An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia

Sheung-Tak CHENG, Alfred C. M. CHAN, Edwin C. S. YU

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Objective   To explore the effect of an activity treatment—mahjong—on the cognitive functioning of persons with mild‐to‐moderate dementia.
Method   Participants were 62 older persons (Mage = 83.94, SD = 7.58) who met DSM‐IV diagnosis of any dementia condition, had an initial Mini‐Mental State Examination (MMSE) score ≤ 24, and were able to play, yet not having played mahjong for the past six months. They were randomly assigned to play either twice (n = 33) or four times (n = 29) a week over a 16‐week duration. Digit forward span, digit forward sequence, verbal memory and MMSE were measured at baseline, post‐test and 1‐month follow‐up.
Results   Regardless of frequency of playing, mahjong produced consistent gains across all cognitive performance measures. It had large effect sizes on digit forward memory (1.0–1.4 for both span and sequence), moderate‐to‐large effect sizes on verbal memory (0.5–0.9), and a moderate effect size on MMSE (around 0.6). The effects lasted after mahjong had been withdrawn for a month, suggesting that constant practice is not necessary to achieve therapeutic effect once an initial threshold is attained.
Conclusion   Mahjong is a viable treatment option for dementia. Because mahjong therapy basically does not require professional supervision and can be implemented as widely as space allows at a given time, the potential benefits of integrating mahjong into the daily routines of an institution are enormous vis‐à‐vis minimal, if any, cost to the institution. Copyright © 2006 John Wiley & Sons, Ltd.
Original languageEnglish
Pages (from-to)611-617
JournalInternational Journal of Geriatric Psychiatry
Issue number7
Publication statusPublished - Jul 2006



Cheng, S.-T., Chan, A. C. M., & Yu, E. C. S. (2006). An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia. International Journal of Geriatric Psychiatry, 21(7), 611-617. doi: 10.1002/gps.1531


  • Dementia
  • Mahjong
  • MMSE
  • Digit memory
  • Verbal memory