By Annie Lennon on July 16, 2023 — Fact checked by Alexandra Sanfins, Ph.D.
“Use it or lose it” is a common adage increasingly used for matters related to brain health. But to what degree does using cognitive faculties prevent them from deteriorating? Medical News Today looked at some of the latest research and spoke with experts in the field to find out.
Millions of people around the world live with dementia, a chronic neurodegenerative condition that affects memory and thinking abilities. The most common form of dementia is Alzheimer’s disease.
While some treatments do exist to help manage the symptoms of dementia, there is currently no cure for the condition.
While research is underway to understand more about dementia pathology and to develop treatments, significant amounts of research are also underway to investigate how lifestyle interventions may affect dementia risk and cognition.
Some of this research is investigating how cognitively-stimulating activities, such as reading and crossword puzzles, affect dementia risk and cognition.
A study published in Neurology in 2021 found that high levels of cognitive activity, such as reading, playing games like checkers and puzzles, and writing letters, can delay the onset of Alzheimer’s disease by 5 years among those aged 80 years and over.
Another study, published in 2022 in PNAS, found that more time spent in cognitively passive activities, such as watching TV, is linked to increased dementia risk, whereas more time spent in cognitively active tasks, such as using a computer, is linked to a reduced risk of dementia.
And a study from JAMA Open, published in July 2023, found that frequently engaging in brain-challenging activities, including journaling, playing chess, and solving crossword puzzles was associated with a lower risk of developing dementia among older adults.
To understand more about these associations, Medical News Today spoke with five experts on topics including how cognitively-stimulating activities reduce dementia risk, what else reduces dementia risk, and how to take action on the research.
To begin, MNT spoke with Dr. Joyce Gomes-Osman, vice president of interventional therapy at Linus Health, and a voluntary assistant professor of neurology at the University of Miami Miller School of Medicine.
She said that cognitively stimulating activities such as reading and crossword puzzles reduce dementia risk and boost cognition by increasing the cognitive reserve, which she likened to the size of one’s mental library.
“Each thing we learn and know is like a book on a shelf. As new books are added, the library grows bigger and bigger. But why does this matter, you might ask? Well, building a library of information in your brain creates a buffer for memory loss,” she said.
“When your library is extensive, even if many books are checked out, there will still be plenty of other books on the shelves, serving as alternatives and keeping the library functioning well,” she added.
She explained that cognitive reserve is developed over the life span through education and life experiences- especially those that are challenging and make one think.
In a recent study — published in 2022 in Neurology— researchers investigated how childhood cognitive skills, education attainment, and leisure activities affected cognitive reserve.
They followed 1,184 people from the United Kingdom from childhood until the age of 69 years, at which point the participants undertook a cognitive test with a maximum score of 100.
In the end, the researchers found that people with a bachelor’s degree or higher tended to score an average of 1.22 more points than those with no formal education. Those who engaged in six or more leisure activities, such as education classes, volunteer work, and social activities, scored an average of 1.53 extra points compared to those involved in only four such activities.
Meanwhile, those who had a professional or intermediate level job scored 1.5 points or more on average than those with partly skilled or unskilled jobs. They additionally found people with a higher reading ability experienced slower cognitive decline than those with a lower reading ability.
“Much like our physical bodies can get out of shape and underperform, our brains can also become deconditioned,” Dr. Robert Wiggins, a neurologist with Novant Health in Charlotte, NC, told MNT.
“Safely challenging our cognitive abilities, as long as it doesn’t lead to frustration, is healthy and will even improve our confidence and sense of independence. Though a 70-year-old may not have the cognition they had at age 20, challenging the mind could help them feel more like they did at age 50.”
– Dr. Robert Wiggins
‘Mental exercises’ engage multiple parts of the brain
MNT also spoke with Dr. David Hunter, assistant professor of neurology with McGovern Medical School at UTHealth Houston. He noted that research indicates that even patients with advanced dementia can benefit from what he calls “mental exercise” — anything that engages multiple parts of the brain at once.
“Reading, puzzles, art, conversation, games, and work are just a few examples. Really, the only rule is that sitting around watching TV doesn’t count,” he said.
He added that coloring books, music, word searches, and simple conversation are also possibilities if patients can no longer participate in their former hobbies.
While experts agree that a person’s cognitive reserve is important in helping them preserve their thinking skills, they also point out that there are limits to how much we can boost this reserve through “mental exercises.”
Raphael Wald, a doctor of psychology and board-certified neuropsychologist at Baptist Health Marcus Neuroscience Institute, told MNT:
“People with high IQs tend to do better with dementia because there is more cognitive reserve. However, once dementia sets in one cannot overcome the degenerative process by doing cognitive tasks like crossword puzzles. It may slow the process down somewhat though.”
MNT also spoke with Dr. Karen D. Lincoln, a professor in the Department of Environmental and Occupational Health at the University of California, Irvine.
She noted that while some evidence suggests that cognitive exercises like crossword puzzles or word games slow cognitive decline in those with mild cognitive impairment, the evidence is inconclusive.
“These types of activities are important for stimulating the brain, but puzzles alone do not necessarily improve cognitive abilities or lower dementia risk. […] We have to consider our entire vascular system as a whole rather than separating them into individual parts,” she noted.
Dr. Gomes-Osman agreed that relying on intellectually-stimulating activities alone is insufficient for reducing dementia risk. She noted that the field’s most “cutting-edge” research shows that the greatest improvements in thinking abilities and dementia risk reduction occur when multiple healthy behaviors are targeted.
What are the 12 modifiable risk factors for dementia?
To share which behaviors to target, Dr. Gomes-Osman referenced the 2020 report on dementia prevention, intervention, and care from the Lancet Commission.
The report highlighted 12 modifiable risk factors that account for 40% of dementia:
- a person’s level of education
- their level of social contact
- hearing impairment
- exercise routine
- depression symptoms
- alcohol use
- midlife obesity
- exposure to air pollution
- smoking habits
- head injuries
- hypertension (high blood pressure)
- diabetes.
The researchers behind the report noted that acting on these factors can reduce dementia risk by reducing neuropathological damage — such as the build-up of tau protein and inflammation — increasing and maintaining cognitive reserve, or both.
“Just to give a sense, if we all took these actions today, we would slash over a third of dementia cases next year,” said Dr. Gomes- Osman.
“It is important to emphasize that even if you are already experiencing memory loss, learning something new can improve your brain health. Challenging your mind by learning something new will boost your memory, attention, and thinking abilities and improve your quality of life,” said Dr. Gomes-Osman.
She added that creating new, enjoyable experiences and seeing new things could also help improve brain health.
“Our brains respond very well to novelty, so picking something that is not too easy, and also not too hard, is key here,” she noted.
“Change the location where you do activities you enjoy. Seeing different places can increase your positive outlook on life and improve your brain health,” Dr. Gomes-Osman suggested.
“For example, if you usually go for a walk, try walking somewhere different. You can also take a different route to work or go to a different grocery store. Even figuring out where the milk aisle is in different stores will make you problem-solve in ways that challenge your brain. Try not to let a day go by that you don’t get around and see something different.”
– Dr. Joyce Gomes-Osman
Dr. Lincoln added “[a] special note for African Americans, who have the highest risk of dementia and Alzheimer’s disease in the United States.”
“[I]f you like to play dominoes, spades, or bid whist, you are actually engaging in healthy brain exercises,” he said. “Not necessarily because the games are very challenging and require good memory, but because the game is played with others. Social engagement is good for the brain!”
