Pamela Almeida Meza is a PHD Candidate and researcher from UCL’s Institute of Epidemiology & Health Care. Her research exploring the various life-course markers of cognitive reserve gained significant media interest in 2022.
In the UK, one in 14 people over the age of 65 are living with dementia, and this number is rising. While there’s no cure yet, researchers are investigating ways we can prevent, or at least reduce, the likelihood of developing dementia and dementia causing diseases.
One researcher, Pamela Almeida-Meza from University College London’s Department of Behavioural Science and Health, recently investigated whether popular activities can reduce the risk of dementia. She found that certain intellectual activities, such as reading, provide the brain with the ability to tolerate damage and could even stave off cognitive decline. The study, funded by Alzheimer’s Society UK (Principal Investigator Dr Dorina Cadar), examined the effect of intellectual activities, such as reading or playing board games, and social activities, such as spending time with family, friends, or a community group.
The study examined the effect of intellectual activities, such as reading or playing board games, and social activities, such as spending time with family, friends, or a community group.
‘Leisure activities are usually divided into three groups – intellectual activities, social activities, and physical activities.’ outlines Pamela.
‘Intellectual activities help maintain and generate new connections in the brain, and help it to maintain its flexibility and efficiency. Social activities are thought to reduce stress, particularly chronic stress, which can be very damaging for the brain.’
The effect of chronic stress on the brain
When we feel stressed, an area in the brain called the amygdala sends a distress signal to the hypothalamus. The hypothalamus is the brain’s communication centre, and tells the body how to respond to a stressful event, increasing our heart rate, heightening our senses, and giving us a rush of adrenaline.
A hormone called cortisol is released to help the body return to normal when a stressful event is over.
Those who experience chronic stress, are at risk of a build up of cortisol. In large quantities, cortisol can stop the brain functioning properly, and even kill brain cells.
Chronic stress has also been found to cause the frontal cortex, the part of the brain used for memory and learning, to shrink.
‘Physical activity has a double effect on the brain. It provides protection, and can actually help with decision making and memory storage. It also protects the heart, and, as a principle, anything that’s good for the heart is good for the brain.’
‘Swimming and walking – brisk walking especially – have been found to be protective, especially when you’re looking at older people. These forms of exercise have been found to improve brain plasticity and the formation of new neurons. They also represent low impact activities. So older adults who might have chronic or physical conditions are more likely to do them more frequently, because the risk of injury is really low.’
‘Most activities in all three of these groups have a combined effect. For example, being part of a book club is both intellectually stimulating and socially stimulating.’
Dorina Cadar, the senior author of the study, also highlighted how certain activities can boost how our brains function, particularly in the areas that are affected by dementia.
‘Memory and logic work side-by-side when they are engaged in certain leisure activities such as reading, using their mobile or playing chess.’
‘For certain activities and games, people use memory to memorise the numbers and use logic to figure out the following step. It stimulates the mind by practising the logical thinking process when you are solving a problem and eventually improves reasoning and decision-making skills.’
‘It also encouraged the brain to do things quickly. Playing certain games like Sudoku is interesting, as they also help increase motivation for completion and a sense of time. It teaches the mind how to make a decision and take action with less hesitation.’
While there have been a number of studies looking at the relationship between leisure activities and dementia risk, Pamela was interested in providing clearer insight on their preventative effects.
‘The motivation was really to understand which activities could reduce dementia risk, and under what conditions. We can find quite a few contradictions in previous research, some will find an association between social activities and reduced dementia, and others say it’s actually physical activity that reduces risk.’
‘What I did is compare only the intellectual and social activities, because these are the activities that elderly people tend to continue to do at this stage of their life.’
‘I think that prevention is more important than cure. We know that around a third of dementia cases are preventable through lifestyle changes. So, if we can find evidence to show what type of activities you should do, under what conditions, and at what age, it will be very informative for the public, practitioners, policymakers and doctors.’
As well as highlighting the importance of intellectual activities on brain health, the research uncovered an interesting and unexpected gender split. Reading the newspaper was found to reduce dementia risk in women by 34 percent, but didn’t reduce the risk for men. On the other hand, mobile phone use reduced the risk for men by 36 percent, but there was little correlation for women.
Discussing these findings, Pamela has her own hypothesis for why men and women seemed to benefit from different activities.
‘The baseline for this study was 2002, smartphones were not necessarily broadly used, so we’re thinking about mobile phones being used for texting and calling. This might be indicating men who are still working, where they have to be on their phone a lot.’
‘In the case of newspapers for women, this association indicates a group of females who are intellectually engaged, who are keeping up with news, and who might be playing Sudoku and crossword puzzles. Now, why this is not also found in men is not clear as I would actually expect to see this benefit both men and women.’
‘I do have a personal hypothesis, however I have no evidence to back it up so we would have to investigate a little bit more. The population that my research is based on is the English Longitudinal Study of Ageing, which is of people 50 years old and older, born in or before the 1950s. ‘
‘At this time, the presence of women in education, and in managerial positions, was not very common unfortunately. So the findings signal that these women are self-teaching and keeping up to date with the world, but do not necessarily have the same education or academic degree.’
