Chess and Alzheimer’s: does playing protect against dementia?
Chess and Alzheimer’s: several large population studies observe that older people who regularly play mentally demanding games, chess included, develop dementia slightly less often. But these studies do not prove that the game protects: part of the gap is explained by level of education, health, or the first signs of the illness, which lead people to give up demanding pastimes.
Dementia (the current term is major neurocognitive disorder): a decline in memory and other intellectual functions marked enough to interfere with daily life. Alzheimer’s disease: its most common cause, linked to brain lesions that develop over years before the first symptoms.
Chess and Alzheimer’s: what the large cohorts show
No study has followed thousands of “pure” chess players for twenty years. The available data concern board games or cognitive activities in general, of which chess is only a part. Four cohorts recur in every review.
PAQUID: the French cohort from Gironde and Dordogne
The PAQUID study, led by Jean-François Dartigues’s team in Bordeaux, followed older people for twenty years. Its analysis of board games is the most cited in France.
Dartigues et al., 2013 · BMJ Open · DOI 10.1136/bmjopen-2013-002998
Playing board games, cognitive decline and dementia: a French population-based cohort study
- Who
- 3,675 people aged 65 and over (PAQUID cohort, Gironde and Dordogne)
- Type
- Observational cohort, 20-year follow-up · level of evidence: Moderate (association)
- Result
- Regular board-game players (32% of the sample) have a 15% lower risk of dementia (HR 0.85) after adjustment for age, sex, level of education and health status. The gap is no longer significant once baseline cognitive score and depression are taken into account (HR 0.96).
- What the study does not say
- Practice reported only once, with no frequency or duration; chess is not separated from cards, lotto or draughts; reverse causation is possible.
The detail that matters: once the baseline cognitive score (MMSE) and depression are taken into account, the difference in risk is no longer significant. The authors themselves consider that most of the effect is explained by initial cognitive state. In other words, the players started out with a better intellectual “capital”, which may explain both why they play and why they decline less. The players nevertheless declined a little more slowly on the MMSE, and had less depression during follow-up.
The Bronx Aging Study, published in the New England Journal of Medicine
Verghese et al., 2003 · New England Journal of Medicine
Leisure activities and the risk of dementia in the elderly
- Who
- 469 people over 75 living at home (Bronx Aging Study, New York)
- Type
- Observational cohort, median follow-up 5.1 years · level of evidence: Moderate (association)
- Result
- 124 cases of dementia during follow-up. Reading, board games, playing a musical instrument and dancing are associated with a lower risk; each point on the cognitive activity score corresponds to a 7% lower risk (HR 0.93).
- What the study does not say
- Modest sample; activities self-reported; no figure specific to chess.
The interest of this New York study is that it tried to rule out reverse causation: participants who may already have shown signs of dementia at baseline were excluded from a further analysis, and the association persisted. It remains observational, however.
The Religious Orders Study
Wilson et al., 2002 · JAMA
Participation in cognitively stimulating activities and risk of incident Alzheimer disease
- Who
- 801 elderly Catholic nuns, priests and brothers (Religious Orders Study, United States)
- Type
- Observational cohort, mean follow-up 4.5 years · level of evidence: Moderate (association)
- Result
- 111 cases of Alzheimer’s disease. Each additional point of cognitive activity (reading, games, etc.) is associated with a risk reduced by about a third (HR 0.67); a very active person (90th percentile) has a 47% lower risk than a person with little activity (10th percentile).
- What the study does not say
- A very particular population (members of religious orders, high level of education); the authors point out that causation is not established.
ASPREE: 10,318 Australians followed for ten years
Wu et al., 2023 · JAMA Network Open
Lifestyle Enrichment in Later Life and Its Association With Dementia Risk
- Who
- 10,318 Australians aged 70 and over (ASPREE-ALSOP study)
- Type
- Observational cohort, follow-up of about 10 years · level of evidence: Moderate (association)
- Result
- “Active mental activities” (games, cards or chess, crosswords, puzzles) are associated with a 9% lower risk of dementia per level of frequency (HR 0.91); reading and writing activities, 11% (HR 0.89). Social activities are not associated with the risk.
- What the study does not say
- Healthy volunteers, almost all of European origin; reverse causation not ruled out.
This recent study is the only one of the four to mention chess in its definition of the activities measured. It adds an interesting nuance: social activities (outings, size of friendship network) were not associated with the risk of dementia, whereas active mental activities and reading and writing were.
The studies in one table
| Study | Country | Sample size | Follow-up | Type | Result | Main limitation |
|---|---|---|---|---|---|---|
| Dartigues et al., BMJ Open 2013 | France | 3,675 | 20 years | Cohort | Risk -15% in board-game players | Not significant after adjustment for MMSE and depression |
| Verghese et al., NEJM 2003 | United States | 469 | 5.1 years (median) | Cohort | Board games, reading, music, dancing associated with less dementia | Small sample |
| Wilson et al., JAMA 2002 | United States | 801 | 4.5 years (mean) | Cohort | Alzheimer’s risk -33% per point of cognitive activity | Highly educated members of religious orders |
| Wu et al., JAMA Netw Open 2023 | Australia | 10,318 | ≈ 10 years | Cohort | Games, cards, chess, puzzles: -9% per level of frequency | Healthy volunteers |
| Lillo-Crespo et al., IJERPH 2019 | Review | 21 articles | — | Scoping review | More promising for prevention than after diagnosis | No chess-specific trial |
All the studies cited on the site are gathered, with their level of evidence, in the table of scientific studies on chess.
