Exercise Your Mind: Cognitively Stimulating Activities and Social Engagement

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Transcript

Nathaniel Chin: My guest today on Dementia Matters is Dr. Kimberly Mueller, an assistant professor in the Department of Communication Sciences and Disorders at UW-Madison. She received her master's degree in Speech Language Pathology at Columbia University and worked clinically as a speech language pathologist with children and adults in New York City for nine years before moving to Madison in 2005. She started working in research at the Wisconsin Alzheimer's Institute in 2006 and earned her PhD in 2017 in Communication Disorders with a focus in preclinical Alzheimer's disease. Dr. Mueller's research is focused on how and when speech changes during the course of aging, ways to detect these changes, and possible interventions. Today she is here to talk to us about another one of her areas of research interests, and that is how cognitive and social engagement affect brain health. Welcome, Dr. Mueller, to Dementia Matters.

Kimberly Mueller: Thank you very much for having me.

Nathaniel Chin: To start, can you clarify for us what we mean by cognitively stimulating activity and social engagement?

Kimberly Mueller: Yes, cognitively stimulating activities are mentally engaging activities that challenge a person's ability to think. I think the two key concepts there are engaging and challenging, you know, so that's what is referred to as cognitive activity. Then social engagement refers to interactions with other people and, in particular, these interactions with other people should be enjoyable for that person.

Nathaniel Chin: Now is all learning considered cognitively stimulating activity?

Kimberly Mueller: I think that not all thinking is cognitively stimulating, but learning new things is cognitively stimulating. So learning a new activity, such as learning a new language, for example; or learning an instrument; or learning a list of words for like a list of grocery items, if you work on memorizing those and then go to the store and pick them up. Those kinds of learning, that is mentally stimulating and engaging.

Nathaniel Chin: Now, what studies have been done looking at cognitively stimulating activity and memory.

Kimberly Mueller: There are so many studies that have been done to look at what effect cognitively stimulating activities have on dementia risk in general, but then also on particular cognitive or memory and thinking skills. There are two types of studies that we usually think about. One is more of an observational study where we look at a large group of people and follow them over time and ask them “what kinds of cognitively stimulating activities have you done”, and then look at what their end result is in terms of dementia or cognitive decline. So one type is an observational study. Then another type is a clinical trial where we prescribe a cognitive activity intervention and prescribed the time that they do it and, as carefully as possible, control those conditions and see what the outcome is in a more immediate sense. 

The first part, the observational studies, are a lot more plentiful because they are a lot easier to do, in general, where we can look at very large groups of people and just see how the natural history of that person's life goes. Many studies have looked at cognitive engagement and I'll tell you about a couple, in particular, showing this very thing, that cognitively stimulating activities, people who engage in those more, have a reduced risk of dementia at the end of life. 

One, in particular, that I love to talk about is based on a religious order study or a nun study. This study was done in 2002 by Wilson and colleagues. This study looked at nuns and priests who lived in the same exact environment – so the surroundings were the same, a lot of things were the same, diet might have been similar for that group – and asked questions about cognitively stimulating activities and did this throughout the nuns and priests lives. Those who reported doing more cognitively stimulating activities like reading, playing games, those kinds of activities, had a reduced risk of dementia up to 47% later in life. It's really compelling, but, you know, there are caveats in terms of interpreting that. They might be doing other things, too, that we don't know about, so that might be one caveat. It also might be that they were, for example, exercising more. It's really hard to separate out what contributed to that reduced risk, but there's some kind of association with cognitive activity. 

Another study that I can talk about is a twin study and that, too, is very similar in terms of the degree of control we might have. The twins are genetically similar, so they're very interesting to study because if one twin has a different outcome and yet their genetic makeup is very similar, it might be due to an environmental factor, like cognitively stimulating activity. This study by Carlson and colleagues in 2008 looked at two male twins, one who ended up developing dementia and one twin who did not, kind of a subset of these twins, and found again that the twin who engaged in more cognitive activity had a 26% reduced risk of developing dementia than the twin who didn't report that cognitive activity. So, really interesting observational studies that we can draw on. 

In terms of clinical trials, where we prescribe an intervention, there are fewer than the observational studies, but still there is some compelling evidence to say that if we put people on a program of cognitive activity, they may improve in memory and thinking, or at least stay the same over several years. One example that I love is the synapse project, which was done in 2014. This project I love because the cognitive activities were photography classes, quilting classes, a combination of the two, or just pure social activity. They compared the groups and the groups that engaged in either the quilting or the photography had better memory scores at the end of the intervention than just the social activity group. It was a very interesting study and very attractive because these are typically things that maybe older adults might want to do as opposed to sitting in front of a computer and doing some kind of cognitive training activity.

Nathaniel Chin: I suspect that not all activity can have the same impact on our brains. An example would be learning a new language is probably more stimulating than reading a book. Would you say that there are certain degrees of cognitively stimulating activity?

Kimberly Mueller: I think so. The research is, again, hard to study those kinds of things. What degree one activity has over another, and it might be also very individual, one thing might be very difficult and challenging for one person and not for the other. I would say that active cognitive activity might have an edge over passive cognitive activities, such as, passive would be like watching a TV show, for example. That would be passively engaging your brain. Not a bad thing. Active is where you're kind of doing something in order to learn it, whether it's mental repetition in your brain or you're learning a skill with your fingers, like piano playing. What we know from teaching pedagogy is that doing sort of supplements just absorbing when we're learning new things.

