cognitive health in older adults

The core solution for ordinary families to delay the cognitive decline of the elderly is never to buy sky-high-priced brain supplements, nor to force the elderly to memorize poems and write questions. It is to make low-threshold micro-adjustments from the three dimensions of daily social interaction, exercise, and diet. The earlier intervention is started, the higher the benefits. Even if mild cognitive impairment (MCI) has already occurred, standardized intervention can reduce the progression of the disease by more than 30%.

I have been a volunteer in a public welfare project for elderly cognitive screening in the community for two years, and I have seen too many families who have taken detours. Aunt Zhang, who lives in Building 12, was diagnosed with mild cognitive decline last year. Her son went out to find out about a bunch of "brain-tonifying medicines", including tens of thousands of neuropathic acid and imported DHA, sent home. He also listed a daily brain training chart, requiring her to memorize 20 Tang poems and do 10 arithmetic problems. If she couldn't complete them, she had to be "checked." Later, we adjusted the plan according to the visit: we didn’t need to do the questions, we went to the community to dance for half an hour every day after dinner, we made an appointment with our old sisters to go to a suburban park once a week, we cooked at home and added more dark green vegetables such as spinach and rapeseed, and we stewed hairtail or salmon once a week. With such a simple adjustment, Aunt Zhang checked again half a year later, and her score increased by 7 points. Now she has actively signed up for a community handicraft class and learned how to make silk screen flowers.

Interestingly, there have been different voices on the academic and clinical sides regarding the specific methods of cognitive intervention. In the past few years, the mainstream view still advocated "high-intensity brain training", advocating that memorizing words and doing logic problems every day can effectively prevent dementia. However, a study released by the Cambridge School of Public Health in 2024 that tracked 12,000 elderly people over 65 years old for 5 years has patched this view: Mandatory brain training that is assessment-oriented and causes psychological stress to the elderly will increase cortisol levels in the body, but will accelerate hippocampal atrophy, which is harmful to cognitive health. ； On the contrary, purposeless leisure mental activities, such as playing mahjong together, chatting with old colleagues about the past when they were young, and learning to cook new dishes from short videos, are 27% more effective in maintaining cognition. The differences in dietary intervention are even more obvious. The nutrition community has always advocated a strict Mediterranean diet model, which requires eating olive oil every day and eating deep-sea fish at least three times a week. However, most practitioners on the front line of community intervention do not recommend adopting this rigidly - many Chinese elderly people have been eating rapeseed oil, Peanut oil, if you try to change olive oil to olive oil, it will taste too bad and make you unable to eat. It is better to make slight adjustments based on the original eating habits: add a small handful of original nuts every day, eat fish 1-2 times a week, and add more mushrooms and dark green vegetables. The elderly have high compliance, and the effect will be better if they persist for a long time.

During the follow-up last week, I came across a very typical example. Uncle Li, who lives in Building 3, used to be a warehouse manager. After retiring, he had nothing to do at home. Last year, he was diagnosed with mild cognitive impairment. His daughter insisted on sending him to a specialized cognitive intervention institution, where he had to attend a one-hour training class every day. Uncle Li felt that he was being trained as a "fool". After going there twice, he made trouble and never went back. He lay at home in a daze every day, and his memory became worse and worse. Later, we discussed with his daughter and asked the owner of the Cainiao Station at the entrance of the community to ask Uncle Li to help sort the express delivery for two hours every day. There was no need to clock in or pressure, and anyone could go if he wanted to. Uncle Li has worked in warehousing all his life, and he is very familiar with sorting express delivery. He can also chat with the neighbors who come and go to pick up express delivery. After working for more than three months, his daughter said that he can remember things much more clearly now. Last week, he took the bus for half an hour to go to his old workplace and gave his old colleagues pickled sugar garlic.

Many people always think that "it's normal to be old and confused". In fact, there are two different judgment criteria here: If you just occasionally forget where you put your keys or can't remember the name of an acquaintance, but you can remember it after a while, this is normal aging forgetfulness, so don't be overly nervous.； But if you forget what you just ate, can’t find your way home when you go out, or even call a close family member by the wrong name, that’s an early warning sign of cognitive impairment. You must go to a neurology or cognitive specialist as soon as possible, don’t delay. Of course, there is also a school of thought that as long as the elderly over 80 years old do not have cognitive decline that affects normal life, there is no need for high-intensity intervention. Instead, maintaining a relaxed attitude and living happily are the first priority. After all, cognitive health itself is part of the quality of life. In order to prevent dementia, the elderly cannot live like they are rushing to school for exams.

In fact, after working in the community for so long, my biggest feeling is that cognitive health in the elderly is never a matter of "treating diseases", but a by-product that allows the elderly to live a secure and prosperous life. If you allow him to do something he likes to do every day, have people to chat with, eat smoothly, and move comfortably, it will be more effective than expensive supplements or complicated training. Don’t panic if you are diagnosed with pathological cognitive decline. Take your medicine as prescribed by your doctor and make small daily adjustments. Even if the disease progresses a little slower, you can live a comfortable life, which is better than anything else.