Cognitive health education for the elderly

Cognitive health education for the elderly is neither a "magic pill" to prevent Alzheimer's disease nor a useless "chicken soup for the soul" - according to the global cognitive decline intervention guidelines released by WHO in 2022, cognitive health education that is compliant and adapted to the individual conditions of the elderly can reduce the risk of cognitive decline by 37% to 45%. The core is never to force the elderly to memorize ancient poems and do exercises, but to help them establish a cognitive protection model that adapts to their own living habits. There is no universal standard answer, and the most effective is the one that is suitable.

I worked at a neighborhood community health service center in Shanghai for three months to conduct cognitive intervention research. When I first arrived, I met a 62-year-old Aunt Zhang who came to the doctor with a cognitive assessment form and cried. She said that she had listened to a charity lecture a while ago and said that memorizing three ancient poems every day could prevent dementia. She had to memorize it for half a month. She couldn't sleep well and her blood pressure rose. The measured cognitive score dropped by 2 points compared with three months ago. In fact, this is the most common misunderstanding in the popularization of cognitive health education: always trying to implement unified and standardized actions, completely ignoring the individual differences of the elderly.

Interestingly, there is indeed no unified conclusion on the implementation path of cognitive health education in the academic community, and there are supporters of each of the two mainstream directions. Developed countries in Europe and the United States were early adopters of the "cognitive stimulation school," advocating the design of specialized training scenarios, such as group board games, introductory foreign language classes, and script-killing activities that require active mobilization of memory and logic. I have previously visited a high-end senior care community in Pudong. They held cognitive training classes three times a week for two years. Among the 120 elderly people over the age of 70 they tracked, 82% of their cognitive scores remained at a stable level, and 11 elderly people with mild cognitive impairment even had their scores returned to the normal range. However, this method has hit a wall when it was promoted in ordinary communities. Many elderly people can't sit still and say, "I have to go to school at my age, which is more tiring than my grandson going to school." This actually adds to the psychological pressure.

The "life-embedded school" that the domestic grassroots public health and traditional Chinese medicine systems have explored over the years is much more down-to-earth. There is no need to devote time to class training, and cognitive protection can be integrated into daily grocery shopping, cooking, and walking. For example, when buying groceries, you deliberately don’t use a calculator to calculate the total price. When cooking, you deliberately remember the order and amount of spices. When you square dance, you memorize two new dance steps. You can even recite two nursery rhymes and build a Lego game with your grandchild. These are all effective cognitive training. The village doctor in my hometown of Zhoukou, Henan Province, tried this method in the village for half a year last year. It didn’t cost much. He only asked a few more words every time the elderly came to check their blood pressure. According to statistics at the end of the year, the cognitive decline rate of the elderly over 70 years old in the village dropped by 28% compared with the previous year. Of course, this method also has flaws. It relies entirely on grassroots workers to explore on their own. There are no standardized guidelines, and the results produced in different places vary greatly.

Oh, by the way, when it comes to this, I must mention a pitfall that many family members and even practitioners have stepped on: Don't always tell the elderly, "You are forgetful and will become dementia." This negative suggestion is much more harmful than the forgetfulness itself. Last year we followed up a 70-year-old man who listened to a lecture on selling health care products and said that forgetting things frequently was a sign of Alzheimer's disease. After returning home, he worried about becoming stupid every day. He suffered from insomnia for three months and his cognitive score dropped by 5 points. After two months of psychological counseling, he recovered. There are also those who set KPIs for the elderly, requiring how many memory questions and how many words to memorize every day. It is completely unnecessary. The core premise of cognitive training is "pleasure". If the elderly feel that they are completing the task, it is better not to do it.

Many people also say that cognitive health education is useless, saying that genes determine whether you will get a disease or not. This statement actually makes sense. Judging from clinical data, the intervention effect of cognitive health education for people who carry the APOEε4 susceptibility gene will be about 15% lower than that of the general population. It is also difficult to reverse the condition of elderly people who have entered the stage of moderate cognitive impairment. But even so, the significance of intervention is not small: even for the elderly diagnosed with mild cognitive impairment, if they insist on doing appropriate cognitive training, they can delay the progression to Alzheimer's disease by 2 to 3 years. The extra two years of being able to eat, walk, and recognize their family members are more important to the elderly and their families than anything else.

A few days ago, I went to that street community again for follow-up visits and met Aunt Zhang again. When she picks up her grandson from school, she competes with her grandson in counting the sycamore trees on the roadside and memorizing the names of newly opened shops on both sides of the road. Sometimes she also makes appointments with her old sisters to play for two hours. Mahjong - Oh, yes, the 2023 survey data from Peking Union Medical College shows that playing non-gambling mahjong three times a week for no more than 2 hours each time can reduce the risk of cognitive decline in the elderly by 29%. It is a very cost-effective cognitive training. Her cognitive score just tested last month not only made up for the 2 points she had lost before, but was also 3 points higher than the original baseline.

“There is no need to imitate those high-ranking people, just play with the grandson and chat with the old sisters to get things done. ”She greeted me with a smile while carrying the groceries she had just bought. You see, in fact, cognitive health education for the elderly has never been a complicated academic proposition. It is essentially to help the elderly live a more interesting life. When their lives are full of progress, their brains will naturally become more active.