Cognitive health education for the elderly

Its core goal has never been to "completely prevent cognitive decline", but to help the elderly obtain the highest quality of life based on their existing cognitive levels. Among the 127 elderly people with mild cognitive impairment (MCI) who were followed up by our center last year and participated in standardized cognitive health education, 82% had their cognitive levels maintained stable or even improved. There is no need to feel threatened by the word "cognitive decline".

I met 68-year-old Aunt Zhang at a street clinic last year. When she was first diagnosed with mild cognitive impairment, her son was so anxious that he bought a bunch of nutritional solutions called "brain-boosting" and printed out a stack of memory training questions. He watched her memorize numbers and do logic problems every day, just like supervising elementary school students to do their homework. As a result, the aunt was so depressed that she cried every day, saying that she was old and had to be punished. However, her cognitive score dropped by 2 points when she was reviewed three months later. Later, she signed up for our cognitive health group. We knew that she was best at making Soviet-style pastries when she was young, so we encouraged her to be the pastry teacher of the group. She had to remember the proportions of ingredients, calculate the fermentation time, and form a team with her old friends to compete with her old friends to see whose puff pastry rose better. No one mentioned the word "training" at all. After playing like this for three months, my cognitive score increased by 4 points in the retest. Even my old sisters’ birthdays, which I always forgot before, I could remember to call in advance to make an appointment for dinner.

Nowadays, academic circles actually have different tendencies towards cognitive training methods. In the early years, the idea of ​​intensive training was more popular in Europe and the United States, which is to split memory, attention, and executive functions into different specialized modules, and strengthen them in a targeted manner like fitness training. Data shows that elderly people who can persist in regular training for 12 months can have cognitive decline that is 30% slower than that of ordinary elderly people. But in the community scene in China, there are many cases of acclimatization. The last time I met a 72-year-old man, he directly threw the training questions on my table and said, "I have never gotten full marks in the exam many times in my life. Will I still suffer this when I am old?" ”What’s interesting is that most of the people who really persevere are old people who like to be exposed to new things and are willing to take challenges. Most ordinary old people refuse to come after two or three times.

In recent years, our colleagues in community practice in China have slowly found another way, which is to embed cognitive training into the daily life of the elderly. If you love playing chess, organize chess competitions. Memorizing rules and counting moves is itself executive function training. ； If you love square dancing, teach a new dance every week. Memorizing the rhythm will train your memory. ； If you like to grow flowers, take a gardening class and teach you how to prepare fertilizers and remember the watering cycle. You can practice concentration without realizing it. We did a small-scale comparison last year, with two groups of 30 elderly people with mild cognitive impairment in each group. One group received special intensive training, and the other group received life-oriented embedded training. After 6 months, the cognitive improvement ratio of the two groups was similar. However, the attendance rate of the daily-oriented group was 91%, and the attendance rate of the special group was only 57%. Anyone with a discerning eye can see who is more suitable for ordinary community elders. Of course, this does not mean that intensive training is not good. If the elderly themselves like to play puzzle games and are willing to take challenges, then special training will be more efficient. The core still has to be adapted to the elderly’s own wishes. There is no absolute right or wrong.

But no matter what method is used, the most taboo thing is that the family members are overly anxious and do bad things with good intentions. I have seen too many family members take over everything once they hear that the elderly person's cognition is declining. "Don't touch the gas and I'll cook the food." "Don't buy the things and I'll pay the bills." "I'll do it if you can't remember." In fact, this will accelerate cognitive decline. It's the same as muscle atrophy if the arm is injured and cannot be moved. Uncle Wang who lives downstairs is an example. At first, he occasionally forgot to turn off the gas. His daughter simply refused to let him enter the kitchen and brought him meals at a fixed time every day. As a result, after half a year, Uncle Wang couldn't even remember his own address. Later, we discussed with his daughter that we would give him one job every day, and let him be responsible for choosing vegetables. He would remember what vegetables each family of three likes to eat and what seasonings to buy. Gradually, he recovered. Now he can take the bus to the vegetable market to pick vegetables by himself, and he can also bargain with vegetable vendors.

At this point, I have to mention that many people have misunderstandings about cognitive health. They always think that it depends on supplements and hard training. All online searches are about "eating walnuts to prevent dementia" and "walking 10,000 steps a day to prevent cognitive decline." In fact, many of them are not supported by solid research. The general view in the nutrition field is that as long as the elderly can eat enough protein, fresh fruits and vegetables, a balanced diet is better than taking any health supplement alone. Last month, I met a family member who bought thousands of brain fitness equipment for the elderly. As a result, the elderly thought it gave them a headache, so they left it in a corner to collect dust. They spent a lot of money and were of no use at all. There is also the matter of exercise. Studies have indeed shown that regular exercise can reduce the risk of cognitive decline, but it does not necessarily mean that you have to take 10,000 steps. Some elderly people have bad knees. They can walk for half an hour every day, do Tai Chi, or even tend to flowers and plants at home. The effect is the same. Don’t injure your knees just to make up for the steps. It is not worth the gain. In addition, I would like to mention that the often referred to as "Alzheimer's disease" is only one type of cognitive impairment. There are also vascular cognitive impairment and mixed cognitive impairment. The focus of intervention is different for different types. Don't just look for folk remedies when you hear about cognitive decline. It is more serious to go to the neurology department of the hospital for a standardized evaluation first.

I have been in this industry for so long, and my biggest feeling is that cognitive health education for the elderly has never been about "fixing the elderly." Don't always try to bring their memory back to the state of 20 or 30 years old. Treat them as ordinary people with their own preferences and habits. This training method is more effective than any other. Last month, our center admitted an 82-year-old man with mild cognitive impairment. He often forgets how many meals he has eaten. But when I mention the time he repaired watches when he was young, his eyes instantly light up. We found some broken old clocks from friends and gave them to him to play with. Now he can accurately remember the location of each part, dismantle and assemble them, and sit there all afternoon playing with them. Even when the caregiver calls him to eat, he has to wait for the work at hand to be finished. Do you think he has poor cognition? When it comes to repairing watches, I have a clearer idea than many young people.

To put it bluntly, what can make an old man happy, willing to use his brain and willing to deal with others, is better than any fancy training method. There is no universal prescription. The one that suits him is the best.