Your attitude towards ageing matters

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Increasing the amount of physical activity that you do cuts the risk of dementia by as much as 60%, when combined with a healthy lifestyle which includes cutting out nicotine and and cutting down on alcohol.

Recent research now explains that exercise is the key to ageing successfully because physical activity keeps your brain healthy. A 2015 study reveals that older adults (their participants were Japanese men aged 60 to 74 years) are more likely to use the same part of the brain for tasks requiring cognitive control (such as the Stroop test — you can try it here) as young adults if they are physically fitter; those with less fitness use more parts of their brain to perform the same task. Another 2015 study also finds that brain atrophy can be reversed among healthy older adults and those with mild cognitive impairment (MCI) through moderate intensity exercise.

But exercise is only half the equation. It’s also important to give your brain opportunities to grow new neural connections. The notion that healthy ageing involves giving yourself cognitively demanding tasks (see our earlier blog post) gets more support from a 2016 study. Building on earlier findings, this study demonstrates that mentally challenging activities – such as learning digital photography or quilting or learning both – produces greater improvements in memory than low hanging fruit, like travel and cooking activities for which participants are not required to learn something new.

It doesn’t do any harm to also increase healthy foods, specifically green vegetables, walnuts, curries, and omega-3 foods like eggs, bananas, dark chocolate, avocado, and blueberries, which have been found to reduce the risk of cognitive decline with age.

But it might surprise you to find out that social connections also have a powerful effect on your health. A 2016 study finds that having a larger social network is crucial for health during late, as well as early, adulthood. Seniors not in social isolation achieve better scores on health markers which include blood pressure, body mass index, and a measure of systemic inflammation.

And that your beliefs about ageing can also be impactful. A 2015 study finds that people who hold negative beliefs (e.g., “elderly people are decrepit”) are more likely to subsequently experience brain changes associated with Alzheimer’s dementia.

Just something to think about as the planets line up on this full moon.

The early signs of dementia

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According to the 2013 Well-being of the Singapore Elderly (WiSE) study, 1 in 10 persons in Singapore aged 60 years and above has dementia, which according to the WHO definition, is a “syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities”.

To suggest that someone with dementia “may” have memory loss, is misleading. Dementia is a condition in which people with dementia encounter problems with memory. But it is of course worth noting that the “symptoms of dementia are not limited to forgetfulness and memory loss“, as the author of this 2015 Institute of Policy Studies (IPS) Commons article points out. The ability to plan and make decisions, as well as solve problems, are other cognitive difficulties faced by someone with dementia.

Recent research efforts offer relatively quicker ways for clinicians to diagnose dementia and identify individuals at risk for dementia. According to a recent study published in 2015, researchers have developed a brief questionnaire, known as the QDRS comprising 10 items, which can accurately identify if someone has very mild, mild, moderate, or severe dementia. And a 2014 study has found a time-efficient method for identifying those at risk for dementia — through their ability to track a moving target with a computer mouse which moves in the opposite direction to what they see on the screen. Those diagnosed with Mild Cognitive Impairment (MCI) (and who are at risk for dementia) made many more errors than the control group. A more recent study also points to the tendency for those with amyloid plaques associated with dementia to have walk at a slower pace compared to healthy peers.

But you’re concerned that you may be developing dementia. Or you’re concerned about someone you know being at risk for dementia…

So here are 3 questions to answer:

1. Have you noticed any of these early warning signs?

The local Health Promotion Board has a print-friendly fact sheet, while the local Alzheimer’s Disease Association offers a checklist and describes the stages of dementia. No? Move on to Question 2!

2. Are you aware that you have difficulties remembering things?

recent study which tracked over 2,000 individuals for 10 years reported that awareness of memory problems is a good clue as to whether they have dementia or not. In this study, those who were eventually diagnosed with dementia stopped being aware of their memory problems about 2.5 years before showing signs of dementia. So being aware that you have memory problems is actually a good thing. But read on…

3. How often do you have problems remembering things?

The US Alzheimer’s Association distinguishes behaviours which are characteristic of dementia from behaviours associated with healthy ageing in their list of early warning signs. Forgetting the names of things and/or the names of people is something that happens to most of us. Some of us experience the tip-of-the-tongue phenomenon quite often in fact. We can also be prone to forgetting appointments. But we’re usually able to retrieve these words and/or names later on, and we typically realise that we missed an appointment at a later time.

