Cognitive health education content for the elderly

The core of cognitive health education for the elderly is not a single piece of popular science about "preventing Alzheimer's disease" as the public has it, but a personalized intervention system that covers all cognitive levels of the elderly and includes four core directions: cognitive reserve maintenance, interventionable risk factor management, abnormal signal identification, and cognitive-friendly environment construction. The core goal is to slow down the rate of cognitive decline and improve the quality of life of the elderly, rather than to absolutely avoid the occurrence of cognitive diseases.

To be honest, I have been doing cognitive intervention for the elderly in the community for almost three years. I have seen too many elderly people come to consult with online articles that say "Forgetting things is a sign of dementia." The first thing they say when they come in is "Doctor, am I going to be stupid?" In fact, most of them are normal age-related memory decline, not even close to mild cognitive impairment (MCI). There used to be a 68-year-old Aunt Zhang who was a math teacher in a key middle school before retiring. During the first six months of her retirement, she was watching short videos at home every day. She always said that she couldn't remember things. We didn't prescribe any complicated training plan for her, but gave her a very simple suggestion: find some "little troubles" in her daily life. For example, I usually go to the south gate to buy groceries, but now I occasionally go around to the west gate. ； In the past, I always cooked three dishes in rotation, but now I learn a new dish from short videos every week. ； Even when I have nothing to do, I use my left hand to peel an orange and hold a chopstick. With these few small changes, she persisted for three months and when she came back, she said that her "mind was much clearer." Currently, there are actually two different schools of thought in the academic community regarding cognitive reserve training. One school advocates high-intensity and complex cognitive training, such as systematically learning a foreign language, playing high-level Sudoku, and participating in debate activities. It is believed that this kind of training can maximize the stimulation of neuronal connections. ； The other group advocates this kind of "life-oriented cognitive stimulation", which does not require too much extra learning cost, is easier to persist for a long time, and has more stable effects. There is no absolute right or wrong between the two ideas, and it can be adapted to the elderly with different physical conditions and cultural levels.

But if you think that as long as you find something to do with your brain, everything will be fine, then you will really get into trouble. I met 72-year-old Uncle Wang last year. He loves to play chess and even won a community chess competition. I guess he has done enough cognitive training, right? As a result, he was diagnosed with mild cognitive impairment during a physical examination last year, and he was stunned. Later, when we looked through his physical examination records, we found out that he had high blood pressure for more than 20 years. He always thought he didn't feel uncomfortable and would not take medicine. He also suffered from sleep apnea all year round. He snored loudly at night, but he didn't take it seriously. This brings us to an easily overlooked part of cognitive health education: the management and control of intervenable risk factors. Many elderly people always think that cognitive problems are "a matter of the brain itself." In fact, according to the Cognitive Decline Intervention Report released by The Lancet in 2020, there are 12 interventionable risk factors for cognitive decline in a person's life. In old age alone, there are 7 types of hearing loss, high blood pressure, obesity, smoking, depression, lack of exercise, and social isolation. There is also an interesting controversial point here: For example, regarding the impact of drinking on cognition, there were studies a few years ago that said that drinking a small amount of red wine can soften cerebral blood vessels and reduce the risk of cognitive decline. However, the latest cohort study in 2023 clearly stated that even a small amount of drinking can cause damage to the hippocampus of the brain and increase the probability of cognitive impairment. When we talk to the elderly now, we will not just say "absolutely not drink" or "drink less and it will be fine." Instead, we will make both research conclusions clear and let the elderly choose based on their own physical conditions.

Speaking of this, I have to mention that the question that many family members are most concerned about is actually: How can I tell whether my elderly family member is an "old fool" or really has cognitive disease? This is also what must be talked about in cognitive health education: the identification of abnormal signals. A family member came for consultation before and said that his father, who is 78 years old and used to be a top chef, always forgets to add salt when cooking. He even turned on the gas stove to boil water and went downstairs for a walk. He almost caught fire. They also always suspected that the nanny at home stole his money. At first, they thought that the old man was stingy because of his age, but later he went to the hospital to find out that he had moderate Alzheimer's disease. In fact, most of the normal aging forgetfulness is "forgetting details". For example, I can't remember what I had for lunch yesterday, but I can remember it after being reminded, and it will not affect my normal life. ； However, pathological cognitive decline means "forgetting the whole thing", and may even lead to fabrication, suspicion, and personality mutations. There are now two different recommendations for family identification. One is to use standardized scales such as MMSE and MoCA to self-test at home. The accuracy is relatively high, but it is not friendly to the elderly with low education and poor vision and hearing. ； The other is the "daily function observation method", which is to see whether the elderly can independently complete the things they have done for decades, such as cooking, withdrawing money, taking medicine, and taking the bus. If they make frequent mistakes in these things, they must go to the hospital for screening. Both methods have their own advantages and disadvantages. You can choose based on your own family situation.

Many people think that cognitive health education is only for the elderly. In fact, it is not. Half of our courses are for family members and community workers. A family member of an elderly man with dementia complained to me before, saying that his mother always said that he was going to pick up his daughter, who is over 30 years old, from school. He corrected her every time and said, "Why do you pick up your daughter when she is at work?" His mother cried every time. Later, we taught him not to correct him the next time he encounters this situation, just say "let's change clothes first and go later." There are now two different focuses on cognitive intervention. One group focuses more on individual cognitive training for the elderly, and the other focuses more on the construction of a cognitive-friendly environment. For example, signs with large characters and patterns are installed in communities, family members post notes at home to remind them to take medicine and turn off the fire, and wear positioning bracelets for elderly people with dementia. In many cases, changing the environment a little is more effective than forcing the elderly to do ten training sessions.

Last week we held a cognitive health market in the community. A 76-year-old grandma learned to make handmade sachets from our volunteers. After sewing, she held it up to show to her old friends around her. She said happily, "Look, my brain is quite useful." In fact, to put it bluntly, cognitive health education for the elderly has never been about labeling the elderly as "you have a bad memory, you will get sick", nor is it about turning the elderly into the "strongest brains". It is about helping them understand more about their bodies and reduce unnecessary anxiety. Even if cognitive impairment does occur, they can live a more comfortable and dignified life.