The ability to clearly think, learn, and remember is essential to performing everyday activities and living independently. Therefore, as we age, one important goal is to maintain this general cognitive health. Because the proportion of older individuals in the general population continues to increase (United Nations, 2019), the demand for effective programs that support individuals in preventing cognitive decline is also growing. The structure of the adult brain has a great capacity to adapt and change in response to experience and training (Colcombe et al., 2006), so preventative approaches are promising.
Encouragingly, research findings from the previous two decades have shown that cognitive decline is strongly influenced by nonbiological factors and lifestyle (Hedden & Gabrieli, 2004): Several lifestyle changes are crucial for cognitive health, first and foremost physical, cognitive, and social activities. Regulations imposed in response to coronavirus disease of 2019 (Covid-19) have restricted various opportunities for such cognitively stimulating activities, such as cultural events and other social interactions. Thus, interventions that support and guide older adults in their daily cognitive activities are even more important to protect them from cognitive decline. This pilot study aims to evaluate an ongoing multimodal online intervention with a cross-sectional survey. The intervention raises older adults’ awareness of the impact of their lifestyle on their cognitive health and sends them weekly exercise suggestions to support them in making cognitively stimulating activities part of their routine.
Crucial lifestyle factors which prevent cognitive decline
A growing body of scientific research and the resulting World Health Organization (WHO) guidelines (Astrup et al., 2019) have identified several crucial lifestyle factors that reduce the risk of cognitive decline and dementia.
The first factor is actively taking care of physical health, by healthy food intake (Morris et al., 2015) and regular physical exercise (Buchmann et al., 2019). Individuals who are obese in midlife have a higher risk of dementia than those of healthy body weight. Indeed, both healthy food and physical exercise modulate the cellular and molecular processes in the brain that are vital for cognitive health, including the optimization of growth factors such as brain-derived neurotrophic factor (e.g., Chieffi et al., 2017). Intervention studies have shown that physical activity and optimized dietary behaviors increase cognitive functioning in older age and that greater physical activity is beneficial in protecting against cognitive decline (Schlaff et al., 2018).
The second factor is cognitive activity such as lifelong learning and intellectual engagement. Higher cognitive activity in midlife and later life is linked to delayed onset of cognitive impairment (Vemuri et al., 2014). Cognitive interventions aim either to train memory and other cognitive processes directly or to train memory strategies that in turn improve cognitive performance (Bottiroli et al., 2013). Findings regarding the effects of cognitive interventions on the general cognitive functions of older adults are inconclusive (for a recent review, see Sanjuán et al., 2020). Some cognitive interventions demonstrated significant benefits and even indicate some transfer to daily life in healthy older adults (Ball et al., 2002; Bottiroli et al., 2013; Tennstedt & Unverzagt, 2013) or in older adults with mild cognitive impairments or dementia (Zhang & Chignell, 2020). Other cognitive interventions produced no significant benefits on cognitive performance of older adults (e.g. Almond, Moulin & Morrison, 2015).
Another crucial factor is social activity. Few social contacts and low social have both been associated with increased dementia risk (Kuiper et al., 2015). Research has confirmed the importance of social connection through social activities to protect from cognitive decline and reduce feelings of isolation and loneliness (see Cacioppo et al., 2015; Masi et al., 2011, for a meta-analysis). Various intervention studies have shown positive effect of social activities on cognitive variables (e.g., Bambini et al., 2020; Christelis & Dobrescu, 2020, for a meta-analysis). For example, a study of older adults with dementia revealed the positive influence of communication with family members and healthcare professionals on patients’ behavior and symptoms (Videler et al., 2020).
A range of other factors have also been found to influence cognitive function in older adults. One of them is mindfulness, which is associated with lower perceived stress and cortisol levels and with improve well-being (cf. Grossman et al., 2004). Because chronic stress is known to affect memory and increase the risk of dementia (McEwen, 2017), mindfulness-based interventions are thought to protect cognitive health (cf. Chiesa et al., 2011). In addition to this indirect effect on cognition through improved physiological mechanisms related to stress and immune function, a direct effect has been proposed through the repeated activation of attentional functions (Malinowski & Shalamanova, 2017)). Indeed, evidence has shown that mindfulness-based interventions improve cognition in older adults both with and without mild cognitive impairment (Wells et al., 2019; Zhang et al., 2018).
Another factor is creativity, which is linked not only to mental and physiological health indicators but also to cognition in older age (e.g., Sharma & Babu, 2017). Individuals that frequently engage in highly creative activities demonstrate higher cognitive reserve than individuals with more routine activities (Colombo et al., 2018). Intervention studies with older adults both with and without mild cognitive impairment or dementia found greater positive effects on cognitive functions and daily living ability after creative therapy (e.g. drawing, dance, music, story-telling) than after standard cognitive training (Martinec & Lera, 2018; Zhao et al., 2018). In addition to interventions traditionally identified as creative, other creative activities include idea generation and improvising (cf. Flood & Phillips, 2007).
Finally, humor leads to the release of endorphins in the brain and a reduction of cortisol, which produces psychological and physiological effects that are similar to the benefits of aerobic exercise (cf. Berk et al., 2001). Also, humor is a form of cognitive reappraisal, allowing individuals to reappraise daily stressors. Therefore, humor is suggested as an approach to decrease stress and protect cognitive abilities in older adults (cf. Mallya et al., 2018). Humor interventions have been shown to relieve chronic pain, and enhance happiness and life satisfaction (e.g. Tse et al., 2010).
In sum, research into cognitive health suggests that the effect of these activities on cognitive fitness may be additive. Consequently, a generally active lifestyle seems to be more effectual than specific short-term interventions (Kuster et al., 2016). Whereas single-component interventions often result in task-specific improvements with very little, if any, generalization to overall cognitive functioning and daily life situations (e.g. Hudes et al., 2019; Reijnders et al., 2013), multimodal interventions may produce greater benefits by addressing multiple factors (cf. Chalfont et al., 2020). For example, lifestyle interventions that combine physical exercise with cognitive training produce good results (Maffei et al., 2017; Ngandu et al., 2015).
The present cross-sectional study evaluates an ongoing public multimodal intervention that combines all of the evidence-based factors mentioned above to support older adults in their cognitive fitness and health. The intervention consists of weekly exercise recommendations for physical, cognitive, social, mindful, and creative activities for daily life combined with psychoeducational information about the impact of their lifestyle on their cognitive health. The purpose of the intervention was to encourage and instruct participants to make particular activities and specific exercises part of their daily activities. The aim of this cross-sectional study survey was to determine what kind of individuals participate in such a public intervention, how much time they spend on the exercises, and whether they experience any benefits from the intervention. Furthermore, we aimed to investigate how the characteristics of the participants and the time they invested influenced self-rated changes and lifestyle adaptations.