An interview with Dr Julia Cook, Consultant Clinical Neuropsychologist

What is important when it comes to keeping our minds active and healthy as we get older?

Good question, and one I am constantly holding in mind while I spend more time than I should sitting at a desk in some form or another. The important thing to note is that cognition does change with age; particularly processing speed. For most people these changes are mild, rather than falling within the range for a dementia.

Lifestyle factors can certainly influence the likelihood of experiencing cognitive decline (i.e., over and above that expected with the ageing process), as well as the rate of progression of any cognitive change. For example, AgeUK (2022a) suggests that diet, exercise, sleep, physical health, mental wellbeing, cognitive stimulation and socialising are significant contributory factors. Think about your own family and/or social circle. Many of us may have someone in our families who has defied all odds – the 90 year old aunt who, defying the laws of longevity, has smoked for their entire life, experienced numerous cardiac problems and/or diabetes and exercised very little, indicating an influence of genetic factors here too.

In terms of diet, diets high in vitamin B (particularly B12), D and E, omega-3 fatty acids (Age UK, 2022a) and antioxidants may be protective against cognitive decline. It is important to highlight though that older people can have difficulties with absorption, so it may be helpful to take additional supplements (and where there is a recognised vitamin deficiency following medical investigations, injections which bypass gastrointestinal processing may be needed).

A physically active lifestyle has been found to be associated with greater grey and white matter volume (i.e., less shrinkage of brain tissue) and reduced white matter lesion load (i.e., fewer negative vascular influences on brain health). Physical activity in mid-life may reduce the propensity for developing risk factors for dementia. Whilst there is a protective effect in mid-life, physical activity does not appear to halt neurodegenerative processes where they have already begun.

High blood pressure, high cholesterol, obesity and diabetes are risk factors for cognitive decline in later life (including dementia). Specifically small vessel disease is associated with a greater risk of Alzheimer’s disease (AD) and vascular cognitive impairment (VCI). Risk factors for small vessel disease include diabetes and hypertension. So maintaining a healthy diet and staying active are crucially important.

As anyone who has had a baby undoubtedly knows, sleep is important for adequate cognitive functioning (e.g., alertness, processing speed). With age, sleep often becomes less deep and more prone to disturbance. Circadian rhythms and sleep behaviour can also be disrupted in people with cognitive impairment/dementia. Whilst it can be easier said than done, where possible it is important to adopt healthy sleeping habits to maintain normal cognitive function.

Greater mental well-being has been linked to better cognitive health in old age, and reduced risk of cognitive decline later in life. Depressive symptoms in old age are associated with an increased likelihood of cognitive decline, while high levels of anxiety are associated with poorer cognitive performance. Chronic stress can influence memory and cognitive flexibility. So the message here is about managing our mood and levels of stress in order to keep our cognitive abilities at their optimum.

Social integration and engagement with community and family are associated with higher levels of well-being and greater cognitive function. Loneliness and social isolation are linked to lower scores on cognitive tests, and have potential to increase risk for cognitive decline. As such, maintaining our connections with others are also key in maintaining our well-being and cognition.

To summarise, modifiable lifestyle factors comprise a huge chunk of what is important to work on in terms of reducing risk of cognitive decline! Diet, physical activity, social connectedness and mental wellbeing are all pivotal to maintaining cognitive health. That is absolutely not to say that if dementia comes knocking, it’s your fault. It is not. There are a host of genetic interactions with environmental factors which significantly influence our individual risk for developing dementia.

What benefits might travel have for our cognitive function? Might there be any negatives?

We all know that travel generally reduces stress and promotes well-being. Research supporting this view includes a recent interview study of 20 participants over the age of 55 who travelled regularly (Patterson et al., 2021). The findings were, perhaps unsurprisingly, that participants believed travel is beneficial to their well-being. This belief included the view that travel provides interest and activities that allow them to stay active and healthy as they grow older. This was a very small study, and most participants were well educated and had been in professional occupations during their working life. This suggests that those who are mindful of the need to look after themselves as they age will use travel as one way to maintain their overall health.

Another recent study in Belgium compared the well-being of older people who travelled regularly with those who didn’t travel. Higher holiday frequency and increased cognitive activities were associated with increased well-being, even after adjusting for socioeconomic status, health, and physical and social activity (Melon et al., 2018). Social activities whilst on holiday were an important predictor of well-being, suggesting that social connectedness is important. Cognitive activities, including reading and travel planning also predicted participant well-being.

There has been some evidence that even short breaks away from our day to day lives (3-4 days) can help to combat the effects of mental fatigue (Packer et al., 2021). Given that reduced mental well-being and chronic stress are associated with poorer cognitive performance, activities like travel may therefore have a positive impact.