But a 2014 study also found that those who reported a change (more difficulties) in their ability to remember things were much more likely to subsequently develop dementia. So if you’re concerned that you might have cognitive issues, you can take an online assessment — Self-Administered Gerocognitive Exam or the SAGE test. But it’s also important that you consult with a medical professional if memory and thinking problems are a concern for you. 

Manage your stress for a sweeter life

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So, here are the answers to yesterday’s quiz:

1. False. Those with Type 1 diabetes have a pancreas that doesn’t produce insulin. In contrast, the pancreas of those with Type 2 diabetes does produce insulin, but their body is unable to respond to the insulin. Here are the facts.

2. False. Most people have Type 2 diabetes. Those who have Type 1 diabetes usually have the condition before the age of 35 years. And in fact, experts project as many as 1 in 2 locals having diabetes by 2050.

3. True. Regular exercise and an appropriate diet both work to improve insulin sensitivity of people with Type 2 diabetes. Find out more about how exercise helps here. According to research, the total amount of carbohydrates that we consume is important for managing blood sugar levels. Read more to understand why here. You can also find out what it means to “eat right” here.

4. False. The risk of developing heart disease for those with diabetes is 2 to 4 times higher than people who don’t have this condition, and smoking doubles this risk if you have diabetes. Read more here. A 2015 study also found that those with mild cognitive impairment were more likely to progress to dementia (which is linked to heart disease) if they also had diabetes.

5. False. People with diabetes are at a higher risk of developing kidney disease because excessive blood sugar damages the kidneys over time. In fact, studies report that about 10 to 40% of people with Type 2 diabetes will need dialysis due to kidney failure. But research also shows early screening and early treatment to be highly effective for maintaining kidney function.

6. True. In addition to excessive sweating, weight loss, and other symptoms, people with undiagnosed diabetes may notice changes and problems with their vision. Read more about these eye problems here.

7. Experts recommend a balanced diet, regular exercise, and blood sugar monitoring for keeping blood sugar levels stable, not just oral medications and/or insulin injections.

And it’s not just common sense. Research shows that exercise does reduce the risk of diabetes. A 2014 study found that people who lived “walkable neighbourhoods” — neighbourhoods where the shops and amenities were within walking distance — were less likely to develop diabetes.

Here are some practical tips for monitoring blood sugar levels.

As this ADA help sheet suggests, it’s also important to tell yourself that tracking blood sugar levels helps you evaluate how well you’re looking after yourself. Instead of berating yourself for not doing better, try these techniques for managing your emotions.

8. True. Nerve damage and/or poor circulation from excessive blood sugar are the reasons why people with diabetes may experience slower healing from cuts and sores. So it’s particularly important to take care of our feet. Read more about that here.

Did you get all 8 questions correct? Good job!

But recent research shows that a balanced diet and regular exercise aren’t the only lifestyle changes to make in order to get a better handle on one’s diabetes.  In fact, a 2015 study found that chronic stress to be a factor for developing diabetes, while another 2015 study found that people who stay awake later at night have a higher chance of developing diabetes than people who sleep earlier, even when both groups have the same amount of sleep.

So there you have it. The key to having a sweeter life (and lower levels of un-metabolised sugar in your bloodstream): Get to bed earlier and manage your stress!

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…

3 simple ways to keep mentally fit

Sleep is essential in order for our brains to function well as we age. A 2014 study found that those with poor sleep tend to have more memory and problem solving concerns. A local study also found that the less we sleep the faster our brains age.

Exercise is another key ingredient for healthy aging. The authors of a 2014 study report that those who didn’t exercise regularly were more likely to have problems with their memory. Moreover, older adults with have better lung and heart health, which is enhanced through regular physical activity, also tend to have better memory and problem solving abilities, according to another 2014 study.

Being socially active is another cornerstone for optimal aging. And these days social connections includes those through social media: According to a 2014 study, training older adults to use social media helped to improve their mental well-being. It’s clearly never too late to learn!

Our outlook on life can also contribute to our ability to age well. A 2014 study finds that those who are cynical — that is, those who tend to believe that others are “mainly motivated by selfish concerns” — are more likely to have dementia. Researchers observed that depression rates were lower among older adults who used the internet, according to a 2014 study.

