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Anthea Rowan

This is the 38th instalment in a series on dementia, including the research into its causes and treatment, advice for carers, and stories of hope.
A regular refrain from my mother was, “I wish I’d become a teacher”.
She would have made a very good teacher: she taught us at home when we were little. She taught a French-speaking friend’s daughter to speak English. She taught me how to teach my children to read and write.
She had exactly the right approach: she was patient, curious, made learning fun, and was a voracious reader.
I wonder now if having an occupation might have protected her from depression – she often articulated the loss she felt when her children went away to school as a key reason for her low moods.
I also wonder if having a job might have protected her from the dementia that took her life. The science says it might have done.

Dr Trine Holt Edwin, a geriatrician and postdoctoral fellow at the Oslo Clinical Dementia Research group at Oslo University Hospital, in Norway, recently authored a study that examined the connection between cognitive impairment and dementia in later life and occupation in midlife.
Holt Edwin’s findings – which examined people between the ages of 30 and 65 – found that the most cognitively challenging jobs help to build cognitive reserve.
A bigger or better cognitive reserve increases the brain’s resilience and flexibility, and allows for cognitive performance that is better than expected later in life, given the degree of life-course-related brain changes or disease.
The cognitive reserve hypothesis, she says, presupposes that “cognitive abilities acquired through education and other cognitively stimulating activities throughout the lifespan can delay the onset of mild cognitive impairment and dementia”.
Holt Edwin’s study, of more than 7,000 Norwegians across 305 different occupations, found that those who held the least mentally challenging – or menial – jobs had a 66 per cent greater risk of mild cognitive impairment, and a 31 per cent greater risk of dementia, after the age of 70 compared with those in more mentally demanding positions.

It illustrates how important work is, Holt Edwin said: using your brain and learning new things as you get older strengthens your cognitive reserve. It may even partially counteract the effect of the APOE4 allele – a gene known to be linked to Alzheimer’s development.
The phrase “cognitive reserve” was coined by Professor Yaakov Stern, a neuropsychologist and chief of the Cognitive Neuroscience Division in the Department of Neurology at Columbia University in the US state of New York.
Stern published a paper in the early 1990s that observed people with higher education were less likely to develop Alzheimer’s disease. When he presented it at the Academy of Neurology, friends and colleagues made fun of the idea.
“It seemed so far-fetched,” he remembers, “that something like education could counter the plaques and tangles of Alzheimer’s”.
He used “cognitive reserve” to differentiate it from the “brain reserve” described by Robert Katzman a few years previously.

Katzman published research in the late 1980s based on the examination of the brains of elderly residents of a care home.
He found a number of their brains showed significant pathology of Alzheimer’s, yet their cognition ranked in the top 20 per cent of the nursing home residents – as good as, or better, than residents without any signs of Alzheimer’s in their brain.
Katzman concluded that this was because these people had bigger, heavier brains with more neurons and synapses, so they had more brain to lose in the face of dementia.
Katzman was a pioneer in the field of Alzheimer’s; his work demonstrated how widespread the illness actually was. When he published research on the prevalence of the illness in China, he concluded that people with higher levels of education appeared to have a lower incidence of dementia.
When he read this, Stern assumed the findings were flawed.
“They were using a mental status exam and I felt sure – of course – that people with higher education would do better on that test,” he said. “I felt it needed an incidence study – starting with people who were not demented and following them over time.”

Stern and his team set out to do exactly that and found that people with fewer than eight years of education had twice the risk of developing dementia compared to those with more.
They also found that people with “low lifetime occupational attainment” bore a similar risk. The implication of these findings, Stern concluded, was that educational and occupational experiences imparted a reserve against the expression of Alzheimer’s pathology.
Holt Edwin’s results support this hypothesis “by showing that cognitive abilities acquired through both education and occupation during early [life] and midlife appear to offer resilience against cognitive decline”.
Categorising individuals according to the level of an occupation’s complexity versus how routine-oriented their work was, the scientists found the jobs with the “most mentally stimulating trajectory” were the ones that seemed to offer greatest protection.
More mundane work – that of cleaners, mail carriers and road workers – was among the least mentally challenging.

