How to Stay Cognitively Unimpaired as an Older Adult

In New Zealand and internationally, brain health has become an important topic of attention. Many dementia organisations in New Zealand provide information on how we can keep our brains healthy to prevent cognitive decline/dementia. The 2020 Lancet Commission report, “Dementia intervention and care,” lists 12 factors, based on reliable evidence, that promote brain health. They are:

1. Prevent hearing loss

2. Cut smoking

3. Manage your weight

4. Treat depression

5. Exercise

6. Glucose control

7. Social connection

8. Modest alcohol

9. Sleep

10. Diet

11. Regulate blood pressure

12. Avoid head injury

    
    

As this is a long list of dos and don’ts, life can become quite boring and unattractive when you want to adhere to all twelve issues every day. Therefore, I wondered if every item listed is of equal importance and, if not, what are the two topics I need to consider doing every day (life is busy!). Luckily, I came across a recent research article that delved into this.

The Research

Mendes and colleagues delved into this question and conducted a systematic review/meta-analysis (this is a research type that figures out what the best and most conclusive evidence says about a topic of interest). They analysed the results of 109 randomised controlled trials in which 23,010 people participated. All participants were cognitively unimpaired and were evaluated on their lifestyle interventions: diet, physical exercise, cognitive training, social activity, and health education, and how all these factors contributed to their overall cognition. The average age of the participants was 70.1 years, with 65% female participants and 35% male.

Findings

What they found was interesting and provides insight into which interventions are more

efficacious than others. The largest statistically significant improvement in cognition was

measured when participants took part in a combination of physical exercise and cognitive

training. Other combinations (diet, physical exercise, cognitive training, and health

education) also caused cognitive improvement, but not as strongly as cognitive training

and/or physical exercise.

Two more interesting findings came to the surface as the results showed that participants younger than 70 years of age benefited more from cognitive training and physical exercise in comparison with older participants. Also, clusters of interventions (diet, cognitive training, physical exercise, health education) were particularly efficacious when carried out for longer than 3 months.

Take home message

What this study shows to me, without disregarding the 12 factors suggested by the Lancet Commission, is that if we, as cognitively unimpaired people, want to keep our brains healthy, regular exercise and cognitive training must be at the top of our to-do list. This, in combination with a healthy diet (preferably Mediterranean), enough social interactions, and a healthy heart, provides the best start to stay cognitive unimpaired.

Find below some suggestions on how to implement these two activities in your daily life. The text is copied from the Brain Health Institute in Sweden.

Physical Activity

The movement pyramid illustrates the recommended activity levels to safeguard the heart, blood vessels, and brain. Everyday movements, such as walking, cycling, cleaning, and playing with children, form the pyramid's foundation. It's crucial to avoid prolonged periods of inactivity. The pyramid's second tier suggests engaging in more intense exercise for 150-300 minutes weekly. All muscle groups should be involved, with activities distributed throughout the week. At the pyramid's peak, strength training should be incorporated 2-3 times weekly.

Mental Stimulation

Education, occupation, and leisure activities all play a role in maintaining cognitive health. Engaging in activities like playing games, attending courses, reading books, visiting theatres or museums, and participating in associations stimulates the brain. Post-retirement, it's advisable to seek brain training to compensate for the daily cognitive stimulation previously provided by work. Puzzles, crosswords, and building projects are excellent daily brain exercises. Learning and employing memory strategies can be beneficial in daily life, aiding in the preservation of cognitive abilities.

Monitoring

Regular journaling of activities in each area helps to maintain focus. Each night, before you go to bed, rate your adherence to activities in each area with a percentage. Average the percentages at the end of the week, and you have your brain health compliance score. This in itself is already a mental stimulation exercise.

Literature

Single-domain and multidomain lifestyle interventions for the prevention of cognitive decline

in older adults who are cognitively unimpaired: a systematic review and network meta-

analysis. Mendes, Augusto J et al. The Lancet Healthy Longevity, Volume 6, Issue 9, 100762