‘There’s no one magic activity’

Researchers have long held that a heart-healthy diet and an active mind are among your best defenses against dementia.

But evidence continues to mount that you should also strive for a life of learning.

Recent studies suggest that mental stimulation at any age—from teens to post-retirement—is apt to improve the odds of enjoying a sound, healthy mind well into your twilight.

JAMA Neurology recently published results from a Minnesota study that found people ages 70 and older could decrease their risk of developing mild cognitive impairment by engaging in activities such as books, crafts, computers, games and socializing.

Interestingly, crafts and computers were especially associated with a decreased risk, according to the study.

Perhaps more compelling, however, is a separate JAMA Internal Medicine study that found an increase in educational attainment when you’re young may lead to a healthier brain in later ages.

Helmed by professor Kenneth Langa, the study reinforces what other researchers have been noticing—an unexpected but encouraging decline in dementia rates among the aging population in the U.S.

Langa and his team uncovered the association between dementia and educational attainment.

They measured dementia rates in two groups, one with an average age of 75 in 2000, the other with an average age of 75 in 2012. They found the dementia rate at 11.6 percent in the first group, 8.8 percent in the second group.

While those in the first group had attained about 11.8 years of education, on average, those in the second group attained about 12.7 years—almost a full additional year.

Coincidentally, the increasing value Americans have placed on education is borne out in the historical data. Prior to World War II, about 38 percent of those ages 25 to 29 had completed high school. By 1960, more than 60 percent in this age group had completed high school.

In comparing earlier generations to subsequent ones, it may suggest a greater return than expected on education: brain health benefits.

Rethinking Dementia

In 35 years as a doctor, Spectrum Health’s Iris Boettcher, MD, has seen positive changes in the realm of dementia treatment—new studies, valuable findings, useful advice.

Awareness, however, is one aspect that still needs some work.

“There is a lot of undiagnosed dementia,” she said. “People just attribute it to old age.”

At a recent community event, she heard from one woman whose mother had recently moved in. The woman repeatedly insisted her mother didn’t have dementia, despite the fact she “can’t figure out how to turn the coffee pot on, she can’t remember what I told her, and she can’t remember to take her pills,” Dr. Boettcher said.

“I said, ‘I think it might be a good thing to have that checked out,’” Dr. Boettcher said. “Once you have a diagnosis, you can then understand that it is a disease—as opposed to attributing it to people just being stubborn or writing it off as old age.

“I think that’s sad,” she said. “You never really get the education around how to deal with someone who has dementia as an illness, and how to approach managing the disease. That’s a concern.”

The good news is that awareness is growing.

“There’s more and more support in the community for people with dementia,” Dr. Boettcher said. “Grand Rapids in particular has a campaign going on around becoming a dementia-friendly community.”

That campaign, Rethinking Dementia, teaches people how to interact with those who have dementia.

“There are simple things you can do,” she said. “One is just recognizing that someone may be having trouble. There are opportunities for people to learn. You don’t have to be clinical—it’s just good citizenship, learning how to work with people who have dementia.”

The notion that education could promote longer-term brain health is certainly not lost on the legion of gerontologists and neurologists responsible for treating some of the 5 million Americans living with Alzheimer’s, and millions more suffering from various forms of dementia.

“We know from other studies that education does appear to be a protective factor, so folks with more education are less likely to develop dementia,” said Maegan Hatfield-Eldred, PhD, a neuropsychologist with Spectrum Health.

“The idea is that education, learning new things, stimulates the parts of the brain that produce new cells and grow connections between cells,” Dr. Hatfield-Eldred said. “So people with more education have more brain matter that they can lose, and still maintain normal functioning.”

The implication here, of course, is that this brain stimulation and development occurs in youth and continues to benefit people into old age.

The takeaway: Brain health isn’t something to ruminate post-retirement.

It’s something parents should keep in mind for themselves and their children from the get-go, with consistent emphasis on education and intellectual development.

“It really emphasizes the importance of thinking about brain health over your lifespan,” Dr. Hatfield-Eldred said. “This isn’t something you should think about when you turn 70. It’s really a lifetime thing. The things you do over your lifespan impact whether you may develop dementia down the road.”

Ponder it

A question remains: What can you do now, as an adult, to increase the chances you’ll have a healthy brain into your 70s, 80s and beyond?

While age is the biggest determinant in the development of Alzheimer’s and forms of dementia, genetic factors also play a substantial role. There is currently no cure for Alzheimer’s, although some medications can alleviate the symptoms.

“The No. 1 risk factor for Alzheimer’s disease is your age,” said Iris Boettcher, MD, chief of geriatrics for Spectrum Health. “The older you get, the higher the risk.”

You can’t change your genes, but you can change your lifestyle.

Activities that require mental concentration are all apt to help with cognitive function, Dr. Boettcher said.

“The advice I give, even once the diagnosis of dementia is made, is we know that regular mental stimulation is helpful in reducing the progression of the disease,” she said.

Dr. Boettcher is especially keen on discussions and activities that encourage higher-level thinking.

“People say reading, and reading is OK, but it’s really discussing what you have read,” she said. “You can read things over and over again, but it’s not necessarily constructive brain stimulation.”

While that’s no call to run out and enroll in the physics track at your local university, it is a call to challenge yourself mentally.

“It’s not a cure-all,” Dr. Hatfield-Eldred said. “But in general, we know that people who stay (mentally) active have lower (dementia) rates. It may prolong the onset of dementia if you are someone who was going to develop dementia. Maybe you’ll get it later than you would, or maybe it will progress more slowly than it would have without those activities.”

Drs. Hatfield-Eldred and Boettcher also emphasize the importance of regular exercise—at least three times a week, about 20 to 30 minutes each time—and a heart-healthy diet such as the Mediterranean diet.

“It’s been shown in multiple studies: It reduces the progression of dementia and it’s healthy for the brain,” Dr. Boettcher said. “You don’t have to be a marathon runner or work out in a gym. It’s very simple.”

The take-home message from these studies: “There’s no one magic activity,” Dr. Hatfield-Eldred said.

Just eat right, exercise and study hard.