cognitive health in older adults

About 40% of cases of cognitive impairment in the elderly can be delayed or even avoided through the intervention of controllable factors. There is no so-called universal "magic prescription". A combination plan of living habits, medical intervention, and social participation based on individual conditions is currently the most effective path proven.

When I was stationed at a community cognitive screening site last week, I met 68-year-old Aunt Zhang who was crying while clutching the report. Last year, she could memorize the entire "Health Tips and Taboos for the Elderly" by heart. This year, she even had to write down her grandson's 11-digit mobile phone number on the back of her hand. From time to time, she forgot to turn off the gas. CDR (Clinical Dr. The Dementia Rating Scale (Dementia Rating Scale) has a score of 0.5, which is just at the point of subjective cognitive decline. Doctor Shinuchi who is attending the clinic put it very bluntly: If you are still bored at home lying on the sofa and watching short videos every day, without even going downstairs, the probability of developing mild cognitive impairment within 3 years is 62% higher than that of an elderly person who often goes out to socialize.

In the past few years of doing cognitive intervention at the grassroots level, the most common question I have encountered is “What exactly is effective? ”, there is even a lot of quarrel within the academic community. The Neurocognitive Laboratory in North America previously published a paper saying that playing targeted digital puzzle games for 15 minutes a day can increase the cognitive test scores of the elderly by an average of 29% after one year. Many brands of cognitive training products use this report as a promotional template. However, when we talked privately with the public health workers in the community, we all felt that it was a bit "paper talk" - we had previously followed up on several elderly people who played Sudoku and puzzle games at home every day, and their cognitive decline was much faster than that of the elderly who spent their days in square dance groups and bargaining at the vegetable market. To put it bluntly, Well, the training of the former is one-dimensional, while the training of the latter is done while moving the legs and walking, chatting with people about family history, exercising language expression, and even practicing calculation skills when doing accounting. It is equivalent to giving the brain several different kinds of fresh stimulation at the same time, and the effects are of course different.

Another point that is even more controversial is "whether supplements are useful or not." Many health care product manufacturers tout DHA, Ginkgo leaf extract, and phosphatidylserine as "cognitive miracle drugs." Children are afraid that the elderly will have problems, so they move boxes of thousands of dollars worth of stuff home. But a 2023 meta-analysis in "The Lancet Elderly Health" made it very clear: for healthy elderly people who have no nutritional deficiencies, the cognitive improvement effect of additional supplements of these nutrients is not statistically different from taking a placebo. But this is not a dead end. If an elderly person is found to have vitamin B12 deficiency, low folic acid levels, or an extremely unbalanced daily dietary intake, targeted supplementation according to the doctor's advice can indeed slow down the rate of cognitive decline. We met an old man before who took B12 supplements for 3 months, and most of his previous forgetfulness problems were cured.

Last year we followed up with 72-year-old Uncle Li. When he was first diagnosed with mild cognitive impairment, his son bought him a cabinet of supplements and signed up for a paid online brain training course. He did questions on a tablet at home every day. After three months of reexamination, his cognitive score did not improve at all, and his blood pressure was so boring that his blood pressure was high. Later, we changed the plan for him and did not ask him to do any training. We asked him to go to the vegetable market with his wife for 20 minutes every morning, bargaining if he could, and to go to the park to play Tai Chi for half an hour in the afternoon. After dinner in the evening, he taught his elementary school granddaughter to recite two Tang poems. He persisted like this for half a year. When he was re-examined, his episodic memory and concentration scores increased by 17 points. He himself said, "It is much more comfortable than doing questions at home, and his brain seems to be moving faster."

Many people don’t know that hearing loss is also a hidden trigger of cognitive decline. Many elderly people think that "early hearing loss is normal" and would rather listen in front of others than wear hearing aids. In fact, the 2021 WHO report said that the cognitive decline rate of elderly people with moderate or above moderate hearing loss without intervention is 2.4 times that of elderly people with normal hearing. To put it bluntly, the brain cannot receive enough external information for a long time, and gradually becomes "lazy", and the reaction naturally becomes slower and slower.

Last week I met Aunt Zhang at the gate of the community. She had just returned from a tour with the square dance team in the next street. She held half a bag of strawberries she had just bought and stuffed it at our screening point. She said that she could now remember the birthdays of the 12 sisters in the team. She even remembered the last time I told her to watch short videos for an hour less. She took out the back of her hand and showed it to me. The place where her mobile phone number was previously written was now the rehearsal time of the square dance team next week.

In fact, there is no universal way to protect the brain. It is better than anything else to make the elderly more grounded and encounter more lively people and things.