Why an association does not prove protection
Three mechanisms can produce the observed gap without the game having anything to do with it.
- Reverse causation. Alzheimer’s disease begins silently years before diagnosis. A person whose memory is starting to falter readily gives up chess, which becomes tiresome for them. We then observe that “non-players fall ill more often”, when it is the early illness that made them stop playing. In PAQUID, the players’ advantage in cognitive decline weakens markedly when people who became demented in the first ten years are excluded.
- Confounding factors. Players have on average had more education, lead more active lives and are in better health. Researchers adjust their calculations for these factors, but never perfectly.
- Selection. Volunteers in large cohorts are often in better health than the general population, as the authors of the ASPREE study acknowledge.
What these studies do not say
- That taking up chess at 70 would be enough to reduce your risk by 15%.
- That chess would do better than reading, crosswords or cards: the studies almost never distinguish between them.
- That there is an effective dose (number of games per week).
And in people who already have the illness?
The question “is chess good for people with Alzheimer’s?” calls for a different answer. A Spanish literature review looked into the subject.
Lillo-Crespo et al., 2019 · International Journal of Environmental Research and Public Health · DOI 10.3390/ijerph16122116
Chess Practice as a Protective Factor in Dementia
- Who
- 21 articles included
- Type
- Literature review (scoping review) · level of evidence: Low (synthesis of heterogeneous studies)
- Result
- Chess appears more promising for prevention, in people without a diagnosis, than after a diagnosis of dementia, where few results exist.
- What the study does not say
- No randomised trial specific to chess in people with the illness was found.
By contrast, cognitive stimulation in general has been evaluated in genuine randomised trials. The 2023 Cochrane review, which brings together 37 of them, concludes that there is a small benefit in people with mild to moderate dementia.
Woods et al., 2023 (Cochrane) · Cochrane Database of Systematic Reviews · DOI 10.1002/14651858.CD005562.pub3
Cognitive stimulation to improve cognitive functioning in people with dementia
- Who
- 37 trials, 2,766 people with mild to moderate dementia
- Type
- Systematic review of randomised trials · level of evidence: Moderate to high
- Result
- Cognitive stimulation (generally about twenty group sessions over around ten weeks) probably brings a small cognitive benefit, equivalent to about six months of decline avoided, as well as effects on communication and mood.
- What the study does not say
- Few data on long programmes; chess is not studied as such.
Chess can be part of these activities, in a form suited to the stage of the illness and the person’s tastes. We detail these adaptations on the page about cognitive stimulation games for Alzheimer’s, and how to organise a workshop on the page chess for seniors and in care homes.
Can Alzheimer’s be prevented? The Lancet’s 14 factors
The international reference on prevention is the Lancet Commission on dementia, coordinated by Gill Livingston.
Livingston et al., 2024 (Lancet Commission) · The Lancet
Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission
- Who
- International synthesis
- Type
- Expert report based on meta-analyses · level of evidence: Reference synthesis
- Result
- 14 modifiable risk factors (including low level of education, hearing loss, social isolation, physical inactivity, LDL cholesterol and uncorrected vision loss); about 45% of dementia cases could in theory be prevented or delayed. The 2020 report counted 12 and put this share at 40%.
- What the study does not say
- A theoretical estimate that assumes each factor is causal; mentally demanding games are not among the factors.
The 14 factors identified in 2024 are: low level of education, hearing loss, high LDL cholesterol, depression, head injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol, social isolation, air pollution and uncorrected vision loss.
Mentally demanding games do not appear as such. They do, however, tie in with two ideas present in the report: the importance of intellectual activity throughout life, which feeds cognitive reserve, and the fight against social isolation, when you play with others. In practice, according to the available data, correcting hearing loss, moving every day or treating hypertension weigh more heavily than a game of chess.
What to take away for yourself or a relative
- Playing chess is an enjoyable intellectual and social activity, compatible with all the other prevention advice. Nothing stands in the way of doing it for pleasure.
- Regularity seems to matter more than intensity: the studies measure habits over years, not one-off courses.
- In a person who already has the illness, the game is played for enjoyment and connection, with simplified rules if need be, without trying to “work the brain” at all costs.
- Any worrying memory problem warrants a consultation: the family doctor can refer you to a memory clinic.
Le Palais des Échecs has an article on this subject, which complements this review with practical advice: chess in the face of dementia.
Frequently asked questions
Is chess good for people with Alzheimer’s?
It can be one of the stimulation activities, in an adapted form and for enjoyment. The 2023 Cochrane review shows a small benefit of cognitive stimulation in general for people with mild to moderate dementia, but no trial has evaluated chess alone in people with the illness.
Can Alzheimer’s be prevented?
It cannot be prevented with certainty. According to the 2024 Lancet Commission, around 45% of dementia cases could in theory be prevented or delayed by acting on 14 risk factors such as hypertension, hearing loss, physical inactivity or social isolation.
How can Alzheimer’s be prevented?
The best-supported measures concern general health: controlling blood pressure, diabetes and cholesterol, correcting hearing and eyesight, staying active, not smoking, limiting alcohol and keeping up an active social and intellectual life. Mentally demanding games fall under that last point.
What activities are suitable for people with Alzheimer’s?
Activities that are meaningful to the person and that they can succeed at: familiar games with simplified rules, music, gardening, cooking, walks, group cognitive stimulation workshops. If the person used to play chess, mini-games or simple problems can rekindle an old pleasure.