Nathaniel Chin: I'm really glad you use that example because a lot of my patients will say, well, I do watch TV, which I don't promote in clinic, but they're watching jeopardy or wheel of fortune. So, they're with other people and they're guessing along with the actual TV show. They feel like it's more engaging and it's more stimulating because it's not just sitting there watching a drama. Would you say that there's some rationale to that, even if the evidence says there's not enough evidence, but does that make sense?

Kimberly Mueller: I think it could, you know. I think, again, it's very individual. It still might be a passive kind of activity, but if you are anything like the way my grandmother used to be and you're yelling at the TV screen, then I think maybe it is a little more active, you know? I think it just depends on that person. 
I think what you're recommending to your patients is probably reasonable.

Nathaniel Chin: What about brain games, like puzzles, sudoku, crosswords? Would you consider those cognitively stimulating?

Kimberly Mueller: Absolutely. Unless, you know, the person is an aficionado on one of those things and it's almost rote to be able to fill one of those out and it's not stimulating for that particular person. Again, it's an individual effort, engagement kind of activity that we're looking at.

Nathaniel Chin: It's that challenging factor. It really has to push your brain. Now, these days, there are online websites that are designed specifically for “cognitive training” or “cognitive engagement,” but does the science actually back any of these websites or online resources?

Kimberly Mueller: I think it's such a wonderful question and one that I get very frequently. I think that, you know, some of these programs have some research that backs their use in certain populations. One example is a program that's called Brain HQ and this is by Posit Science. This one has had the most, sort of, press about the research behind it, in especially a trial called Active, which was looking at typically aging adults and they, sort of, put them on a regimen of this computerized training program. They also did other activities besides the computerized training and these adults reported, kind of, better activities of daily living 10 years later. That study was publicized a lot in the media. That website, in particular, has a link to look at all the different research studies behind it. Generally, what we see is that people tend to get better on the actual computer task, but that there's not a lot of evidence to say that that would transfer to an everyday activity of daily living, which is what we want. We want our brains to function better in our lives so that we enjoy life longer. The studies have not yet really proven that getting better at a computerized program would actually translate to, say, driving a car and your reaction time getting better or that kind of thing. 

I also recommend when people ask about these things to look at the website carefully because, you know, a lot of these programs charge you money and they're expensive and sometimes a yearly recurring fee to use these programs. I often recommend that you look at the website carefully and if anything says this program will prevent dementia or this program will cure Alzheimer's or will prevent Alzheimer's, I think you should shut down immediately and not invest, not look into getting that program because it's kind of a false claim to say those things. We don't really recommend that. Then the other thing is to look at the research behind it and just try to be an educated consumer about it.

Nathaniel Chin: Then going back to the social engagement piece, are there studies showing an association of being social with improved thinking abilities?

Kimberly Mueller: Yes. Socialization has been harder to study than cognitive activity because it's very difficult to isolate social activity. It's also difficult to do a clinical trial, let's say on social activity, because you don't want to isolate one group of people and not let them have social contact versus, you know, the other groups. There's those kinds of inherent problems. Also, social activity is cognitive, so it's very hard to study it by itself. What we do think, and studies have shown, is that social engagement leads to happiness and improved wellbeing and, also, a reduced dementia risk in people who report being more socially engaged. So, you know, again, it's hard to tease out what that is, whether it's the wellbeing or whether it's the cognitive engagement or what, but there is more and more compelling evidence to say that people need to be socially engaged to have a better quality of life.

Nathaniel Chin: You hinted at this before, is there science showing that multiple aspects of, whether it's socialization and cognitive engagement, or socialization and physical activity, that those combinations may be more effective when it comes to our brain health than each item alone?

Kimberly Mueller: Common sense would say that that would be true, in my opinion. But, there's evidence now to say that comprehensive or multi-domain interventions are effective and maybe we don't have to tease apart — is it social, or is it cognitive, or is it physical — and instead take what we know about those three things and put them all together. For example, the Finnish Geriatric Study, which is referred to as the FINGER study, and this is by Dr. Kivipelto and her colleagues. That study does exactly this. It takes a large group of aging adults and puts them on a social activity intervention, a cognitive activity intervention, recommendations about diet, recommendations about physical activity, and managing medications. That study has shown really positive effects on these people who have engaged in that intervention, including, kind of, a maintenance of cognition or even an improvement in some cognitive skills. It's very compelling, so much so that other studies like that are popping up, including here in the U.S. So, it's definitely an area that needs to be explored.

Nathaniel Chin: I would like to end by asking you an important question of what advice do you give to older people in your own life to help them maintain and strengthen their brain health?

Kimberly Mueller: Yes, and I do get this question at family parties and things. I often talk about the things that I just said today. So, something that you enjoy and so if you don't enjoy sitting in front of the computer, then don't do that. Find something that you really always wanted to do, or used to do and stopped doing, that will challenge your brain. Sometimes people ask, you know, should I retire? I don't really want to. So then I might kind of encourage them to either not retire because that's cognitively stimulating and socially engaging to stay at work, or to think about maybe a different kind of work scenario and sort of an easing out of it. That's another question that I get. But again, I usually say if it is both cognitively stimulating and socially engaging, you're going to get a double bang for your buck. Then if it has physical activity, something like Tai Chi maybe, or dance, as a third component, then you're triple arming yourself. I usually give that kind of advice to my loved ones.

Nathaniel Chin: Wonderful. Now we have it on for our podcast listeners. With that, I'd like to thank you for being on the show today, and we do hope to have you back in future.

Kimberly Mueller: Thank you so much.