups, charities, evening classes or arts or music classes, social clubs, sports clubs, other societies) Fancourt, D., Steptoe, A., Cadar, D. (2018). Cultural engagement and cognitive reserve: museum attendance is inversely associated with dementia incidence over a 10-year period. British Journal of Psychiatry
Museums and dementia incidence Fancourt, D., Steptoe, A., Cadar, D. (2018). Cultural engagement and cognitive reserve: museum attendance is inversely associated with dementia incidence over a 10-year period. British Journal of Psychiatry
Museums and dementia incidence (competing risks) Sample: 9,550 adults aged 50+ Timescale: Tracked for 12 years Activity: Visiting museums, art galleries or exhibitions Statistics: • Data linkage with NHS mortality data • Competing risk of dementia vs death • AND competing risk of dementia or death with a high prob of dementia vs other death Covariates: Model 1 unadjusted. Model 2 adjusted for demographic covariates (age, sex, educational attainment, wealth, employment status). Model 3 additionally adjusted for health covariates (depression, eyesight, hearing, cardiovascular conditions, sedentary behaviours). Model 4 additionally adjusted for social covariates (marital status, living status, social network size, perceived loneliness, perceived positive social support, perceived negative social support). Fancourt D, Steptoe A, Cadar D (under review) The comparative protective effects of different types of social activity on dementia incidence: time-to-event analyses from a national cohort study
Museums and dementia incidence (competing risks) Socialising Cultural engagement
Potential underlying mechanisms Disuse syndrome Hedonic tone Social support Sedentary Depression behaviours Inflammation Stress
Social behaviours surrounding dementia Hackett, Steptoe & Fancourt (under review) Social behaviours surrounding the diagnosis of dementia: findings from the English Longitudinal Study of Ageing
Cultural behaviours surrounding dementia Hackett, Steptoe & Fancourt (under review) Social behaviours surrounding the diagnosis of dementia: findings from the English Longitudinal Study of Ageing
Potential underlying mechanisms Disuse syndrome Hedonic tone Social support Sedentary Depression behaviours Inflammation Stress
Re Results Depression incidence rates per 100 person-years 7 n=616 cases detected in follow-up 6 48% lower risk 5 32% lower risk 4 3 2 1 0 Never < once a year 1-2 times a year Every few > Once a month months Fancourt, D., Tymoszuk, U. (2018). Cultural engagement and incident depression in older adults: evidence from the English Longitudinal Study of Ageing. British Journal of Psychiatry
Potential underlying mechanisms Disuse syndrome Hedonic tone Social support Sedentary Depression behaviours Inflammation Stress
Arts and cortisol Finn, S., & Fancourt, D. (2018). The biological impact of listening to music in clinical and nonclinical settings: a systematic review. In Progress in brain research (Vol. 237, pp. 173-200). Elsevier. Fancourt, D., Ockelford, A., & Belai, A. (2014). The psychoneuroimmunological effects of music: A systematic review and a new model. Brain, behavior, and immunity, 36, 15-26.
Attending concerts and biological stress response Fancourt, D., & Williamon, A. (2016). Attending a concert reduces glucocorticoids, progesterone and the cortisol/DHEA ratio. public health, 132, 101-104.
Potential underlying mechanisms Disuse syndrome Hedonic tone Social support Sedentary Depression behaviours Inflammation Stress
Music and cytokines Fancourt, D., Ockelford, A., & Belai, A. (2014). The psychoneuroimmunological effects of music: A systematic review and a new model. Brain, behavior, and immunity, 36, 15-26.
Singing & cytokine response Fancourt, D., Williamon, A., Carvalho, L. A., Steptoe, A., Dow, R., & Lewis, I. (2016). Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity in cancer patients and carers. ecancermedicalscience, 10.
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