Over 60

Cognitive Decline

Preventing Cognitive Decline in the Over-Sixties

Many people fear suffering cognitive decline as they get older. Some of that fear can be allayed by a reassurance that cognitive decline is not the same as cognitive impairment, which would otherwise indicate a greater risk of developing Alzheimer's or another form of dementia. Further reassurance comes from the fact that there is a great deal that individuals can do that may reduce their risk of cognitive decline and its severity. Most of these approaches can be followed regardless of a person's age but they assume greater importance as individuals age.

Distinguishing Cognitive Decline From Cognitive Impairment

Cognitive decline is regarded as a natural consequence of brain ageing. It affects certain brain functions, particularly working memory and speed of thought, more frequently than others. Meanwhile, verbal ability, for example, usually remains unaffected. Cognitive impairment, on the other hand, is not a normal part of brain ageing. It is estimated that between 5% and 20% of the over-65s suffer from some degree of mild cognitive impairment (MCI). Even for most of these people, their MCI is not sufficiently pronounced to prevent them from living independently. However, for one in six sufferers, their MCI will progress to dementia.

Self-help Strategies for Cognitive Decline

Whilst cognitive impairment and dementia are the results of genetic and environmental factors that individuals can usually do little to influence, the same is not true of cognitive decline. Research estimates that three-quarters of the factors that influence cognitive decline are those over which individuals can exercise varying degrees of control, vis:.
Diet
A healthy, balanced diet can reduce the chances of suffering cognitive decline. This does not have to mean an over-emphasis on goji berries, blueberries, wheatgrass or whatever is the current favourite “super food”. Instead, it means following a traditional approach to healthy eating, including plenty of fresh fruit and vegetables, especially leafy greens. There is some evidence to suggest that a Mediterranean-style diet may be particularly beneficial. This means a diet that centres around plant-based foods, including vegetables, fruit, legumes, whole grains and nuts. It also includes olive oil, oily fish and replacing salt with herbs and spices. Red meat consumption is usually limited to no more than a few times per month, but chicken can be eaten more frequently. Occasional small glasses of red wine are a popular optional feature of this diet. More recently, evidence has emerged that following a new diet, called the "MIND diet", can drastically slow mental decline. Sharing some similarities with the better known Mediterranean-diet, the MIND diet places less emphasis on fruit, dairy and potatoes, and does not require fish to be eaten more than once a week.
Exercise
Doctors and nutritionists who promote the Mediterranean or MIND diets tend to emphasise the need for it to include plenty of exercise. However, even those not following this diet should understand the relevance of exercise to reducing their risk of suffering cognitive decline. Research demonstrates a clear link between regular exercise and reduced cognitive decline. It appears that cardiovascular exercise sufficient to raise the heart rate results in increased blood flow to the brain and promotes increased levels of chemicals known as “brain-derived nerve growth factors”. The exercise taken need not be akin to training for a marathon. For many people, regular gardening or brisk walking can be sufficient to raise their heart rate. Strength training is also important and, with the right instruction, can even be done from a sitting position.
Keeping mentally active
There is evidence to suggest that those people with the highest levels of formal education are also some of those least likely to suffer either cognitive decline or dementia. However, even for those who are not Oxbridge graduates or PhD-holders, there is no need to despair. Learning and education at any stage of an individual’s life can be hugely beneficial. It also can be as simple as attending evening classes or engaging in an online learning programme. As well as formal learning, it is important not to neglect challenging the brain in everyday life. This can be achieved by activities like crosswords, Sudoku, jigsaw puzzles and strategic games, such as bridge. New NHS guidance emphasises the importance of staying mentally active throughout the entirety of an individual's life, in order to see the greatest benefits.
Companionship
Evidence suggests that those people who place significant emphasis on maintaining strong social networks benefit cognitively. Of course, not everyone is fortunate enough to have close family but lunch with friends, volunteering or participating in a group activity, such as singing, can all help to promote better brain health.
Sleep
Sleep does not always come easily, particularly for older people, who may wake earlier or experience increasing bouts of insomnia. However, managing to get the optimum amount of sleep, which, of course, varies between individuals, will reduce the likelihood of memory and processing problems. More generally, it will also ensure that it is easier to function properly and so enjoy each day to the fullest extent possible. Ensuring any sleep apnoea is treated, perhaps with oxygen supplementation while asleep, is also thought likely to be beneficial in reducing the risk of cognitive decline.

Maintaining Good Mental Health

Some scientists suspect that individuals with a history of depression are more likely to suffer cognitive decline. While no-one can prevent themselves becoming depressed, it is important to seek medical help in the event of depressive symptoms appearing. Depression is a medical condition and can be treated as such. From a self-care perspective, watching out for signs of stress and trying to manage it effectively are also important. Yoga, meditation and breathing exercises are all proven ways of helping to manage stress levels.

Preventing head injuries

Brain injuries significantly increase the risk of both cognitive decline and dementia. Wearing helmets when cycling, horse-riding, skiing or engaging in other similar sports is essential. So, too, is considering how best to prevent falls. For older people, or those with reduced mobility, this may mean installing grab rails in baths and showers, fitting a stair-lift and replacing steep or slippery steps with a ramp. When travelling in cars, at whatever age, seat belts should always be worn.

Heart health

Risk factors for cardiovascular disease and strokes also detrimentally affect brain health. Obsesity, raised blood pressure, high cholesterol levels and diabetes are all things to try to avoid. Following a healthy diet, which includes reducing salt and sugar intakes, and taking regular exercise help to counteract the risks to both heart and brain.

Further reading

1) harvard.edu: how to pevent cognitive decline
2) NHS: new 'brain diet' slows cognitive decline
3) NIHR: Being ‘mentally active’ limits cognitive decline in later life
4) PubMed: social networks V cognitive decline
5) NCBI: efects of sleep on risks of cognitive decline/dementa
6) NIA: risk factors for dementia
7) headway.org.uk: cognitive effects of brain injuries
8) livescience.com: heart health and cognitive impairment
9) Age UK: a major study into cognitive decline (written for professionals but reasonably clear to the rest of us, and well worth a read)
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