It’s of course also important to eat right. A 2014 study finds that one gramme (1g) of tumeric a day improves the memory of those in the early stages of diabetes (and who therefore have a higher risk of dementia). Other research shows that eating baked or broiled fish once a week is associated with better brain functioning among older adults. According to this 2014 study, it doesn’t matter whether the fish that you’re eating has a lot of omega-3 fatty acids or not. That means that including ikan kurau could be just as beneficial for your brain health as salmon is. Fish curry, anyone?

Pursuing mentally challenging activities also plays an important role in determining how we age. A 2014 study shows that having a mentally challenging job is associated with better cognitive functioning later in life, while another 2014 study finds that those who engage in intellectual activities are less likely to experience cognitive decline later in life.

But it’s not actually about playing more majong or playing video games. Rather, it’s important for us to learn new skills. As they say, either you use it or you lose it. And recent research does show that learning a demanding skill pays dividends.

So here are 3 simple ways to challenge yourself.

1. Shop at a different supermarket
Instead of going to your usual supermarket, challenge your brain by going to a supermarket that’s not familiar to you. By going to the a different NTUC, Giant, or Sheng Siong, you’ll be able to find the brands you want, but your brain will have to work harder to locate them. Plus it could save you time, especially if you did your grocery shopping together with your other errands at the same location.

2. Explore a new route
Instead of doing your errands by the usual route that you know, try a different route. It could be using a different MRT line or bus route. It could be finding a different way to walk from the bus stop or MRT station to your office or home. Challenge your brain to add more information to the mental map that you already have for that neighbourhood or area.

3. Learn a new routine
You may already have a hobby that involves learning a pattern or routine. If you already read music, learning to play a genre that’s new to you (e.g., jazz) or learning a new instrument (e.g., the ukelele) will definitely help you make new neural connections.

If your hobby involves movement, try learning a new form. For dancers, this could mean trying something new like ballet for adults, tango, or tap. For those who practise tai chi, it could mean learning another style or form. Instead of cycling, learn to roller-blade or ice-skate. Or try a cycling trail in a nature reserve instead of using the park connectors.

If you like learning languages, it may be time to switch to a new language. If you play chess, challenge yourself with a new strategy game like weiqi (圍棋) or bridge.

If you’re already very practised at solving sudoku and optimizing your Freecell score, you may be surprised to find out that doing more of the same (even if you’re attempting the really difficult stuff) isn’t likely to be helping you delay dementia.

Because if you’re not outside your comfort zone, your brain’s probably not busy making new neural connections and you’re not building up your cognitive reserve.

What’s the difference between mental health and mental illness?

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There are many local news stories which implicate mental health issues. But rarely an explanation about the mental health issue involved.

We use the term “mental illness” to refer to medical conditions including schizophrenia, depression, and bipolar disorder. Other times, we use the term “mental health” to refer to the same things.

But there are conceptual differences. WHO defines mental health as “a state of complete physical, mental and social well-being, and not merely the absence of disease“. That means that mental health is also about our immune system, physical health indices, life satisfaction, and psychological wellbeing, as well as our capacity to regulate mood and manage emotions, ability to manage daily stress, resilience, and coping mechanisms for dealing with stressful events.

The collaboration between mental health professionals and the police service (e.g., a UK pilot scheme) is a step in the right direction. Education is of course a reliable way to address mental health awareness issues at the workplace.

But what information is available about mental health in Singapore? A speedy search on google for local information about individual mental health issues and concerns yields at least one relevant website. Here’s a cheat sheet:

1. Stress
HPB lists the impact of stress on our physical and mental health: SAMH has useful tips for managing stress levels.

2. Depression
HPB lists symptoms to look out for: Insights into myths and misconceptions here.

3. Eating disorders
AWARE offers an FAQ on eating disorders here.

4. Anxiety
HPB offers an overview of anxiety, including symptoms and treatment options.

5. Obsessive Compulsive Disorder
HPB lists the symptoms of OCD.

6. Alcohol Dependence
NAMS lists the warning signs.

7. Gambling Problems
NAMS lists the signs to watch out for and offers a tool for self-assessment.

8. An Addiction to Gaming
Among the signs is the use of gaming as a means of escaping problems and the act of concealing game playing from family and friends. Read this NAMS overview.

9. Substance Dependence
Watch out for these behaviours in your co-workers (NAMS).

10. Schizophrenia
Schizophrenia is defined by IMH as “a disorder of fragmented mental processes”. Click here for more information.

