Keeping mentally fit as we get older

What happens to our brains as we get older? What can we do to stay mentally fit? Can reading, board games, computer games or doing crosswords help? What about learning a new language or how to play a musical instrument? Do social networks help? What about brain training? If what we eat and how much exercise we get affects our bodies do these affect our brains too?

What happens to our brains as we get older?

As we get older our brains can shrink. Some cognitive functions (like memory and speed of processing) can deteriorate. And, as we live longer, the number of cases of dementia is rising. Dementia can lead to such a serious decline in mental ability that it interferes with our daily life and ultimately leaves us dependent on others. This helps explain why we tend to have a negative perception of our mental ability as we age.

In fact research published in 2012 suggests the memory of a person declines at a faster rate in the last two-and-a-half years of life than at any other time after memory problems first begin.

However, increasing evidence is emerging that our brains can adapt, that mental decline isn’t inevitable and that there is much we can do to keep mentally fit as we get older. You can teach an old dog new tricks, as a New Scientist article explained in 2013. In fact history is full of examples of this. For instance Leo Tolstoy learned to ride a bicycle when he was 67 and Queen Victoria started to learn Hindustani at 68. At a more everyday level, each year Adult Education classes attract older students keen to learn new skills. 

MRI scans of the human brain have suggested one possible explanation. Even when the brain is shrinking, these scans have shown reliable increases in prefrontal activation. This is important because the prefrontal cortex is believed to act as the brain’s executive or conductor – helping us plan complex behaviour, express our personality and make decisions. 

These observed increases in prefrontal activation have given rise to the theory of neurocognitive scaffolding as a mechanism by which the brain adapts as we age. We know that human bodies have the ability to self regulate, for instance to maintain a reasonably constant temperature. By self regulating the body maintains equilibrium and enables us to keep functioning in a reasonably stable way. If the same principle applies to our brains, then, as they begin to shrink and functions deteriorate, they will seek a way to self regulate, adapt or compensate, in order to keep functioning. Neurocognitive scaffolding assumes the brain adapts by engaging in ongoing reorganization and repair, for instance through strengthening existing connections, forming new connections, and stopping using weak or faulty connections. This leads to the hypothesis: ‘Scaffolding is protective of cognitive function in the aging brain, and available evidence suggests that the ability to use this mechanism is strengthened by cognitive engagement, exercise, and low levels of default network engagement.’ 

Mental fitness as we get older seems to span a spectrum. Sadly, people suffering from early onset Alzheimer’s will start to see their mental fitness erode from their fifties or early sixties. At the other end of the spectrum many people remain mentally very fit well into their eighties and nineties. For example Verdi was still composing operas in his 80’s and George Bernard Shaw still writing plays in his 90’s.

So what can we do to increase our chances of keeping mentally fit as we get older?

What is good for our bodies is usually good for our brains

As the Geriatric Mental Health Foundation explains, ‘Many of the same things we do to keep our bodies healthy contribute to healthy minds. Physical activity and a diet that helps lower cholesterol levels and blood pressure also helps to keep our minds healthy by allowing our bodies to deliver oxygen-rich blood to our brains.’

Social connections also seem to keep us mentally fit 

The Foundation also reports that studies have shown those who are engaged with family and community groups take longer to show the symptoms of Alzheimer’s disease than those who are socially isolated. So stay connected with your family and friends or get reconnected. Other options include joining a book club, sports club, volunteer group, continuing education class or some form of community activity. 

Physical Activity seems particularly helpful

Physical activity can slow the rate at which your brain shrinks as you get older. That’s according to research at Edinburgh University published in the medical journal of the American Academy of Neurology in 2012. The brain scans of 638 people born in 1936 were studied over three years. According to the report’s author, "People in their seventies who participated in more physical exercise, including walking several times a week, had less brain shrinkage and other signs of ageing in the brain than those who were less physically active,"

Dance is one form of physical activity in particular which seems to help keep us mentally active. In fact research published in the respected New England Journal of Medicine suggested that dance helps protect against dementia. It may be that dance achieves this by combining physical activity (with its aerobic benefits), mental activity (for many dance forms you need to remember and execute particular sequences of steps and movements) and social activity (as you usually dance with a partner or friends). 

Learning a new language may help too

Several recent studies suggest that being bilingual helps protect our mental ability. For example a study published in 2011 analyzed CT scans. It found that people who speak more than one language were able to absorb twice as much brain damage as unilingual people before they exhibited symptoms of Alzheimer's disease. Previous observational studies had found that bilingualism delays the onset of Alzheimer's symptoms by up to five years. This new study is the first to find physical confirmation through brain imaging.

In the following year Dr. Ellen Bialystok of York University, Canada published a review of recent studies using both behavioural and neuroimaging methods to examine the effects of bilingualism on cognition in adults. She reported, ‘"Our conclusion is that lifelong experience in managing attention to two languages reorganizes specific brain networks, creating a more effective basis for executive control and sustaining better cognitive performance throughout the lifespan."

Being a musician could also help

A small scale study published in 2011 researched seventy healthy older adults, comparing non musicians, low and high activity musicians. This preliminary study found that participants with at least 10 years of musical experience had better performance in nonverbal memory and executive processes in advanced age relative to non musicians. It concluded that high musical activity throughout life helps preserve cognitive functioning in old age.

More research is clearly needed here but the fact that many professional musicians (players, conductors and composers) continue to play, conduct and perform well beyond conventional retirement ages suggests this may prove a fruitful area for research.

Does what we eat matter?

