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This study examined whether participation in leisure activities during early and middle adulthood was associated with reduced risk of Alzheimer's disease. The sample consisted of 107 same-sex twin pairs discordant for dementia and for whom information on leisure activities was self-reported more than 20 years prior to clinical evaluation. A factor analysis of these activities yielded three activity factors: intellectual–cultural, self-improvement, and domestic activity. Matched-pair analyses compared activities within the discordant twin pairs while controlling for level of education. For the total sample, participation in a greater overall number of leisure activities was associated with lower risk of both Alzheimer's disease and dementia in general. Greater participation in intellectual–cultural activities was associated with lower risk of Alzheimer's disease for women, although not for men.