Researcher Pamela Almeida-Meza, at University College London, found that even those who were not afforded the same educational or employment advantage can make up for the losses in learning, by reading for example.
She refers to the 1946 British National Birth Cohort study – a study arranged by social class and initially consisting of 5,362 people chosen at random from all births in England, Scotland, and Wales during a single week in March 1946 – as evidence of this.
At the time, she says, there were few women in higher education or senior positions at work, but many were self-educating, which had a positive impact ultimately on brain health.
If we were to extrapolate our results, Holt Edwin adds, “You could say that our study shows that it is never too late, or a waste of time, to start learning something new”.
All cognitively demanding activities later in life contribute to strengthening one’s cognitive reserve, she says, even if you are not working and did not work in an especially cerebral or taxing position.
Ironically, given my mother’s voiced wish that she had been a teacher, the jobs ranked as most stimulating were teachers and university lecturers.
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Wellness

How having a mentally stimulating job in midlife may protect against dementia later on

Having a mentally stimulating job, such as being a teacher (above), in midlife may help build cognitive reserve which protects you against dementia as you age. Photo: Shutterstock

Dr Trine Holt Edwin, of Oslo University Hospital, in Norway. Photo: Anne Elisabeth Næss (Norwegian Health Association)

Yaakov Stern, an American cognitive neuroscientist and professor of neuropsychology at Columbia University in New York state, coined the term “cognitive reserve”. Photo: Columbia University

New research suggests that it is never too late, or a waste of time, to start learning something new. Photo: Shutterstock

Jobs ranked as most mentally stimulating – and therefore able to build up greater cognitive reserve – included teachers and university professors. Photo: Shutterstock

Pamela Almeida Meza, a researcher at University College London. Photo: www.researchgate.net/profile/Pamela-Almeida-Meza

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Longevity experts recommend weightlifting as a way to build and maintain muscles and strength and rid the body of those niggling aches and pains that come with age. Photo: Shutterstock

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JJ Virgin says creatine is an important nutrient to take as a supplement. Photo: JJ Virgin

Put on your blue light filtering glasses in the evening to block out screen light, says Alka Patel. Photo: Alka Patel

Another reason to stop smoking: it increases dementia risk from brain shrinkage – but quitting, at any age, helps

Smoking shrinks your brain, increasing the risk of dementia. However, quitting the habit, even aged 60, substantially reduces the risk. Photo: Shutterstock

Dr Laura Bierut, a psychiatry professor at Washington University School of Medicine, led a study that links habitual smoking with brain shrinkage. Photo: Washington University School of Medicine

Studies show smoking damages the brain as well as the heart and lungs. The habit is linked to brain shrinkage, which causes memory loss – a hallmark of dementia. Photo: Shutterstock

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Smoking while pregnant harms not only the mother-to-be, but also the unborn child. Studies show tobacco smoke exposure in pregnancy is linked to smaller brains in newborns. Photo: Shutterstock

Forgetfulness is an early sign of dementia, but also normal as we age; experts explain the difference

There is a big difference between exiting a shopping centre and not remembering where you parked your car and forgetting where you are or how you got there. The latter could indicate you have a problem, an expert explains. Photo: Shutterstock


Charan Ranganath, a psychology professor at the University of California, Davis, says the most common question he is asked is ‘Why am I so forgetful’? Photo: University of California, Davis

“We don’t remember things often because we were never there in the first place. We’re checking our phones, being distracted by noises on the street and so forth,” says Charan Ranganath, a psychology professor. Photo: Getty Images

Richard Restak, 82, a clinical professor of neurology and rehabilitation medicine at George Washington University, in the United States, advocates napping to help ward off memory loss. Photo: Richard Restak

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Lifestyle

Health & Wellness

Health

Decoding dementia

How caring for a parent with dementia taught me about symptoms, prevention and why seeking out the latest research is so important

Author Anthea Rowan (right) with her mother.

