6 Easy Ways to Prevent Cognitive Decline

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According to a recent study, 1 in 10 people above the age of 60 years in Singapore has dementia, which is a “syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities” (WHO).

If someone were to ask you how you can prevent dementia, you might be tempted to say that an active brain is the answer. Challenging your brain to do something difficult like learn a new language, dance, sport, or musical instrument does delay the symptoms of dementia by several years, but it may not lower your risk of dementia. A 2015 study found that those who had cognitively demanding jobs were less likely to show signs of dementia at the age of 75 years and above, and another recent study found that bilinguals were less likely to show signs of dementia compared to monolinguals, while earlier studies have already shown that learning to master something that you’re not already expert at, such as mahjong or tai chi, improves your cognitive skills if you have mild dementia.

So what causes dementia?

That’s not an easy question to answer. But research in the last decade has identified what makes it more likely for us to develop dementia.

Having diabetes increases our risk. A 12-year-long 2015 study conducted in Taiwan has found that individuals with diabetes have a higher risk of dementia, and that risk increases further with diabetes complications such as blindness and kidney failure.

But it’s not just diabetes. In fact, research shows that the factors which put us at risk for cardiovascular disease leading to heart attacks and strokes — alcohol consumption, smoking, and obesity — are also risk factors for dementia. Research shows that as many as 50% of people have dementia because of known risk factors such as physical inactivity, depression, smoking, mid-life hypertension, mid-life obesity, and diabetes.

So what lowers our risk?

The answer is exerciseOne study estimates that physical inactivity is the reason for over 20% of the population to have dementia in US, UK, and Europe, while a 2013 study found that the risk of dementia at age 85 to 94 was 60% lower for men who maintained 4 out of 5 healthy lifestyle habits (regular exercise, not smoking, a low body weight, a healthy diet, and low alcohol intake) than those without these habits (with exercise being the main cause for lowering the risk of dementia).

But what if we’re already doing all those things. We exercise the recommended number of hours a week, if not more, and we don’t smoke…our BMI is within the healthy range and our lifelong goal is pursuing a wonderful diet of fruits and vegetables.

What else can we do to prevent cognitive decline? Here are few things we can do…

1. Spend less time sitting down because a 2015 study found that the more we sat down, the higher our chance of heart disease, obesity, and diabetes (…and dementia).

2. Get a creative hobby because a recent study which followed older adults for 4 years found that those active in arts and craft were less likely to experience cognitive decline.

3. Spice up your food because a recent study found that a once-a-week intake of chilli lowered the rate of cancers, respiratory diseases, and ischemic heart disease. The authors didn’t report its effects on dementia though. Instead, spice in the form of tumeric (curcumin) has been found to be useful for repairing brain cells affected by dementia.

4. Eat leafy green vegetables because a 2015 study found that cognitive decline was slower among those who regularly ate spinach, kale, collards, and mustard greens. And go easy on the meat and cheese (Why? Read this article on the Blue Zones to learn more).

5. Increase your intake of walnuts because a new study suggests that they delay the progression of Alzheimers.

6. Incorporate eggs, bananas, dark chocolate, avocado, blueberries, and omega-3-rich foods into your diet because a collection of studies show that omega-3 fatty acids, choline, magnesium, and cocoa flavanols are among the nutrients which support brain functioning.

There are 6 easy steps to support brain functioning and delay cognitive decline, but preventing dementia requires regular exercise, a diet of vegetables, fruits, and no tobacco, good control of blood sugars, and good mental well-being. No one said it’d be easy…

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Signs of cognitive decline that we should worry about

Aging successfully

It was recently reported that tip-of-the-tongue phenomena isn’t something that we need to worry excessively about.

It appears that older people have the experience of not being able to identify someone famous or find the name of something more frequently than younger people (“Tip-of-the-Tongue Moments May be Benign“, American Psychological Science, 16 Oct 2013). But it has been found to be unrelated to cognitive changes associated with onset of dementia, suggesting that we shouldn’t be too concerned when we can’t name an actor in the midst of our frenetic discussion of the current k-drama series during family reunion dinners.

In contrast, there are other signs which we should be paying attention to. The Agency for Healthcare Research and Quality (US) for example lists a number of symptoms which might indicate dementia, which include experiencing increased difficulty remembering recent conversations and appointments, performing complex tasks which involve a number of steps, orienting and finding one’s way to familiar places. The Alzheimer’s Association (US) lists 10 symptoms which distinguishes the signs that someone may have Alzheimer’s from that of typical age-related cognitive changes. Given that dementia is a progressive condition, where there is “deterioration in memory, thinking, behaviour and the ability to perform everyday activities” (WHO), these early stage signs serve as a useful guide. The tendency to confuse time and place, resulting in one going to an appointment at the wrong time or at the wrong place, is another such sign – mentioned here by the Health Promotion Board.

There is also much talk about a scan which may determine if one’s cognitive difficulties are caused by Alzheimer’s disease (“Alzheimer’s Anxiety“, NY Times, 16 Nov 2013). But perhaps more pressing for most of us is the issue of whether we’re experiencing cognitive difficulties which warrant a closer look. And the answer to that might just be in a 12-question pen-and-paper questionnaire (known as the SAGE) which has been found useful for discerning cognitive decline, and for which validity research findings were recently published in the Journal of Neuropsychiatry and Clinical Neurosciences and reported in this article in Forbes (14 Jan 2014).

Majong is good for you

That majong is good for us is music to our ears (well, at least for some of us who actually play majong). The claim is based on recent research findings, which has led to reports that “tai chi, majong offer hope for dementia patients” (South China Morning Post, 22 April 2013; see also a similar report in www.majongnews.com).

The evidence is based on two studies. The first showed that a 3-times-a-week programme of either tai chi or majong for 12 weeks was significantly more effective in reducing depression scores among older adults with mild dementia and moderate depression in nursing homes than a handicraft control condition (Cheng et al., 2011). The second showed that the same programme was effective in improving cognitive task performance for a sample of 110 participants with the same population characteristics (Cheng et al., 2012); the first study sampled 12 participants for each condition. It’s not the case that the findings are limited to only nursing residents because these results replicate an earlier finding by Cheng and colleagues. Their 2006 study found that playing majong twice or four times a week for a duration of 16 weeks improved the cognitive performance of 62 older adults living in the community.

Although it would appear that playing majong is helpful in protecting against dementia, it would be wise to also observe that the participants in the 2006 study had not played (although they knew how to play) the game for at least 6 months prior to the study. Similarly, nursing residents were also not regularly practising tai chi or playing majong on a regular basis before the intervention programme was implemented. That is to say, there may be some benefit initially of engaging in mentally challenging activities, but at some point the cognitive demand of these activities may not be sustained over the longer term.

So the advice is to provide your brain with opportunities to grow new neural connections. Giving yourself cognitively demanding tasks like mastering a new language, musical instrument, skill, dance, game, or exercise form, serves this purpose. Learning to play a mentally challenging game like Chinese or international chess, weiqi, taboo, scattergories, and majong for the first time will definitely put us out of our comfort zone. But with a little practice (or a lot for strategy games), it likely loses its edge in its ability to build cognitive reserves and its protective cloak against Alzheimer’s disease. If you’re feeling comfortable, whatever you’re doing is not likely to be of extra benefit. If you’re feeling the strain on your brain, you should keep doing it (at least for a while).

Learning is important. But what’s crucial is that we keep levelling up.