In terms of possible negatives, these benefits may be short-lived, and that travel can cause or increase stress levels in the short-term due to increased work/home load prior to travelling. We need more research about the impact of travel on cognitive function.

Going back to basics, we know that a healthy lifestyle is key. Travel could be a way to promote physical activity, but it probably depends on the type of holiday. City breaks are often good for the step count (personal experience) or hiking holidays, but sitting on a sun lounger at an all-inclusive probably less so. With high blood pressure being linked to the risk of mild cognitive impairment and dementia development in late life, participating in activities that can reduce blood pressure will be protective against cognitive decline. The key message here is to ensure you stay active on your trip!

Social engagement, time with family and novel experiences are all important parts of travel, so these factors may also help with maintenance of cognitive function.

The  Alzheimer’s Society recommends challenging yourself and engaging your brain in activities as a way of maintaining cognitive function. Do you think regular travel could be a way to achieve this?

Travel often involves experiencing novel environment, so provides enrichment; in particular environmental enrichment – stimulation of the brain via physical and social surroundings. This has been found to contribute to functional and structural changes in the human brain, and in animal models it has been found to mitigate cognitive decline. They say “a change is as good as a break” and travel often provides both! In addition, learning new skills can stimulate the brain and mitigate cognitive decline, and travel often involves learning; for example, learning to navigate new environments and learning about cultures and languages.

Anecdotally I can tell you more about the way the sun shines on the sand dunes in Moroccan desert and how it feels to eat traditional Bedouin meals in a tent at sundown when the desert cools than I can about what I ate for breakfast yesterday. Travel pushes us outside of our comfort zone and outside of the “norm”, which helps with forming memories; it’s like time stops, and our brain returns to childlike fascination, taking in all the details with curiosity!

There is also some evidence from longitudinal field studies that holidays can enhance cognitive flexibility. As I explained earlier, my guess is that sitting on a sun lounger at an all inclusive is likely to be less beneficial than an adventure holiday!

If we have travelled a lot in our earlier life, might this be protective for us as we age?

Some people appear to be more protected against cognitive decline than others, known as ‘cognitive reserve’. Cognitive reserve is influenced by intelligence levels, as well as life experiences such as education, occupation, and cognitively stimulating activities. In addition to physical activity, regular engagement in activities that combine leisure activities, learning and social interactions are most beneficial to maintaining cognitive health (Age UK, 2022b), and one study suggested that those engaging in more than six leisure activities had reduced risk of developing dementia by 38%.

As a cognitively stimulating leisure activity, frequent travel earlier in life may contribute to buffering cognitive reserve, leading to a protective effect against cognitive decline with age. I imagine this effect is likely to be relatively small, but anything that we enjoy and might have a positive impact must be good! It’s also important to note that we don’t (yet) know which specific activities may slow rates of cognitive decline or reduce dementia risk.

As well as being a psychologist I am a literary fan, so I found some wonderful quotes by Pico Iyer. To draw to a close, here is one that sums up my feelings about travel and its benefits:

“We travel, initially, to lose ourselves; and we travel, next to find ourselves. We travel to open our hearts and eyes and learn more about the world than our newspapers will accommodate. We travel to bring what little we can, in our ignorance and knowledge, to those parts of the globe whose riches are differently dispersed. And we travel, in essence, to become young fools again- to slow time down and get taken in, and fall in love once more.”

— Pico Iyer

You can follow Dr Julia C (@julia_c_psych) on Twitter

With thanks to Millie Padget-Wharton (Honorary Assistant Psychologist) for supporting this interview with a background literature review.

References

Age UK. (2022a, August 9). Looking after your thinking skills. https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/staying-sharp/looking-after-your-thinking-skills/

Age UK. (2022b, September 20). What is cognitive reserve. https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/staying-sharp/thinking-skills-change-with-age/cognitive-reserve/

Mélon, M., Agrigoroaei, S., Diekmann, A., & Luminet, O. (2018). The holiday-related predictors of wellbeing in seniors. Journal of Policy Research in Tourism, Leisure and Events, 10 (3), 221-240.

Packer, J. (2021). Taking a break: exploring the restorative benefits of short breaks and vacations. Annals of Tourism Research Empirical Insights, 2(1),

Patterson, I., Balderas-Cejudo, A., & Pegg, S. (2021). Tourism preferences of seniors and their impact on healthy ageing. Anatolia, 32(4), 553-564.

If you enjoyed this article check out our previous post What are the psychological benefits of travel?