The Best Games for Brain Health?
What bridge, pickleball, and mahjong have in common
Hello, everyone. Sometimes I feel like I’m the only person I know who isn’t in a mahjong group.
Many of my friends gather regularly to learn and play this Chinese tile-based game. I’ve always suspected it must be good for their brains. For one, it’s inherently social, and the groups I know seem to have a lot of fun. Plus, the brain loves novelty, and most people I know didn’t grow up playing.
As I was digging into the science of how our hobbies shape our brains, I was curious whether mahjong had been studied as a brain-healthy activity. That naturally led to questions about other popular pastimes. What about playing cards? Is bridge just as cognitively enriching? And what about games like pickleball? While one is played on a court and the others around a table, both may help protect cognitive health. I was delighted to discover a growing body of research examining the brain health benefits of these seemingly very different hobbies.
My reading of the literature suggests that the most brain-beneficial hobbies share three characteristics. I’ll break that down for you, below, with a rubric you can use to look at how you spend your own leisure time.
This month we are in the midst of a mini-series about dementia risk factors—the ones we have the power to change. Last time we dove into cognitive enrichment, or which hobbies have been studied to help build a more resilient brain. In case you missed it, catch up with these articles:
Before we dive in, a few announcements:
Join us for Cooking Club on June 28. The next BHK live-on-zoom cooking class is happening soon! I sent out a poll to all Founding Members earlier this week to vote on what we will be cooking. Should we make chilled summer soups, better-for-you Greek dishes, or a few seafood recipes I brought home from Italy? There’s still time to join and weigh in on the menu. Upgrade your subscription to Founding Member (and get 4 classes/year, just $35 each if you have an annual subscription) and I’ll send you the recipes and zoom link.
The BHK Course is now in session! My new course is built directly from the semester-long brain health course I teach to pre-med students — structured, comprehensive, and designed to take you from curious to truly informed, step by step. Learn more about the course here and use the BHK discount code SPECIAL50 for $50 off the Full Program. I look forward to seeing all the BHK students in our next live Q & A.
June 23 at 11 am MT: Join me for this free live brain health talk and Q and A hosted by NeuroReserve. I’ll be joining some of my favorite brain health experts for a 4-pronged discussion about how to optimize social connection, cardio/metabolic heatlh, nutrition, and strategic supplementation. The best part? You can submit your questions here and I’ll put them on the agenda. Register here for free.
Now, let’s talk about games!
Mahjong or cards?
When I started researching the brain health benefits of playing cognitively enriching games, I was impressed by how extensively both mahjong and card playing have been studied. Most of the data comes from Asia where people have been gathering around tables to play games for hundreds of years. And yet, I was surprised to find more than 50 studies, some of them randomized controlled trials. Some looked at mahjong playing alone, and others grouped it with other card games.
One of the strongest prospective studies followed 11,821 Chinese adults over age 65 for 10 years. Researchers looked at how frequently they got together to play cards or mahjong. Compared with people who rarely or never played these games, those who played almost daily had a 37% lower risk of developing dementia.
Another study of 7308 older Chinese adults looked at the cognitive impact of playing cards or mahjong regularly, occasionally, or never. Those who played almost daily had better cognitive function than those who played sometimes or never. Researchers found that the more frequent players showed significant differences in attention, language, and total cognitive scores.
The problem of reverse causation
While this suggests being in a group that plays cards or mahjong is strongly linked to aging with a healthy brain, reverse causation can cloud these observational studies. People in the earliest stages of neurodegeneration often withdraw from hobbies years before diagnosis. So when we observe that people who read, play music, or socialize more have less dementia, some of the association may reflect healthier brains enabling those activities rather than the activities preventing dementia.
That’s why I was happy to find this 2024 review evaluated 53 studies, all focused on mahjong’s impact on cognitive health.
The case for joining a mahjong group
Most studies in this review were observational, looking at the correlation of playing mahjong and aging without dementia. But there were six intervention studies, too, that evaluated the game’s impact on slowing progression in mild cognitive impairment. Four of these were randomized controlled studies that compared mahjong to other activities like tai chi and handicrafts. Frequent mahjong participation has been studied in both cognitively healthy adults and as in intervention for those with early dementia.
In dementia-free adults, most studies were aligned. Those who participated frequently in mahjong groups showed:
