Does Mahjong Keep Your Brain Sharp?
What the research actually says — trials, large long-term studies and reviews, read one by one, including what they can’t tell us.
One hand, five mental jobs at once
Sit down for one hand and count what you’re asked to do. You hold thirteen or fourteen tiles in mind and keep sorting them into possible shapes. You track every discard. You estimate what’s left in the wall. You read three other people. And you do it again every few seconds, for an hour or more, while talking to the table.
What a single hand asks of you
Mahjong also has a practical advantage for scientists: in China, Hong Kong and Taiwan, millions of older people already play it, so it can be studied at scale. That’s why nearly all of the research below comes from there.
Not all studies are equally strong
Before the results, one idea that makes everything else easier to read: a study that follows people over time can show that two things go together; only a trial can test whether one causes the other.
The mahjong evidence base, as of a 2024 review
In people who already have dementia
The best-known trials come from Hong Kong researcher Sheung-Tak Cheng and colleagues.
62 people, average age about 84
Participants with mild-to-moderate dementia who had stopped playing were randomly assigned to mahjong twice or four times a week for 16 weeks. Both groups improved on memory tests (sequences of digits, word lists) and on the MMSE, a standard screening test for thinking skills. The gains were still there one month after the sessions ended.
110 nursing-home residents: mahjong vs. tai chi vs. handicrafts
Whole nursing homes were randomly assigned to one activity, three times a week for 12 weeks. Over the following months, the handicrafts group declined while the mahjong and tai chi groups largely held steady.
Difference in MMSE score at 9 months
Thousands of older adults, followed for years
Several teams have used the Chinese Longitudinal Healthy Longevity Survey, which has followed tens of thousands of older adults in China.
Dementia risk among near-daily players, by group
A second analysis of the same survey (7,535 people, average age about 82) found that mahjong players kept higher MMSE scores than non-players from 2008 to 2018, and that people who played less over time tended to see their scores fall faster.
Why “association” matters here
Three ways to explain the same pattern
Mood, connection — and what the reviews conclude
13,258 middle-aged and older adults in China
People who did not play mahjong, cards or chess, and did not attend sporting or social clubs, were more likely to follow worse long-term paths of depressive symptoms.
The 2024 Lancet Commission on dementia lists social isolation among 14 risk factors that can be changed, and estimates that nearly half of dementia cases could, in theory, be prevented or delayed by addressing them. Mahjong isn’t on that list — but a regular game night is one practical way of staying connected.
Traditional board games, including chess, Go and mahjong
Board games may slow overall cognitive decline and improve quality of life, with different games linked to different skills. For mahjong, the clearest signal was executive function — planning and mental flexibility — and a short-term improvement in depressive symptoms.
Digital mahjong on an iPad, 60 adults aged 55+ in Taiwan
Two 30-minute sessions a week for six months, plus step-count rewards, versus no program. The mahjong group improved slightly more on a delayed-recall memory test, and brain scans showed changes in some regions — including increased activity in one area and a small decrease in grey-matter volume in another, which the study could not fully explain.
Twenty years of research at a glance
The studies side by side
| Study | Type | Who | What they found | Keep in mind |
|---|---|---|---|---|
| Cheng 2006 | Trial | 62 people with dementia, Hong Kong | Memory and MMSE gains after 16 weeks; lasted 1 month | No non-mahjong comparison group |
| Cheng 2014 | Trial | 110 nursing-home residents with dementia | Held steady; +4.5 MMSE points vs. handicrafts at 9 months | Open-label; some memory tests unchanged |
| Tian 2022 | Cohort | 11,821 adults 65+, China | Near-daily cards/mahjong: HR 0.63 for dementia | Association only; cards and mahjong combined |
| Zhu 2024 | Cohort | 7,535 adults, average age 82, China | Players kept higher MMSE scores | Association only |
| Lin 2023 | Cohort | 13,258 adults 45+, China | Not joining games or clubs linked to worse depression trajectories | Activities grouped together |
| Pozzi 2023 | Review | Board-game studies | May slow decline; mahjong linked to executive function | Mixed quality of included studies |
| Tse 2024 | Review | 53 mahjong studies | Mostly positive associations | 47 of 53 were observational |
| Tung 2026 | Trial | 60 adults 55+, Taiwan | Digital mahjong + walking: slightly better delayed recall | Can’t separate mahjong from walking |
What we don’t know yet
Most evidence can’t separate “mahjong keeps the brain healthy” from “healthy brains keep playing.”