According to Surgery Door eggs and ginko biloba may help slow age related memory loss and oily fish may help protect against dementia.

Can brain training help?

A study called the ACTIVE trial was carried out in the USA with 2,800 participants. It compared three groups (each of whom received a different type of brain training) with a control group (who received no brain training). According to a report on this research in Pub Med ‘The trials showed that, in general, brain training can improve cognitive abilities somewhat, but the improvement was not large. The results of the ACTIVE trial confirmed what some experts have been arguing: that a brain training exercise only has an effect on the very specific ability it is aimed at, and not on mental fitness in general.’

Video and computer based brain training are also now available. A 2012 systematic review looked at 38 different studies published between 1984 and 2011. The reviewers concluded, ‘Overall, findings are comparable or better than those from reviews of more traditional, paper-and-pencil cognitive training approaches suggesting that computerized training is an effective, less labor intensive alternative.’

This suggests that as we get older brain training (whether paper or computer based) probably doesn’t harm but is likely to have modest effect and needs to cover different skills. It isn’t enough to focus on one specific skill.

Games and your brain

A 2012 research report explored whether exergame training (based on physically simulated sport play as a form of physical activity) might have cognitive benefits for older adults. The researchers observed, ‘The trainees improved significantly in measures of game performance. They also improved significantly more than the control participants in measures of physical function and cognitive measures of executive control and processing speed, but not on visuospatial measures. It was encouraging to observe that, engagement in physically simulated sport games yielded benefits to cognitive and physical skills that are directly involved in functional abilities older adults need in everyday living.’

Leisure activities

Participation in leisure activities has been associated with a lower risk of dementia. However it isn’t yet clear whether increased participation in leisure activities actually does lower the risk of dementia or if participation in leisure activities declines during the preclinical phase of dementia. Research published in the New England Journal of Medicine in 2003 suggested that a number of leisure activities were associated with a reduced risk of dementia. These were: reading books or newspapers, playing board games or cards, doing crosswords, playing musical instruments, and (as previously mentioned) dancing. In this study dancing was the only physical activity which appeared to have this association. 

However, a more recent study was published in 2013. It aimed to explore whether combining physical and mental activity would improve cognitive functioning. 126 inactive, community-residing older adults with cognitive complaints participated. The researchers concluded, ‘12 weeks of physical plus mental activity was associated with significant improvements in global cognitive function.’

Passive leisure activities, like watching TV, unfortunately seem to hinder rather than help. A study reported in 2006 looked at 5,437 older people over a 5 year period. It found, ‘Cognitive activities in both the individual item (playing board games and reading) and the composite measure were associated with the reduced risk of cognitive impairment, while watching television was associated with an increased risk of cognitive impairment.’

Meditation and your brain

Mindfulness meditation practices (MMPs) are a type of meditation practice. A 2011 systematic review analysed twenty three studies. It reported, ‘Overall, reviewed studies suggested that early phases of mindfulness training, which are more concerned with the development of focused attention, could be associated with significant improvements in selective and executive attention whereas the following phases, which are characterized by an open monitoring of internal and external stimuli, could be mainly associated with improved unfocused sustained attention abilities. Additionally, MMPs could enhance working memory capacity and some executive functions.’ However, they also noted some methodological limitations in the research reviewed, together with some negative results – leading them to conclude that further high quality studies are needed.

Can keeping mentally fit reduce the risk of dementia?

Frequent cognitive activity in old age has been associated with reduced risk of Alzheimer’s Disease (AD) – although why this should be so isn’t yet certain.

One interpretation is that if we stay mentally active throughout our lives, by developing new interests and skills, then this develops some form of reserve in our brain which helps protect against or compensate for dementia. This is known as the Cognitive Reserve hypothesis. A number of possible explanations for such a reserve have been suggested. Perhaps bigger or denser brains can tolerate more loss before functions are impaired. Perhaps the same brain networks have been helped to work more efficiently. Or perhaps the brain is able to shift operations to alternative circuits. Whatever the mechanism, ‘Exposure to an enriched environment, defined as a combination of more opportunities for physical activity, learning and social interaction, produces …. a host of structural and functional changes in the brain.’

A recent study by researchers at Rush University Medical Centre in Chicago, published in the online issue of Neurology observed 1,076 people with an average age of 80, who were free from dementia, over a 5 year period. The people studied were asked to report how often they read the newspaper, wrote letters, visited a library and played board games such as chess. “The results suggest a cause and effect relationship: that being mentally active leads to better cognitive health in old age," according to the lead researcher.

Conclusions

  • Use it or lose it. If we are going to keep mentally fit, we need to exercise the brain and keep it active.
  • What is good for our bodies is usually good for our brains – like physical activity and a healthy diet.
  • You can teach an old dog new tricks. Leo Tolstoy learned how to ride a bicycle when he was 67 and Queen Victoria started to learn Hindustani when she was 68.
  • Physical activity appears to slow the rate at which our brains shrink.
  • Learning new skills (like a new language or a musical instrument) seems to be particularly helpful.
  • So too does staying socially connected (for instance through family, friends, volunteering and community activities).
  • Dance (which combines physical and mental activity and social interaction) seems to be especially helpful.
  • The Cognitive Reserve and Neurocognitive Scaffolding hypotheses suggest ways the human brain can adapt as it ages - provided we help it through regular mental, physical and social ‘exercise.’
  • These can keep us mentally fit and prevent or delay the onset of dementia. 

Delia Morick

Published 02/07/13   Review Date February 2015

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