How to maintain the Cognitive Health as a Part of Healthy ageing? - Dr Pramod Krishnan

Even though all of us would like to age without any decline in our cognitive functions, the reality is that aging involves a slow and steady decline in our cognitive abilities.

As we approach age 60, our cognitive speed with respect to new learning, processing, responses, analysis, problem solving and reasoning gradually decline while our fund of knowledge and vocabulary remains stable.

This is accompanied by a gradual reduction in brain volume. In a substantial minority, this cognitive decline is minimal even at advanced age.

Though the reason for this heterogeneity is likely a combination of genetic and lifestyle factors, certain measures may reduce the risk of accelerated age-related cognitive decline and prevent conversion to disease states like dementia.

Dementia is an umbrella term representing a group of diseases characterised by a progressive decline in cognitive abilities that is sufficiently severe to affect the day-to-day activities of the individual. Alzheimer’s disease is the most common type of dementia worldwide with decline in recent memory as its most defining clinical symptoms.

Measures to Maintain Cognitive Health:

Though there are a few very expensive therapies to treat early Alzheimer’s disease, these are currently not available in India and have only modest benefit. We will therefore focus on preventive aspects to maintain good cognitive functions and prevent progression to dementia, and these need to be incorporated early in life and enhanced as we age.

1. Regular exercise: apart from regular exercise like brisk walking or jogging, one should attempt age-appropriate activities like swimming, cycling or working out in the gym to maintain physical fitness. Doing household chores and gardening can keep the body slim and trim. A physically fit body means a sharper cognitive ability. The key is to keep moving. Regular practice of yoga can also improve cognitive functions.
2. Healthy diet: A well-balanced diet rich in vegetables, fruits, nuts, berries, milk products and meat (for non-vegetarians) provide the body and brain with the essential nutrients to stay healthy. Vitamin B 12 supplements can be considered in vegetarians and for those with low levels of this vitamin.
3. Sleep: Chronic sleep deprivation, poor sleep quality and sleep disorders like obstructive sleep apnea (OSA) are proven to impact cognitive functions adversely. Addressing both the quality and quantity of sleep through good sleep hygiene measures and correction of OSA will enhance cognitive abilities in the long run.
4. Do not retire: While retirement from a job may not be avoidable for most people, it is important not to acquire a ‘retired’ mentality. Maintaining physical independence, managing one’s home and its needs, continuing to work if one finds it enjoyable, pursuing new avenues for employment, managing one’s finances and refusing help for activities one can do on their own goes a long way in keeping the body and brain sharp.
5. Social bonding: Interacting with multiple people from different walks of life, being part of various social groups, attending festivities and other functions, visiting friends and family, having guests over, and interacting with people with varied interests are highly stimulating for the brain. This is exemplified by the recent experience with social isolation due to COVID resulting in many older people developing cognitive decline and dementia.
6. Cognitive stimulation: This may include a variety of activities like solving different types of puzzles, creative work like painting, sketching and other hobbies, engaging in discussions and debates with friends and colleagues, reading analytic articles, writing diary and opinions, among others. Learning new skills like a new language or a musical instrument is one of the most powerful ways to stimulate the brain.
7. Management of stress: Managing chronic stress through activities like mindfulness and meditation or seeking necessary help through counselling or psychiatric interventions will prevent cognitive blunting. Identification and early management of psychiatric conditions like generalised anxiety disorder and major depression can have dramatic impact on cognitive abilities. Clinically significant depression can mimic dementia.
8. Travel and new experiences: Traveling to new places and exposure to new cultures and environments are considered an effective way to stimulate the brain.
9. Control of vascular risk factors: Progression to dementia can be reduced significantly by better identification and control of vascular risk factors like hypertension, diabetes mellitus and dyslipidemia, reduction in alcohol use and cessation of smoking.
10. Other medical disorders: Hormone deficiencies like hypothyroidism and adrenal insufficiency, vitamin deficiencies, chronic pain syndromes, chronic fatigue syndrome among others are often associated with decline in intellectual abilities. Prompt identification and treatment can reverse such a decline and prevent any further occurrence of such symptoms.