Author Anthea Rowan (right) with her mother, who has Alzheimer’s disease, the most common type of dementia. Photo: Anthea Rowan

Anthea with her mother. Photo: Anthea Rowan

Studies suggest that regular exercise lowers the risk of cognitive decline by 35 per cent. Photo: Getty Images

Staying active can help prevent or delay the onset of dementia, studies suggest. Photo: Shutterstock

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Timothy Rittman, the neurologist who led the dementia research at Cambridge University. Photo: Cambridge University

A brain scan showing signs of dementia. Photo: Getty Images

Lizzie Perry, founder of This is Dementia, with her father, who was diagnosed with the disease at 58. Photo: This is Dementia

The approval in the US of a new drug that slows the onset of Alzheimer’s makes Rittman hopeful about the future of dementia treatment. Photo: Cambridge University

Why women are more likely to have dementia than men as they age, and how exercise and engagement can help lower your risk

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Taking regular exercise is key for women – and men – to reduce the risk of dementia. Photo: Shutterstock

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Having blood pressure that is too high or too low has been linked to a higher risk of dementia, but it’s never too late to start living a healthy lifestyle that will help maintain optimal blood pressure. Photo: Shutterstock


An optimal blood pressure reading, easily measured with a home device, is around 120/80. Photo: Shutterstock

Dr Ruth Peters was lead author of a study looking at the links between blood pressure and dementia. Photo: Dr Ruth Peters

It’s never too late, or too early, to start thinking about brain health and living a healthy lifestyle. Photo: Shutterstock

Problems with reasoning, planning, judgment, memory and other thought processes may result from damage caused by impaired blood flow to the brain – which may be brought on by high blood pressure. Photo: Shutterstock

6 dementia fighting tips from Dr Sanjay Gupta and Marc Milstein, experts on brain health – walk, talk, read, learn, relax, and eat and drink properly

We can protect ourselves against the risk of dementia with some simple lifestyle practices. Exercising (above), eating a good diet, drinking less alcohol, socialising, reading more and trying new things all help keep the brain sharp, say brain experts including Dr Sanjay Gupta. Photo: Shutterstock 

The cover of one of Dr Sanjay Gupta’s book. Photo: Simon & Schuster

The cover of Marc Milstein’s book. Photo: Marc Milstein

Drink alcohol mindfully and ask yourself why you are having that drink. Photo: Shutterstock

Learning new things creates new brain cell connections and helps keep your mind sharp. Photo: Shutterstock

Reading is good for brain health. Try to read a wide range of book styles, and join a book club to discuss with others what you are reading. Photo: Shutterstock

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Relationships keep us engaged, interested and interesting, and may help prevent dementia. Photo: Shutterstock

‘Like a light switch’: how sundowning syndrome affects dementia sufferers – and their carers; what it is and tips for how to cope

A person with dementia may experience “sundowning” syndrome - towards the end of the day they become more agitated, confused, panicked, resistant to instruction and restless. This affects their carers, too. Photo: Shutterstock

A person in bed, unable to sleep. Conservative estimates suggest about 20 per cent of dementia patients experience sundowning at some point.

