Cognitive health education for the elderly

Cognitive health education for the elderly is not a rumored "magic drug to prevent dementia", but according to the Global Cognitive Impairment Intervention Report released by WHO in 2023, standardized cognitive health education for the elderly can delay the process of cognitive decline by 30% to 40% and reduce the risk of Alzheimer's disease by 25%. It does not require high-end equipment and can be implemented in ordinary communities and families - this is currently the lowest-cost and most universal first-level intervention for cognitive impairment.

Last month, I was doing a follow-up visit at a community lecture hall in Zhaohui Street, Xiacheng District, Hangzhou. I met 72-year-old Aunt Zhang doing finger exercises with a few old friends. She also had a small notebook in her pocket, writing down the prices of the vegetables she bought that day and the number of steps she walked. Don't tell me, half a year ago she was crying at home every day, saying that like her deceased mother, she would suffer from "Alzheimer's disease" sooner or later. At that time, she often even misremembered her granddaughter's grade. Cognitive screening fell into the category of Mild Cognitive Impairment (MCI), which is often called the early stage of cognitive decline. After attending cognitive health classes in the community for three months, her current scale score is 2.3 points higher than before, and her anxiety score has dropped by more than half.

Speaking of this, I have to mention a disagreement that has been quarreling in the academic community for almost three years. Should cognitive health education be provided to the entire population, or should it be provided only to the elderly who already have signs of cognitive decline?

Researchers who hold the view of population coverage mostly come from the public health field. Community tracking data from the U.S. CDC in 2023 shows that communities that insist on providing cognitive education to all elderly people over 60 years old at least once a month have an overall incidence of cognitive impairment that is 32% lower than communities that do not provide education. Their logic is that many elderly people's cognitive decline is silent. By the time they discover it, they have already reached the mid-to-early stage, and the intervention cost is high and the effect is not good. Giving everyone "preventive shots" in advance is the most cost-effective.

But another group of researchers from clinical psychiatry does not agree with this statement. A survey conducted by the Shanghai Mental Health Center in 2022 showed that about 18% of elderly people with completely cognitive health, after listening to the general version of cognitive education, developed an excessive anxiety state of "panic when forgetting things". A 68-year-old man even went to the hospital for a week in a row to ask for cognitive screening because he occasionally forgot to bring his keys, feeling that he was already sick. The view of this school is that cognitive health education cannot be "sprinkled with pepper". Basic screening must be done for the elderly first, and targeted education must be provided only to at-risk groups to avoid unnecessary health anxiety.

I have been doing cognitive intervention for the elderly for almost five years, and I have encountered many pitfalls. Many communities think that cognitive health education is just printing pamphlets and putting up a PPT to read "Top Ten Tips to Prevent Dementia". The elderly will turn around and forget after listening, which is ineffective at all. There was a community that came to us for guidance. They said that they had been teaching for half a year, but the cognitive scores of the elderly had not improved at all. I went to listen once, and the teacher said on the stage, "You need to do more cognitive training, such as memorizing English words." Most of the elderly people in the audience have not even graduated from elementary school. How can they understand English words?

In fact, doing cognitive education is really not that complicated. Just integrate the content into the daily life of the elderly. Teaching the elderly to remember their daily grocery bills is much more effective than asking them to memorize vocabulary.； Teaching them to use smartphones to post to Moments and shoot short videos is more than three times more effective than doing paper-based cognitive training questions. Cognitive health is actually like a muscle. You have to train it in a way that it is familiar with. If you always ask it to do things that it is not interested in at all, it will easily lead to resistance.

To be honest, cognitive health education is not a panacea. We never guarantee to family members that "you will not get dementia if you take classes." If the elderly have moderate or above cognitive impairment, such as being unable to find their home or recognize their close family members, then missionary education will be of little use. Instead, they must first go to the hospital for clinical intervention and provide professional care and support. A family member came to me before and said that his father had been lost twice and whether he could get better by taking cognitive classes. I directly advised him to take the old man to the neurology department first and not delay the intervention time.

The longer I work in this field, the more I feel that cognitive health education for the elderly is never as simple as "instilling knowledge into the elderly." It is essentially about helping the elderly develop a normal attitude toward aging - forgetting things does not necessarily mean you will get dementia. Don't be afraid. As long as you find the right method, you can use your brain until you are 80 or 90 years old. I met an 81-year-old man before. He used to take classes with us for half a year because he always forgot things and dared not go out. Now he has also signed up for a calligraphy class at the University for the Elderly. Last time he gave me a handwriting he wrote, which read "Live and learn". He said that now he feels that there are new things to learn every day and he has no time to worry about whether he is "stupid or not."

There is no perfect cognitive education template now. Some elderly people in communities like to be lively, so they are suitable for activities such as group games and finger exercises.； Some elderly people living alone have inconvenient mobility, so it is suitable for volunteers to come to chat with them and keep accounts together. ； Some elderly people like to watch short videos, so they cut popular science content into 1-minute snippets and send them to them. As long as the elderly are willing to participate and feel comfortable, half the battle is already won.