Sep 13, 2010
By: Alvaro Fernandez
(Editor’s Note: you may have read all the confusing -if not outright misleading- recent media coverage on the effect of mental stimulation on cognitive health and Alzheimer’s Disease. To help clarify matters, please find below part of the ongoing discussion at SharpBrains’ group in LinkedIn, and keep tuned since in a few days we’ll be publishing an analysis of the scientific study that, while bringing largely Good News, has been largely reported as Terrible News.)
Stuart • I just came across this article in Medical News…Mental Stimulation Delays The Decline In Thinking Skills, But May Accelerate Dementia Later On….
It’s the first time I have seen an article talking about the potential down side of mental stimulation in later life…I would be interested in the views of the more qualified than myself in this area…http://tinyurl.com/22ovdfv
Jenny • I wouldn’t say I was more qualified. However having read this article although initially it would seem a disappointment that having done all that mentally stimulating activity to build one’s cognitive reserve to then be subject to a rapid downhill decline. But in fact I think the study is good news. Firstly it supports the notion that by being engaged in mentally stimulating activities we can maintain our cognition as we age. Secondly we may be on the way to developing dementia but isn’t it better to delay or defer the onset fro as long as possible? It may be by the time the symptoms manifest themselves we have meanwhile being enjoying continuing to live normally.
In the Nun study the autopsies of some of the nuns brains showed they were full of Alzheimer’s disease yet clinically had shown no outward sign. I believe this study is very important in reinforcing the message that we all benefit from keeping mentally fit.
The other key point is that by deferring the onset of symptoms the economic and social savings to the health system and society will be huge.
And lastly. If I had the choice between living for longer symptom free of dementia and then going into a rapid decline I think I would choose that any day over the possibility of developing symptoms earlier and living longer with the disease.
So I don’t see this article as having a down side. Being mentally engaged and having a bigger cognitive reserve, does not confer immunity against dementia and I don’t believe has ever purported to do so. Maybe that has just been our wishful thinking.
Stuart • Jenny……thank you for your comments, I recall reading the article on the Nun study which was very interesting in terms of their findings. I totally agree doing something to remain mentally active completely outweighs doing nothing, in addition of course to exercise and good nutrition, if we take this approach we give ourselves the best chance….this is what I am hoping !!
Alvaro • Jenny, excellent explanation! this is another example where it is key to understand that brain fitness is much more than the absence of Alzheimer’s plaques & tangles, it is the brain functionality that we can build through life in order to a) remain healthy and productive longer, every single day we live (objective 1), b) compress the potential disease time at the end of our lives (objective 2).
Also, the talk about rates of cognitive decline can be very misleading: if I have nothing to decline from, of course the rate of decline will be lower than if my starting point is higher and more functional. The rate of decline when I descend from the peak of Mt Everest is of course going to be higher than if I descend from my nearby little hill. The main point is: how long can I be over the threshold of required functionality to live and work well?
Shelah • After I read the article, I remembered a study I had read about in the 80’s, one which tracked retired nuns living in a convent in Minnesota. Their particular order’s vows emphasized mental vigor, so these women were learning new skills, e.g., painting, violin, bridge–even Chinese, in their 60’s, 70’s and 80’s.
The study concluded that the rate of Alzheimer’s disease among the nuns was dramatically lower than in the general population; furthermore, among those whose autopsies confirmed a diagnosis of Alzheimer’s Disease, the telltale signs in the brain were much less advanced than subjects in a control group who had had symptoms of the disease for an equivalent period of time.
I know that recent studies are given more weight in many cases; perhaps, though, the two studies are not mutually exclusive.
Stuart • Shelah ….I was interested in your comments relating to retired nuns, and the findings going back to the 80”, my own view would be that the two studies, the one in the 80’s you mention, and the recent study mentioned by Jenny, confirm that brain health requires a holistic approach to life.
In “The sharpbrains guide to brain fitness” book, by Alvaro and Dr. Elkhonon Goldberg, (which I think is great short ref. book on brain fitness) , they talk about the 4 pillars of brain health as being, 1. Balanced nutrition, 2. Stress management, 3. Physical exercise, 4. Mental stimulation. When I think about it, if you project these 4 pillars onto what we understand to be the life style of a Nun, you can pretty much tick the box on all 4 points, in terms of how they live their lives.
Not suggesting we all need to live like nuns, but I cannot recall every seeing a nun eating a big mac or throwing a tantrum !!. …….. The more I read about brain health, and the continued discoveries from neuroscience, the more I appreciate that brain health is not just about mental stimulation, to optimize your brain health you need to try and follow the right life style.
Daniel • Alvaro is correct that the “rate of decline” can be very misleading. In discussing this article, we have to keep this in mind, and find a good way to explain this to people. For example, if you knew you had a progressive fatal condition (Alzheimer’s) that was definitely going to kill you in 10 years, then which of the following would you prefer:
1) Steady, gradual, progressive deterioration over 10 years, with death at that point (i.e. a slow rate of cognitive decline)
2) Symptom free life for 9 years, followed by rapid deterioration in year 10 ending in death (i.e. an eventual rapid cognitive decline, at the end stage of illness).
Anyone in their right mind would choose option 2 over option 1.
Paula • Very concerned about the article and the representation of information about mental stimulation. I am a Registered Nurse specializing in the field of cognitive interventions with individuals challenged with early onset Alzheimer’s, early stage dementias, and any condition that exhibits cogntive decline. Much of our work has been focused on providing very specialized interventions and activities for these individuals. With this representation I fear that the perception of the public would be that once diagnosed with dementia that doing any cognitive intervention or activities would hasten their decline. I would not ever believe this to be true. Providing opportunities for individuals to engage in cognitive and socially stimulating activities will provide for the opportunity to prolong independence, purpose and quality of life. I would be interested in additional feedback on how to better explain this research and findings.
Anne • Paula makes a good point regarding how people might receive this recent information about mental stimulation. For an example of how information can be over simplified visit WCTV.tv: http://www.wctv.tv/healthmatters/headlines/102387459.html
The report is titled ‘Health Matters: Why you shouldn’t play mentally stimulating games’
Erica • I would have preferred to see the author position the title in this manner: Studies have indicated that there will be people for which additional mental stimulation will effect a positive delay in decline of thinking skills to such a degree that they will succumb to something other than Alzheimer’s (regardless of pathology).
The original article and subsequent over simplifications are really salient examples of how far we have come, yet how much further we have to go with regard to public education on the subject of brain fitness. I agree with Alvaro that an important aspect of education with regard to brain fitness is functionality. The author positions the study as a case of the cure being worse than the disease which couldn’t be further from the truth. When parsed carefully, as Jenny reflected above, the article is positive. First, “mental stimulation delays the decline in thinking skills”, is certainly encouraging and exciting on any level. Second, “…may accelerate dementia later on”, that is if the symptoms (regardless of pathology) even manifest in which case, I would agree with Daniel.
The big picture: “Individuals who lead mentally stimulating lives, through education, occupation and leisure activities, have reduced risk of developing Alzheimer’s symptoms. Studies suggest that they have 35–40% less risk of manifesting the disease”- Dr. Yaakov Stern, Division Leader of the Cognitive Neuroscience Division of the Sergievsky Center at the College of Physicians and Surgeons of Columbia University, New York. Read Full Interview Notes.