Trey Todd is a neuroscientist at the University of Wyoming. Photo: Trey Todd

Sundowning was coined in 1987 by Lois Evans of Penn Nursing at Pennsylvania University. Photo: University of Pennsylvania

The pineal gland in our brain produces melatonin, which is what helps prompt us to sleep and awaken. In a broken system it is disrupted. Melatonin supplements might help fight sundowning. Photo: Shutterstock

Taking a patient with sundowning syndrome for a walk at a consistent time each day, morning or evening, may alleviate symptoms. Photo: Shutterstock

Getting out into the daylight early in the day is good for our sleep patterns, whether we have dementia or not. Photo: Shutterstock

Healthy marriage, healthy mind? Dementia risk lower for people married a long time, studies show; expert suggests why

Research suggests that people who have stayed married for a long time have a lower risk for dementia because they feel less lonely, are more likely to eat well and exercise more, and are more cognitively engaged. Photo: Shutterstock

Vegard Skirbekk is a researcher at the Norwegian Institute of Public Health. Photo: Norwegian Institute of Public Health

Anthea Rowan’s parents on their wedding day. Photo: courtesy of Anthea Rowan

A long-time married partner represents a security that provides a buffer against stressors. Photo: Shutterstock

Anthea Rowan and her husband on their wedding day. Photo: courtesy of Anthea Rowan

If you live with a partner long term, you are more likely to develop healthy daily patterns, to eat well and exercise more. Photo: Shutterstock

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Residents are free to live their lives as they like at the world’s first “dementia village”, The Hogeweyk in The Netherlands. Photo: The Hogeweyk

The Hogeweyk, a “dementia villlage” in the Netherlands, provides care and a familiar and safe environment in which people with dementia live while retaining their own identity and autonomy as much as possible. Photo: The Hogeweyk

Jannette Spiering is the senior managing adviser and co-founder at The Hogeweyk in the Netherlands, which offers “humanising care for people with dementia”. Photo: The Hogeweyk

Residents relax around the fountain in the theatre square at The Hogeweyk. Photo: The Hogeweyk 

Residents of The Hogeweyk respond positively to their increased autonomy. Photo: The Hogeweyk

Residents at the healthcare facility take part in a painting class. Photo: The Hogeweyk

Hearing loss dramatically raises the risk of dementia, so why are so many people in midlife doing nothing to prevent it? A test is easy to arrange

Hearing loss has been linked to a higher risk of dementia and cognitive decline,  say experts, who recommend testing for preventable hearing problems (above).  Photo: Getty Images

Alison Huang, a senior research associate at the Cochlear Centre at Johns Hopkins, in the US, says hearing loss makes the brain work harder to process sounds. Photo: Johns Hopkins

Jiang Fan from the School of Public Health at China’s Shandong University. Photo: Shandong University

Checking your hearing in midlife is crucial, and can help you stave off cognitive deterioration. Photo: Shutterstock

Can HRT reduce dementia risk? New hormone replacement therapy studies say yes, upending 2002 reports

HRT use has been linked to better cognition, blood flow and brain size and a reduction in all neurodegenerative disease in recent studies. Photo: Shutterstock

HRT (hormone replacement therapy) use has been linked to better cognition, blood flow and brain size and a reduction in dementia and other neurodegenerative disease in recent studies. Photo: Shutterstock

If HRT is started after the age of 65, brain cells will have already been deprived of oestrogen for many years. This could mean there is a decline in neuronal connections – the brain’s messaging system. Photo: Shutterstock

HRT was found to be most effective when introduced early in menopause, says Anne Marie Minihane, director of the UK’s Norwich Institute of Healthy Ageing at the University of East Anglia. Photo: University of East Anglia

Dr Andrea Kwakowsky from at the University of Galway in Ireland believes the “critical period” for starting HRT is within five years of menopause. Photo: University of Galway

How can you prevent dementia? Free brain health online tool teaches the risks and gives essential tips on avoiding it

The new free “Think Brain Health Check-in” online tool from Alzheimer’s Research UK doesn’t test your memory but checks how well you’re looking after your brain and gives tips to help prevent dementia. Photo: Shutterstock

Dr Susan Mitchell is head of policy at Alzheimer’s Research UK. Photo: Dr Susan Mitchell

The Think Brain Health Check-in asks how often you challenge your brain - and then highlights why challenging your brain is key to staving off dementia. Photo: Shutterstock

Getting a good night’s sleep every night is one way to lower the risk of developing dementia. Photo: Shutterstock