‘Self education is also a way of staying connected, which is, of course, very good for the brain, but again this is just my hypothesis.’
Surprisingly, the research didn’t find an association between social activity and reduced dementia risk, despite previous studies indicating a link.
It did, however, find that married people who took part in regular activities had greater protection from developing dementia causing diseases, such as Alzheimer’s. Pamela believes this highlights the impact loneliness can have on dementia risk, as well as the importance of keeping older adults connected to the world around them.
‘Studies vary widely on what activities they consider social. While they may capture whether someone is socially engaged, they may not take into account whether they’re still lonely. Someone may have 1000 people around them, but still feel pretty lonely, and a major risk factor for dementia is loneliness.’
‘Unfortunately, it is a reality that a really high proportion of elderly people have to deal with loneliness. Not only is this very painful, but it’s a massive risk factor for poor physical and mental health outcomes, all of which are risk factors for dementia.’
‘More support is definitely needed to make sure elderly people have spaces where they can feel connected. And not only that, but spaces where they feel welcome, important and relevant, and that they can actually access. If it’s too pricey, too far away, or if they feel like a burden, then the space might be there but they’re probably not going to use it.’
‘I think two important interventions that have shown really good effects on the elderly have been free bus passes and reduced fees for certain activities, like museums. And obviously, if they have someone to go with it makes it more likely that they’ll take advantage of these initiatives.’
‘There are also programmes where younger people can volunteer and go for a cup of tea with them, or call them for a chat. I think working with families too, and letting them know, ‘hey, give your elderly loved ones a call’, ‘Keep up with them’, is really, really important.’
Unfortunately, due to the ongoing COVID-19 pandemic and resulting national lockdowns, many of these interventions have been inaccessible over the past 12 months. While this may have seen some people take up more intellectual, home-based activities, Pamela believes there may be some very different findings if this research was to be repeated in the future.
‘It’s a double-edged sword. For some people, the lockdowns might have been an opportunity to engage with cooking at home, crafts, reading, or learning something new, because they had more free time on their hands. It might also have meant reconnecting with family members and friends.’
‘So, for them, I would really expect to see a reduction in dementia, particularly when talking about cognitive reserve, you don’t necessarily avoid dementia, but you sort of push back the diagnosis date.’
What is cognitive reserve?
Cognitive reserve is a theory that we each develop a ‘reserve’ of thinking ability throughout our lives, which can make our brains more resilient in later life.
This theory could explain why two individuals of the same age, with the same health conditions, will perform differently at the same cognitive task.
It’s thought that our education, occupation, hobbies, and social interactions can all help us build our cognitive reserve.
‘But the lockdown also meant a higher risk for those who were already at risk. For elderly people who were already isolated, or perhaps had to shield and could no longer see their families, there was a greater risk of depression. Depression is amongst the most important risk factors for dementia. People tend to retreat and disengage in activities.’
‘Elderly people may also lack the right resources, buying a book can be expensive, or they might not have a computer or a mobile phone to call their loved ones.’
In light of her research, Pamela hopes there will be a greater focus on intervention, and that it will encourage policymakers to address social and economic inequalities, to ensure everyone has the opportunity to enjoy a wider range of activities. She also hopes older adults feel inspired to get involved in new pastimes.
‘I think the most important lesson from this research is that dementia prevention starts early in life. The lifestyle habits and the skills you learn early on, will determine the activities you continue engaging in throughout your life. A healthy lifestyle predicts much healthier ageing.’
‘It’s also highlighting the importance of education, and the importance of self-teaching through reading and leisure activities. It’s not only formal education that is protective, it’s just being able to learn.’
‘However, there is an issue with social inequalities and access to quality education, appropriate work conditions, and resources for leisure activities, so that everybody can benefit from these. Social and economic factors are a massive predictor of wellbeing.’
‘Highly educated people are more likely to experience healthier ageing and to have a reduced risk of dementia. Education is up there amongst the most important protective factors.’
Also, we know it might be protective to start these activities from when we were really young, but what’s the message for people who are already in their 50s?
‘The message here is that it’s never too late to start something new, whether it’s that language you always wanted to study, or that career you wished you had pursued. Start reading on the topic, there’re many science communicators who provide very, very complicated sciency stuff in books that are very easy to read and very interesting.’
This final message is one that is echoed by senior author Dorina Cadar.
‘Just like physical exercise, the mind needs some training too. We showed that being engaged in cognitive and social leisure activities contributes to a decreased risk of dementia. We also showed that people with more years of formal education or greater literacy have a lower risk for dementia, offering solid and consistent evidence for cognitive reserve.’
‘These findings highlight once again that it is never too late to pick up that book, enter an online game of chess or social club with like-minded people in your area, make your brain healthier and reduce your dementia risk through healthy lifestyle habits, hobbies and cognitive leisure activities.’
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