Nearly all studies use Chinese or Hong Kong-style mahjong. We found none on Japanese Riichi, with its riichi calls, defensive reading and hand scoring.
Two and four sessions a week gave similar gains in one trial. There is no established “dose.”
Mahjong is almost always social. Some of any benefit may come from company and conversation.
The research is almost entirely about people over 55.
Making mahjong part of your routine
None of this is medical advice. But if you enjoy the game, these habits line up with what the research looked at.
- Play regularly, with people. The studies with positive results involved steady, repeated play — usually in groups, not alone.
- Keep learning. When the game feels automatic, push it: learn new yaku, practise reading discards, or count your own score before you check it.
- Bring someone new to the table. Teaching a friend or family member is a challenge in itself — and builds the social side too.
- Keep it light. Play for fun, not money. Take breaks and stand up between hanchan; sitting for hours isn’t good for anyone.
- Don’t use it instead of a doctor. If you or someone close to you is worried about memory or thinking, talk to a healthcare professional.
References
- Cheng ST, Chan AC, Yu EC. An exploratory study of the effect of mahjong on the cognitive functioning of persons with dementia. Int J Geriatr Psychiatry. 2006;21(7):611–617. doi:10.1002/gps.1531
- Cheng ST, Chow PK, Song YQ, et al. Mental and physical activities delay cognitive decline in older persons with dementia. Am J Geriatr Psychiatry. 2014;22(1):63–74. doi:10.1016/j.jagp.2013.01.060
- Tian G, Shuai J, Li R, et al. Association between playing cards/mahjong and risk of incident dementia among the Chinese older adults: a prospective cohort study. Front Aging Neurosci. 2022;14:966647. doi:10.3389/fnagi.2022.966647
- Zhu L, Wang Y, Wu Y, et al. Longitudinal associations between the frequency of playing Mahjong and cognitive functioning among older people in China: evidence from CLHLS, 2008–2018. Front Public Health. 2024;12:1352433. doi:10.3389/fpubh.2024.1352433
- Lin X, Liu S, Hu Z, Xu H. Social activities and long-term depressive-symptoms trajectories among middle-aged and older adults in China. Front Psychiatry. 2023;14:1131084. doi:10.3389/fpsyt.2023.1131084
- Pozzi FE, Appollonio I, Ferrarese C, Tremolizzo L. Can traditional board games prevent or slow down cognitive impairment? A systematic review and meta-analysis. J Alzheimers Dis. 2023;95(3):829–845. doi:10.3233/JAD-230473
- Tse ZCK, Cao Y, Chau BKH, et al. Does playing mahjong benefit older individuals? A scoping review. J Prev Alzheimers Dis. 2024;11(5):1363–1377. doi:10.14283/jpad.2024.102
- Tung HH, Kuo CY, Lee PL, et al. Digital mahjong-based cognitive engagement intervention for older adults: randomized controlled trial. JMIR Aging. 2026;9:e85339. doi:10.2196/85339
- Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404(10452):572–628. doi:10.1016/S0140-6736(24)01296-0
This article is for general information only and is not medical advice. It does not diagnose, treat or prevent any condition. If you have concerns about memory or thinking, please consult a qualified healthcare professional. It was researched and written with AI assistance by the ALBAN editorial team; every number was checked against the original papers listed above.