cognitive health in older adults

Cognitive decline is not an inevitable result of aging. Up to 30% of cognitive impairment in the elderly can be avoided through early intervention. Mild cognitive impairment (MCI) that has already occurred has a 60% probability of slowing down the process or even reversing some cognitive functions through scientific means.

Aunt Zhang, whom I met at a community free clinic last week, is a typical example. She is 68 years old. She always forgot to bring her keys six months ago, and she can’t even remember how much sugar she put in the sweet and sour pork ribs she has eaten all her life. Her family members asked her to take a cognitive scale, and her score was just above the red line of mild cognitive impairment. The whole family was afraid that she was in the early stages of Alzheimer’s disease. As a result, there was no complicated treatment, but the antihypertensive drugs she had been taking for five or six years were adjusted. She was encouraged to go to the community elderly center to take two hours of exercise every day to get the level. She was retested in three months, and the scale score increased by 11 points. Last week, she took three bus stops to go to the vegetable market to pick out ribs, saying that she wanted to cook a special meal for her grandson.

When it comes to cognitive intervention, there are actually two different practical directions in the academic community. One group follows the evidence-based medicine route, and the core view is that "managing vascular risks is to protect cognition." After all, the Lancet's 2020 report on cognitive impairment has long made it clear that controlling high blood pressure, diabetes, and hyperlipidemia in middle age can reduce the risk of cognitive impairment in later life by 40%. The 72-year-old Uncle Li I met was a beneficiary of this view. Before, his systolic blood pressure was always above 160. He always said that his "brain couldn't move" and he couldn't even remember the content of the news broadcast he had watched for a lifetime. Later, the cardiology department adjusted his blood pressure lowering method. We asked him to monitor his condition regularly every day, and we found him a group of elderly hypertensive patients. Everyone posted about his blood pressure in the group every day and chatted about daily life. After half a year, his cognitive scale score increased by 12 points, and he can now go fishing in the suburbs with the old friends in the group.

The other group prefers lifestyle intervention, believing that social interaction, exercise, and active cognitive stimulation play a greater role than drugs. However, this direction has always been controversial. In the past two years, many scholars have publicly said that cognitive training on the market is an "IQ tax", saying that the training effect can only cover the training content itself and cannot be transferred to daily cognitive abilities. But last year, a cohort study covering 1,200 elderly people published in "Natural Aging" slapped many people in the face: Elderly people who persisted in targeted cognitive training for 40 minutes three times a week for one year had cognitive function aging 29% slower than the control group. This improvement effect can even be maintained for more than 5 years.

Interestingly, we have been conducting cognitive intervention projects in the community for five years, and found that when it comes to implementation, the two sets of methods do not need to be so clearly distinguished at all. The most effective thing is never to force the elderly to do arithmetic problems or memorize vocabulary words, but the small things they are willing to do on their own: if you like to grow flowers, think about how to mix the soil for breeding, and write down the watering time of each pot of flowers. ； If you like square dancing, just learn new moves and memorize the rhythm of the new dance steps. ； Even if you take your grandson to school every day and chat with other grandparents at the school gate for half an hour, the effect is much better than buying a lot of brain supplements.

Many family members have asked me before, if the elderly forget things, does that mean they will suffer from dementia? In fact, there is really no need to panic. Normal aging forgetfulness is "forgetting to bring my keys when I go out in the morning, and when I go through my bag at night, I suddenly remember where I put them." But if it is "standing at the door of the house with the keys, and can't remember what it is used for for a long time," or even calling the names of family members wrong, then you should rush to the neurology department for screening. Some people also ask whether supplements such as DHA and Ginkgo biloba extract are useful. There is currently no unified conclusion on this: the US FDA has not approved any health products for the prevention of cognitive impairment. However, many small-scale clinical studies in China have shown that for the elderly with an unbalanced diet and lack of Omega-3, appropriate supplementation can indeed improve cognitive performance. If you often eat fish and nuts on a daily basis, taking more supplements will not have any additional effect, but may increase the metabolic burden.

I met Aunt Zhang again at the free clinic last week. She gave me a handful of small tomatoes grown on her balcony and said she still remembered what I told her before, "It's more effective to chat with old sisters than to take supplements." In fact, after all, cognitive health in the elderly is not a profound knowledge. It is nothing more than making the elderly live a busy and thoughtful life, with a comfortable body and an open mind. It is more effective than any expensive intervention plan.