Up to 40 per cent of dementia cases could be prevented if people were mindful of the risk factors for the illness and made lifestyle changes to prevent them. Photo: Shutterstock

Can lack of sleep raise dementia risk? Yes, studies say – but with one exception

Having only five hours of sleep a night can increase dementia risk by 30 per cent for adults over 50, one study says. Photo: Shutterstock

One tip to overcome insomnia is to avoid clock-watching. Photo: Shutterstock

Taking a warm shower or bath in the hour or so before bed may help you fall asleep – and stay asleep. Photo: Shutterstock

Professor Roger Wong of the department of public health and preventive medicine at the State University of New York’s Upstate Medical University. Photo: Roger Wong

Sleep aids can heighten dementia risk, Wong says. Photo: Shutterstock

Can’t sleep? Try getting up and engaging in cognitively stimulating activities, like reading or making jam. Photo: Shutterstock

Dementia and ACB scores: how common prescription and over-the-counter drugs raise the risk of memory loss and cognitive decline

Certain common drugs, including antihistamines, antacids, antidepressants and anti-anxiety medicines, can disrupt the neurotransmitter acetylcholine, dubbed the “memory molecule” increasing the risk of dementia. Photo: Shutterstock

The writer, Anthea Rowan, with her mother. Photo: Anthea Rowan

Taking medications that block the action of acetylcholine can lead to memory loss, problems with spatial awareness, and cognitive decline. Photo: Shutterstock

Studies have found that anticholinergic drugs carried “significant’ dementia risk” for the over-65s. Photo: Shutterstock

Doctors need to be mindful of the risks posed by anticholinergic drugs, especially to an already at-risk population: the over 65s. Photo: Shutterstock

How to safeguard your ageing brain: build ‘cognitive reserve’ with mental and physical exercise, and stay active and socially engaged

The phrase ‘use it or lose it’ is not just a hypothesis, it’s a basic biological fact that holds as true for our brains as our muscles or bones. Photo:
Shutterstock

Our brains, like our muscles need regular use to stay healthy and flexible, say experts, and keeping our brains active builds our ‘cognitive reserve’, helping us to stave off dementia. Photo: Shutterstock

Geriatric psychiatrist Dr David Merrill recommends the active pursuit of activities that keep the brain sharp to stave off dementia. Photo: Dr David Merrill

Dorina Cadar says cultural and social engagement, reading, doing crossword puzzles, visiting art galleries, clubs and cinemas, and volunteering all increase our cognitive reserve. Photo: Dorina Cadar

Visiting an art gallery or doing something new and different are good ways to build up cognitive reserve. Photo: Shutterstock 

How yoga benefits dementia patients: new study uncovers brain-health boosts, supporting earlier research

Yoga has health benefits including better brain neuroplasticity, improved sleep quality, and more robust cardiorespiratory fitness, all of which help people experiencing cognitive decline or dementia. Photo: Shutterstock

Dr Diana Karamacoska is a research support programme fellow in healthy ageing and dementia at the NICM Health Research Institute at Western Sydney University. Photo: Courtesy of Diana Karamacoska

Yoga could be helpful in managing brain inflammation, particularly with its mindfulness component. Photo: Shutterstock

Wendy Du is the founder of Shan Studios in Hong Kong. Photo: Wendy Du/Shan Studios

Du has maintained a daily yoga practice for 10 years. Photo: Courtesy of Shan Studios

5 nutrients good for brain health that can delay dementia, or prevent it, and foods to eat with a high concentration of them

Research has identified some key nutrients we need in our diets to maintain good cognitive function and delay or prevent the onset of dementia. Photo: Shutterstock

Eating healthy isn’t just good for our bodies, it’s good for our brains, too. Photo: Shutterstock

How having a mentally stimulating job in midlife may protect against dementia later on

Author’s mother wished she had been a teacher; science shows it might have helped protect her against the dementia that took her life