11. Dementia
Working adults are increasingly faced with the challenges of juggling work and caregiving roles: Alzheimer’s Disease Association and HPB have fact sheets.

12. Learning Difficulties
Employees are also often parents who may have children with learning difficulties at school. Attention deficit (hyperactivity) disorder or ADHD information is available on Spark, while dyslexia assessments are available through the Dyslexia Association of Singapore. Autism resources are abundant at the Autism Resource Centre.

The International OCD Foundation has a useful fact sheet on hoarding. Finally, Singapore Focus on the Family offers advice for families faced with bullying at school, while the Media Literacy Council has information for individuals experiencing cyberbullying and AWARE has advice for personal protection orders and family violence.

Information is power. Don’t be afraid to use it.

Ageing successfully

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According to the World Health Organization (WHO), life expectancy and medical advances has lengthened lifespans in most countries, and the number of people aged 60 years and older has doubled since 1980. Living longer is easy, with the advances we’re making in the domain of science and medicine. But we’re probably more interested in answering the question of how we can age successfully. That and avoiding dementia.

On this International Day of Older Persons, let’s review what’s been known for a while:

1. Eat your veggies!

There’s no getting away from it. Studies show that those who live a long independent life in Okinawa eat lots of fruits and vegetables, as well as fish and whole-grains. Their habit of eating until they feel 80% full is also likely a major contributor to the reason for their disability-free longevity.

2. Stay active!

Research indicates that cardiovascular disease risk is a major contributor to Alzheimer’s and vascular dementia (Fratiglioni et al., 2004). Lowering this risk through regular, weekly moderate-to-vigorous exercise is one strategy. And also a reason why Sardinians, who herd sheep over steep hills, are reputed to age successfully (see this TED video about the blue zones).

3. Engage your social brain!

A review of the literature shows that adults who are socially active are also likely to have better psychological wellbeing in their later years; being engaged in social activities and having stronger social networks is a protective factor against dementia (Fratiglioni et al., 2004). Various studies show that religious attendance, community involvement, and being employed are associated with better mental wellbeing among older adults. These activities are also shown to be helpful for local residents too…

So to sum, it’s the same thing that us active younger (a little bit younger) adults need to start doing. But we just need to keep doing them!

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.

It’s the holidays!

It's Christmas!

As the holiday season approaches (well, the school holidays are already here but the adults are still earning their keep with their more-than-9-to-5 lifestyle), it’s not unusual for stress levels to rise. Whether you’re going away for the holidays or staying at home with the family (and possibly extended family), there’s opportunities for tempers to flare, tantrums to be thrown, and arguments to ensue. When it comes to keeping everyone happy, it may be prudent to pre-empt the disagreements:

1. Tips for parents

2. Tips for children

  • With holiday time being also time to revise study material, it’s good to know the best ways to do this. Top tips include giving oneself a quiz, having study goals, leaving you room to rest and engage in other fun activities, finding a good place and good buddies to study at and with.
  • Research also suggests that we remember information best if we process it in depth not superficially. This and other tips are described and explained here.
  • Self-testing and distributing the studying over time are more effective than underlining and re-reading textbook materials: Scientific American explains why.
  • Summarizing material also isn’t the best way to study; but rephrasing study material and explaining things in one’s own words is (Washington Post).

3. Tips for grandparents

  • There’s much research to indicate that engaging in mentally challenging activities has a protective role against dementia. The growth of new neural connections which result from cognitively demanding tasks such as mastering a new language, musical instrument, dance, or skill, are helpful in building cognitive reserves, which not only lowers the risk of Alzheimer’s dementia (AD) but reduces the effects of brain changes relating to AD (Stern, 2012).
  • But puzzles may not be challenging enough: It’s about doing something “unfamiliar” and not “inside your comfort zone” (“Learning new skill beats puzzles for boosting seniors’ memory“, CBS, 21 Oct 2013; APS, 31 Oct 2013).
  • Lifelong learning is one strategy used to build cognitive reserves.
  • Learning programmes which teach seniors new technology like Skype and social media at the Council of the Third Age not only allow learning to take place; the programmes enable seniors to keep engaged and in contact with their families.
  • A Graduate Diploma and Master in Gerontology is available at SIM University for the brave. Their next intake is in July 2014.
  • But if going back to school is not for you, it might be for your grandchildren. Temasek Polytechnic offers the Diploma in Gerontological Management Studies. Their academic year starts late April 2014.