Brain Push-Ups Prevent Dementia
Excerpt By Christine Haran, Healthology

Everyone knows that regular exercise can help keep the body in good shape. But many assume that there's nothing they can do about becoming forgetful in their old age. Now, evidence suggests that older people can preserve their mental acuity by exercising their brains.

Dr. Joe Verghese is an assistant professor of neurology at the Albert Einstein College of Medicine and the lead author of a recent New England Journal of Medicine study on the impact of leisure activities on dementia in the elderly.

As part of the Einstein Aging Study, he and his colleagues followed a group of about 500 subjects over a 21-year period. The participants were between 75 and 85 years of age when they joined the study.

The researchers interviewed them about their leisure activities, including their mental activities, such as board games or reading, as well as their physical activities. They found that people who participated in mental activities had a reduced risk of dementia.

Below, Verghese discusses how leisure activity that involves some mental effort might protect older people from dementia.

Why did you decide to examine the relationship between leisure activity and dementia in the elderly?
There's been a great deal of interest about the so-called use it or lose it theory in cognitive aging. Generally what we do in dementia research is look for risk factors associated with developing dementia, things that are bad. Cognitive activities, on the other hand, seem to have a positive effect on preventing dementia, so that's one of the things that drew me to it.

What type of dementia did you look at specifically?
We looked at all types of dementia. Most of dementia in elderly is due to Alzheimer's disease, which starts with memory complaints in people in their 60s and 70s. We also looked at vascular dementia, which occurs as a result of strokes or poor circulation to the brain, as well as dementias associated with Parkinson's disease.

How would you define dementia?
Dementia is defined as severe memory impairment and impairment in other cognitive functions like planning, judgment, problem solving or language. And these impairments have to be severe enough to impact on one's daily functioning.

What did your study find?
When our participants entered the study, they were given a detailed clinical, neurological and neuropsychological examination. As part of the clinical interview, they were asked about their participation in various kinds of leisure activities. We broadly divided leisure activities as either cognitive or physical. We particularly asked about six cognitive activities and 11 different physical activities. Some of the cognitive activities were reading, writing, playing a musical instrument or playing board games. Some of the physical activities were things like walking, swimming, dancing, doing housework or baby-sitting.

When we analyzed the results after following the participants for 21 years, we found that increased participation in cognitive activities was associated with a reduced risk of dementia, but increased participation in physical activities was not. The third of people who were engaged in the most mental activity had 63 percent reduced risk of dementia compared to people in the lowest third.

Among the mental activities, there were three activities in particular which had a significant association. Those were reading, playing a musical instrument and playing board games, such as chess or checkers, or playing card games like bridge. Among the 11 physical activities that we looked at, only dancing had a significant impact on risk.

Were there any similarities among the activities that might explain the benefit?
One thing was the frequency of participation. Frequent participation was defined as engaging in the activity three or four days a week. The more often people participated in an activity, the lower their risk of dementia.

Something we didn't study was the intensity of participation. For example, depending on how well you play chess, you might be spending more or less mental effort.

Why do you think dancing was associated with a benefit?
I think it's probably because dancing is not purely physical in some ways. It involves a lot of mental effort because you have to coordinate with your partner, you have to follow the music, and you have to remember the dance steps.

In previous studies, other such activities like gardening were found to be associated with a reduced risk. Again, it might be because that activity combines both the physical and mental.

What activities did not lower risk?
Among the mental activities, writing and group discussions did not lower risk. But with crossword puzzles, there was a trend toward a protective effect.

Because group discussions are unsupervised discussions, the quality of discussions could vary. Being part of a journal club or a book club is probably more protective than four people sitting around a room just talking.

With writing, again, everyone says they write, but someone who's writing a book or an essay is probably spending more mental effort than someone who just writes a shopping list.

How is your study different than previous studies?
There's been a few recent studies like ours that had similar findings. The one big difference between all these studies and ours was that we had a longer follow-up period. That allowed us to address some limitations of previous studies and to extend the findings of previous studies.

For example, you get diagnosed with dementia when you meet a certain criteria. But for six or seven years prior to that, you might have mild deficits in your memory and other cognitive areas. This can progress over a period of time until you meet the criteria for a dementia diagnosis; this period is called preclinical dementia. During preclinical dementia, people might reduce their participation in various leisure activities.

To study this, you need a long period of follow-up. After we analyzed our results, we went back and excluded people from our study who developed dementia in the first seven years. By doing so, we were reasonably sure that the people who remained in the study were as cognitively normal as we could get. And when we did that, the associations were still the same.

Do you think education levels play a role in preventing dementia?
Years of education have been found to provide a protective effect. And well-educated people are the kind of people who are most likely to participate in leisure activities. In our analysis, we adjusted for the years of education as well as the intellectual status and the results were still the same.

In a subgroup, we looked at people who had a high-school level education or less. Even in this group, leisure activities had a significant association with reduced risk of dementia.

So, overall, it seems like a message of hope. It doesn't really matter what your level of education is, participating in a leisure activity is good for your brain.

Do we know why both education and cognitive activities might protect brain?
One of the theories, called a cognitive reserve theory, says that by engaging in leisure activities, or through education, you are building a buffer in the brain against the disease. So it's not that either of these things affects the disease directly, but you're increasing the amount of time you have before you start showing clinical signs of the disease. This might occur by either increasing connections between brain cells or actually increasing the number of brain cells, so you can afford to lose more.

The other theory is that the brain is more plastic than people thought before. People used to think that once you get older, all you do is lose cells; you don't grow new cells. But starting to engage in activities might actually promote cell growth.

How might the role of social interaction be significant?
We didn't look into that directly, though a lot of leisure activities involve social interactions. There was a study that was reported a few years ago that found that people with more social networks, who had more family or friends or were engaged in social activity, had a reduced risk of dementia. So there are additional reasons to encourage people to participate in these activities.

What would your advice be to older people about leisure activities?
In my clinic, I see a lot of these people with memory complaints, and I always try to assess the level of participation in leisure activities. If they are participating, I encourage them to participate even more. If they're not, I talk with family members or caregivers and encourage them to find ways to get their elderly family members to participate in leisure activities.

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