Summary of experiences in cognitive health education for the elderly

For the vast majority of ordinary elderly people over the age of 60, no complicated medical intervention is required. As long as they can incorporate cognitive health-related exercises into their daily routine and persist for more than 3 months, they can slow down the rate of cognitive decline by 27%-35%. The effect is even better than some auxiliary drugs, and the subjective will of the elderly is more than 10 times more important than the "professionalism" of the training program.

I didn't think so at all when I first entered the industry. At that time, I took the standard courseware given by the neurology department of a tertiary hospital. I started talking to the elderly about the pathogenesis of dementia and the dangers of amyloid deposition. I gave three lectures, and the highest attendance rate was as fast as 40%. The uncle also said to me on the spot, "Just tell me whether I will get Alzheimer's disease. Why are you talking about these useless things?" I choked and was speechless for a long time.

Later, I met Aunt Zhang from the community. She was 72 years old. When she came for free screening for the first time, her MoCA (Montreal Cognitive Assessment Scale) score was only 20 points. The normal threshold is 26 points. A score below 22 is a high-risk group for mild cognitive impairment. Her son said that the old man forgot to turn off the gas three times a week, and even lost his wallet when he went out to buy groceries. But when he asked her to go to the hospital for further examination, the old man wiped his tears and said, "I won't go. If I go, they will put me in a mental hospital." We didn't arrange any complicated training plan for her. Knowing that she had to go to the market to buy vegetables every day, we asked her to memorize the prices of three commonly purchased vegetables every day, test each other when walking with old sisters in the same neighborhood in the evening, and do 10 minutes of finger exercises every day following the short videos we sent. As for these two requirements, she did not resist and persisted day by day.

Her MoCA score in the last retest just reached the qualifying line of 26 points. Last week, she signed up for a calligraphy class at a senior college. She said that it is no longer difficult to write down strokes. When she saw that I stuffed a bag of pickled sugar garlic into her, she said, "I can remember how much salt I put in now. Try it, it will definitely not be salty."

In fact, there have been differences in the academic circles on the path of cognitive intervention. One group is the clinical group, which advocates that as long as mild cognitive impairment is detected, medical intervention should be initiated as soon as possible, including taking cholinesterase inhibitors and regular cerebrospinal fluid examinations. This program is very effective for high-risk groups. The benefits have been confirmed by many core journal papers, and I myself recognize its medical rigor. However, the problem is that in a community setting, at least 70% of the elderly are resistant to "going to the gods for medical treatment" and "taking medicine to treat the brain." The actual implementation rate of this plan is less than 10%. The other group is the life-oriented intervention that we prefer to implement in public health, which is to break down the training into small things that the elderly can do every day, without spending money or taking time. Even playing mahjong for half an hour a day or memorizing new steps for square dancing is effective as long as it can mobilize the cognitive function of the brain. The disadvantage of this method is that it is slow to take effect and cannot quickly reverse the cognitive damage that has already occurred. However, it has wide coverage and high compliance, and is suitable for early prevention for the vast majority of ordinary elderly people.

I have encountered many pitfalls that I took for granted before. For example, I first tried to ask the elderly to write a 200-word diary every day. Half of the elderly people said that their eyes were too dizzy to hold the pen. Some elderly people who had never read a book just waved their hands and said, "I have never written in my life. Isn't this embarrassing?" , and later changed to taking three photos of the day every day, and telling their family members what they took in the evening. On the contrary, 80% of the elderly can persist, and some elderly people are addicted to taking pictures. They take photos of flowers in the community and cats at home every day, and they talk to their families a lot more.

It took me a long time to figure out the trick. When communicating with the elderly, you must not say, "You have a poor memory and you will get Alzheimer's disease." The elderly people will immediately resist when you hear this word. If you change it to "Let's practice our brains, we will be able to play mahjong more in the future, and we will not miss the time when we take care of our grandchildren." The elderly people will immediately be willing to try. To be honest, there is no perfect training plan. Some old people like to do Sudoku to train their brains, and some like to play chess with their old friends. As long as they are willing to do it and can persist, it will be much more effective than a professional plan tailor-made for them if you stay up for several nights.

A family member came to ask for an explanation before, asking if you were lying. Why did my mother still forget things after practicing for two months? Later, when I asked about it, I found out that the old man just did finger exercises for two minutes every day, and after that, he sat on the sofa and watched three hours of mindless short videos. The brain was not effectively stimulated at all, so it was definitely useless. Don't tell me, there are quite a few such situations, so we will specifically tell the family members later on not to just push the elderly to do training, but to chat with them about the past when we have time. Reminiscing about the past is more effective in stimulating the brain than doing exercises.

Now looking back at the work of the past year, we tracked 47 elderly people who persisted in training, and the average MoCA score increased by 3.2 points. 80% of the elderly said that they forget things much less. But what makes me happiest is that Aunt Zhang, who was afraid of going to the hospital before, can now take the bus to attend classes at the University for the Elderly. She also actively helps us promote to other elderly people, saying, "Practice is really good, I can now make braised pork for my granddaughter." To put it bluntly, cognitive health education for the elderly has never been about instilling professional knowledge into the elderly. It is about making them not afraid and willing to do it. It is enough to incorporate these small things into their daily lives.