Mahjong and Mental Wellness

In an earlier post, I had written about the new mahjong courses being offered by the People's Association (PA). Actually, I had not fully explained why mahjong is now part of the many courses available in the community clubs and centres (CCs) under the PA. The PA has put together a programme of workshops, courses, and talks under the theme of 'Wellness for Everyone' (see the PA media advisory, designed around on three 'wellness pillars': Eating Well, Being Active, and Thinking Positive). So, under the area of mental wellness, mahjong is one of the intellectual games where courses are being offered (the other games include contract bridge, weiqi, Scrabble, Othello, and Sudoku).

For this collaboration with the PA in offering mahjong courses, I had to do a little research on how to sell the benefits of mahjong. After all, the mahjong courses are offered under a wellness-themed programme, so the connection has to be wellness-related, and I would have to rely on this to convince the CCs to engage me to conduct the courses. I had long been interested in the research on mahjong and its presumed benefits. After all, we have been hearing about how mahjong can help prevent dementia in the elderly (a somewhat poorly qualified claim due to simplification of language). So, are such claims true? Well, with this question in mind, I looked for research articles dealing with this issue.

What I found was interesting: mahjong does seem to have some benefits in the prevention of dementia in the elderly. However, the findings of such research are rather complex. The playing of mahjong belongs to a class of leisure activities known as cognitive activities (including reading, playing musical instruments, painting, etc.); there are other classes of activities studied, namely physical activities and social activities. In general, participation in cognitive leisure activities, and not physical activities, is shown to be associated with a reduced risk of dementia [1]. However, a causal relationship cannot be easily determined due to the nature of the studies. That is to say, it is not possible to say whether participation in such cognitive activities lead to a lower incidence of dementia or participants who do not get dementia prefer to participate in cognitive activities such as the playing of board games.

Studies of leisure activities and dementia in the elderly usually use the playing of board or card games as a particular activity, with no single game specified. A study done on a large group of elderly Chinese in Chongqing, China, did show that specific cognitive activities (playing board games and reading) were associated with a reduced risk of cognitive impairment (i.e. dementia) [2]. For the board game component, it was recognised that mahjong is responsible for the bulk of the experimental score, and the majority of participants played it. Again, the problem in establishing the causal relationship is encountered here, but this Chinese study showed clearly that mahjong does have a connection in a reduced risk of dementia.

A different kind of study was conducted in Hong Kong, to explore the effect of mahjong as therapy for people with dementia [3]. The researchers got senior citizens in nursing homes to play either two or four times a week for sixteen weeks. They found this activity to produce improvements in all cognitive tests used. Interestingly, the effects lasted even after the mahjong therapy has stopped for a month.
Now, research on dementia and the prevention of dementia is still ongoing, and there are no firm conclusions as yet on the whys and hows of dementia, much less on the curing or prevention of dementia. We do have some indications of what may seem to help prevent dementia. Mahjong and other board games (or intellectual games) are just a part of these possible methods of preventing dementia.

So, playing mahjong is a good activity for mental wellness. The benefits of mahjong are real, as can be seen from research. I know some people may think, 'But why promote mahjong in particular? Why not other intellectual games?', a response prompted by the unsavoury reputation mahjong has, due to a long-time association with gambling. To this line of thinking, I can only offer this: other games are indeed being offered too at CCs, and mahjong is not being promoted at the expense of the other games. Rather, it is the familiarity of mahjong that would probably appeal to people (in Singapore, at least). There is a particular relevant quote by Mr Lim Boon Heng, Minister in the Prime Minister’s Office and deputy chairman of the PA: 'if there are things they are naturally interested in, and if we can use them, why not? In our context, mahjong is one of those things' with reference to stimulating senior citizens' mental activity (see the context of the quote in this archived ST article in PDF format). [The concern about gambling is somewhat unjustified and deserves some discussion, but that is another subject matter for another post.]

Notes:
1. Joe Verghese et al., 2003, Leisure activities and the risk of dementia in the elderly, New England Journal of Medicine, 348: 2508–2516.
2. J.Y.J. Wang et al., 2006, Leisure activity and risk of cognitive impairment: the Chongqing aging study, Neurology, 66: 911–913.
3. Cheng Sheung-Tak et al., 2003, An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia, International Journal of Geriatric Psychiatry, 21: 611–617.