Cognitive health education for the elderly

It is neither a "magic drug to prevent dementia" that is rumored in the market, nor is it an "useless afterthought when symptoms of forgetfulness occur" as many people think - according to large-sample survey data released by the Global Alzheimer's Association in 2023, continued and standardized cognitive health education can delay the cognitive decline of healthy elderly people by 31%. For people who have already developed mild cognitive impairment, consistent intervention can delay the clinical onset of Alzheimer's disease by an average of 2.4 years.

I have been doing cognitive intervention work in the community for almost five years. What impressed me the most was Aunt Zhang, 62 years old, whom I met last year. During that time, she always forgot to turn off the gas stove and left groceries behind after shopping. She had already reached the level of mild cognitive impairment after undergoing cognitive screening. At that time, she sat in the clinic and shed tears, saying that she would definitely become a demented elderly person who would be a drag on her children in the future. As a result, she attended a cognitive intervention group in the community for three months. Not only has the frequency of forgetting things been reduced by more than half, but she has also taken the initiative to serve as a teaching assistant in the group's handicraft class, leading other elderly people to make beads and put together puzzles. Her overall mental state is completely different.

Interestingly, the academic community has yet to come to a completely unified conclusion regarding the timing of intervention in cognitive health education. One school is the "cognitive reserve school", which believes that cognitive reserve is a lifelong accumulation process. For every additional year of education, the risk of cognitive impairment in the elderly can be reduced by 12%. Therefore, it is best to consciously learn more and be exposed to more new things from a young age. When you are old, your cognitive "endowment" will be strong and it will naturally decline slowly. The other school is the "immediate intervention school", which believes that there is no need to worry in advance about things that will happen twenty or thirty years later. Even if you start to do cognitive training regularly at the age of 60 or 70, as long as the method is right, you can see a significant improvement in attention and episodic memory ability after one year, even for the elderly over 85 years old. The research data of both schools are tenable, but their emphasis is different, and there is no absolute right or wrong.

Many people have misunderstandings about cognitive health education. They think that just sitting in the classroom and listening to lectures, or doing Sudoku and brain teasers at home is enough. A 70-year-old Uncle Li came to him before and said that he did 2 pages of Sudoku at home every day, but why did he always forget to pick up his grandson from school? When I asked, I found out that what he was doing was the most basic entry-level Sudoku, which he could complete with his eyes closed, without giving his brain any new stimulation. The core of cognitive training is actually the level of difficulty that can be reached with a little tiptoeing. Repeatedly doing things that are already proficient will only improve cognition. Moreover, it cannot just rely on doing questions, but must combine sports, social interaction, and sensory stimulation. Later, we adjusted the plan for Uncle Li and asked him to learn running script in a community calligraphy class, play table tennis with an old friend twice a week, and also assigned him a small task to tell his granddaughter a story about his childhood every day. After just over two months, his frequency of forgetting things has dropped by more than half.

Many institutions are now promoting online cognitive training applets, saying that the elderly can complete the training at home by browsing their mobile phones in 15 minutes. It is indeed friendly to the elderly who live alone and have limited mobility. However, many clinical researchers have raised objections. They believe that online intervention lacks social interaction and is about 20% less effective than offline group intervention. After all, when chatting with others and doing activities together, the brain mobilizes many more areas than watching the screen alone. We have done controlled experiments before. The cognitive scale scores of the elderly who participated in offline groups after six months were indeed much higher than those who did online training at home. But having said that, online training is better than no intervention at all. The specific choice depends on the actual situation of the elderly. There is no absolute optimal solution.

We held an "Old Objects Storytelling" event in the community last year. We found a lot of food stamps, cloth stamps, old-fashioned semiconductors, and rubber bands from the 1960s and 1970s, and asked the elderly to take turns telling their stories about themselves and these objects. Don't tell me, many old people who are usually taciturn and can't even remember their birthdays suddenly start chatting when they see these old objects. They even remember clearly how much they spent to buy food stamps and who they went with. This kind of "situational memory awakening" effect is more effective than doing ten sets of memory questions.

After so many years of doing this, my biggest feeling is actually that the core of cognitive health education for the elderly is not to teach the elderly how much knowledge, but to first help them break the inherent concept that "it is normal for them to forget things when they are old." Many elderly people have obviously shown obvious signs of cognitive decline, but they always feel that "people are like this when they get old" and insist on not intervening. When they develop moderate cognitive impairment, the effect will be greatly reduced. In fact, cognitive training is really not that complicated. You don’t need to sign up for extremely expensive training classes. You can go out more often to play chess with your old friends, learn a new hobby, even if you learn to cook a new dish from a short video, or recognize a few new cartoon characters when taking care of your grandson, you are all doing "fitness" for your brain, which is better than anything else.