Cognitive health in older adults

Cognitive decline is not an inevitable result of aging. According to the dementia prevention report released by The Lancet Neurology in 2020, about 40% of cognitive decline among people over 60 years old can be avoided through intervention of controllable factors. Even if mild cognitive impairment (MCI, the transitional stage between normal aging and dementia) is diagnosed, more than 30% of people can be reversed to normal cognitive levels after standardized intervention.

When I accompanied Aunt Zhang Guilan from the community to the hospital to get the cognitive screening report last week, her daughter was still saying, "My mother is old and has a poor memory, so there is no need for such a big battle." Aunt Zhang had forgotten to turn off the gas stove for three months in a row. She would leave the eggs she just bought on the vegetable stall when she went out to buy vegetables. At first, her family laughed at her for being "confused." If she hadn't been dragged through a free community screening, they wouldn't have discovered that she had reached the stage of mild cognitive impairment. Guess what? It has only been more than three months since I intervened. Last week I saw her teaming up with her old sisters to play novice script killing, and they could count clues faster than the young people.

In fact, the academic community's intervention ideas for cognitive decline in the elderly have always been in two parallel directions, and no one can convince anyone. One group is the neurodegenerative group. The core view is that the essence of cognitive decline is physiological lesions such as β-amyloid deposition and hippocampal atrophy. Early screening and early use of targeted drugs to control the development of lesions are the core. For example, the targeted drugs for Alzheimer’s disease that were just approved in China this year are considered by this group of scholars to be the first choice for patients in the early and middle stages. The other group is the lifestyle intervention group, which advocates "prevention is better than cure". It believes that as long as the 12 controllable risk factors such as high blood pressure, diabetes, smoking, alcohol abuse, sedentary life, and social isolation are well controlled, even if there are genetic susceptibility genes, the probability of disease can be greatly reduced, and even some of the effects of existing physiological diseases can be offset.

I have been doing cognitive intervention in the community for almost three years, and the cases I have seen really confirm both sides of the point of view. 72-year-old Uncle Li had a cerebrospinal fluid examination last year and found out that he was positive for amyloid-β, which puts him in a high-risk group for Alzheimer's disease. The doctor asked him to take targeted drugs, but he refused to say anything for fear of side effects, so he turned around and followed our cognitive intervention group to practice. He walked 5,000 steps a day, ate a Mediterranean diet with less oil and salt, played chess with an old man three times a week, and learned how to shoot short videos and edit films from his grandson. During this year's review, the protein deposition did not increase, and his cognitive score was 2 points higher than last year. But there are counterexamples. Aunt Wang downstairs has been taking her medicine on time since she was diagnosed with mild cognitive impairment. However, her children are out of town and she doesn’t like to go out. She sits at home and watches TV every day. Her score dropped by 4 points in more than half a year, and she has already shown symptoms of early dementia.

Speaking of this, some people must want to ask, are those cognitive training devices and seven-day memory-improving courses on the market that sell for thousands of dollars really useful? This is also a point of great controversy at present. I have to be honest. The current cognitive training recognized by evidence-based medicine is targeted memory, logic, and executive function training at least three times a week for more than 40 minutes each time. It must last for more than 6 months to see obvious effects. To put it bluntly, it is like exercising the brain. How can you build muscles in just a few days? Devices that can be bought at home and plugged in can "repair brain nerves", as well as courses that claim to improve the memory of the elderly in ten days, basically charge an IQ tax. In fact, playing mahjong with the elderly at home, learning how to use a smartphone to post in Moments, and even asking him to keep track of grocery shopping every day are all very cost-effective cognitive training. In essence, it is to find more things for the brain to do and accumulate "cognitive reserves" - you can think of this reserve as the brain's deposits. If you save more when you are young, even if you spend it slowly when you are old, you will be able to spend more than people with less savings.

Many people can't tell the difference between normal forgetfulness and cognitive decline. In the past few years, I have figured out a little rule that is very easy to remember. You don't need to memorize those complicated scales. If there are more than two elderly people in the family who have this kind of situation, they should be taken to the neurology department of the hospital for examination: For example, something that has been done for a lifetime suddenly becomes inoperable. For example, after cooking for decades, suddenly forget to add salt or add salt twice.； Another example is asking the same question over and over again. In the morning, I just asked if you will go home on the weekend. I asked again at noon, and again in the afternoon. ； Also, after walking for more than ten years, you suddenly can't find your home, or you can't tell the difference between the year, month and day. These are not "normal" signs of getting old, but are a distress signal sent by the brain. I have seen too many family members who always feel that "how can people not be confused when they are old" and put off seeing the elderly until they can no longer take care of themselves. By then it is really too late to intervene.

To put it bluntly, cognitive health in the elderly is never something that only doctors have to worry about, nor is it something that only needs to be taken care of when someone gets sick. I was giving a lecture in the community last week, and a young man signed up his parents for a calligraphy class at a senior college after listening to it. He also took one day a week to go hiking with his parents. Isn't this much better than waiting for the elderly to have a bad memory before worrying? Oh, by the way, next time an elderly person in your family tells you, "My memory is getting worse and worse recently," don't just respond with "This is what people do when they get old." Ask a few more questions and give them more treats, and maybe you can close the door in front of dementia.