Countering Cognitive Decline - Awareness of Social Prescribing and Making Links

John Bews, from U3A Heswall, has been one of a small team concerned with dementia prevention and have been working on an action plan to encourage popular participation in a range of activities, recommended by the experts, that might reduce the risk of future cognitive decline. He has kindly provided this blog article to VSNW to explain further.

“My interest in this subject arises from within U3A where the National Subject Adviser on Memory and I have developed a memory workshop manual in the form of a keynote presentation which we have successfully delivered around the network. It was originally designed to be mainly educational and entertaining, but has recently gained an additional, more vital, dimension in the role of helping to counter cognitive decline. This is not only of importance to U3A members but is worthy of wider circulation to our ageing population.”

Need for action

Our journey to this point follows the increased public awareness of dementia/Alzheimer’s, with an estimated 850,000 confirmed cases in the UK, and this figure likely to increase. As you know, there is currently no cure for this condition and the race is on to find an answer. Some progress is being made and there are claims that there will be a positive solution ‘within the foreseeable future’. Neuroscientist Joseph Jebelli, in his 2017 book ‘In Pursuit of Memory - the fight against Alzheimer’s’ states, “We are closer than ever to the abolition of Alzheimer’s”.

In pursuing this investigative work to find a cure, attention has been given to the origins and cause of the problem from which it has been noted that particular lifestyles have a major influence in minimising cognitive decline. This opens up a second line of offence and introduces self-help measures to tackle the problem. Prevention is now considered to be of major importance.

Prevention

The Alzheimer’s Society says, “Delaying the onset of dementia by five years would cut the number of people affected by a third by 2030” and, “A treatment that could slow a disease like Alzheimer’s by 25% would almost halve the number of people in the severe stages of the disease by 2050.”

Numerous experts (see references below), including Alzheimer’s Society and Alzheimer’s Research, now recognise that engagement in particular lifestyle activities is paramount in countering the risk of cognitive decline. The Global Council on Brain Health have said, “More research is needed on the impacts that cognitively stimulating activities have on the brain, but we have sufficient evidence to conclude that it is beneficial to remain mentally active and to continue learning over the course of your lifespan”.

The range of recommended activities is broadly acknowledged by all parties but does have some variants and there is no definitive list. This is partly because the specific activities have not yet been evaluated for their effectiveness, and disparate research projects continually add their new findings to the growing accumulation of knowledge. In addition, there is a piecemeal flow of random advice in the media (See examples below) which Alzheimer’s and other experts say should be read with caution.

Refining the message

What is needed is an overview of the full range of recommended lifestyles to enable everybody to become engaged. The point here is that we are all different and, just as Dr Dale Bredesen says that there is no ‘one fits all’ solution, so there needs to be a ‘pick and mix’ choice of activities to empower people to accommodate their particular needs.

In order to assist and encourage individuals to engage in suitably effective activities, what is needed is a general understanding of the benefits of the recommended lifestyles.

In the book, ‘The Preservation of Memory’ edited by David Bruno and containing contributions from scholars of cognitive science it says, “In working with older adults, it is extremely useful to present knowledge about how memory works, and in particular, explanations about the ageing process and memory” (Troyer 2001).

U3A Memory Presentation

Our presentation endeavours to meet this need by first explaining in simple, layperson terms how the brain works in managing memory, including its strengths and weaknesses. It then utilises this information to refresh the memory process itself and make recommendations for its continued maintenance.

We have drawn on a wide collection of recommended lifestyle activities and have categorised them into recognisable groups, which we have then matched with the earlier, simple explanations as to their cause and effect on memory maintenance. This not only helps individuals understand their importance and benefit, but also empowers them to pick and mix their own selection of activities to help counter cognitive decline. “Ballroom dancing or learning a new language may be beneficial - but why is that and couldn’t I do something else instead?”

To answer this question, we have produced an action plan to help individuals identify and select their preferences. This can be used to assess an individual’s current performance level; plan for future improvement and review and monitor subsequent effectiveness. This would not only regularise and encourage a popular uptake but could provide a valuable source of data in assessing effectiveness.

Further Development

Two further elements are required:

• The extensive dissemination of the message to encourage self-help participants; and

• The comprehensive listing of organised activities and events to attract the more reticent. This would include an expansion of provision to fill gaps

Conclusion

We are not medical experts and recommend anyone with concerns about their memory to consult their GP. We are lay students (75 years plus) with a strong shared interest in cognitive matters stretching back over many years. We believe that our presentation is different from any other work on the subject, is easy to understand and could benefit a wider audience in pursuit of the ‘prevention’ target.

References and Sources

David Bruno’s book, ‘The Preservation of Memory’ says, “In working with older adults, it is extremely useful to present knowledge about how memory works, and in particular, explanations about the ageing process and memory” (Troyer 2001)

Both Dr Dale Bredesen, ‘The End of Alzheimer’s’, and Joseph Jebelli, ‘In Pursuit of Memory’ recommend these lifestyle activities as being of benefit in postponing cognitive decline.

In his book, ‘The Brain’ and TV series, neuroscientist David Eagleman concludes that the key to postponing cognitive loss is to adopt a lifestyle to include cognitive exercise such as crosswords, learning new skills, social and physical activity.

The Global Council on Brain Health - (a collaborative of scientists, professionals, scholars and experts from around the world) in their March 2017 meeting ‘Engage Your Brain’ concluded with a recommendation to, “incorporate enjoyable, cognitively stimulating activities (CSA) as part of a healthy lifestyle to help maintain your brain health and reduce the risk of cognitive decline as you get older”. Also - Knowledge Gaps - “More research needed to better understand the underlying mechanisms involved in cognitive stimulation. One major problem is how to measure the benefits.”

And - Conclusion - “More research needed on impacts that CSA have on the brain, but we have sufficient evidence to conclude that it is beneficial to remain mentally active and to continue learning over the course of your life span”.

Michael Mosley on TV’s ‘Trust Me I’m a Doctor’ undertook, ‘The big brain maintenance experiment’ in which he tested and recommended three lifestyles to help maintain, and even improve, cognitive skills.

Alzheimer’s Society and Alzheimer’s Research have publications on ‘Reducing the Risk’ which list recommended lifestyle activities.

Public Health for England PHE Report 16 June 2018:

People over 40 in England will be given advice on how to reduce the risk of dementia as part of their free NHS health check.

Daily Mail news items:

Even slightly higher blood pressure raises the risk of dementia. DM Jun 13 2018

Sleep, exercise and a wee tipple … how to ward off Alzheimer’s. DM Jun 7 2018

Eat healthily ‘to have a bigger brain and stave off dementia”. DM May 17 2018

How learning a language helps ward off dementia DM Feb 8 2018

Drug to slow dementia “just three years away’. DM March 21 2018

Now that’s clever … Being bright helps you to live longer. DM March 13 2018

What to eat to beat dementia. DM January 30 2018

Jog Your Memory With Exercise DM 30 2018

How to make sure you never forget your brolly again. Dm 12 August 2017

How to never forget where you left your keys. Dm 2 December 2017

Listening? Now you can prove it. DM 23 February 2018

Why women are not dreaming enough DM 21 February 2018

GP’s urged to prescribe coffee mornings to lonely patients. DM 21 February 2018

The Alzheimer’s Solution: DM 2 October 2017

1. How to eat to beat dementia.

2. Warning; sitting down could give you dementia.

3. How stress can shrink your brain.

4. Why a good night’s sleep is your best defence against dementia.

5. Why your BRAIN wants to be challenged.