Love, Actually?

When considering factors that could reduce the risk of dementia onset, or delay symptom onset – the factors that you can actually do something about – there are a few well known candidates: eat a healthy diet (Mediterranean if possible) – check; don’t smoke, and drink in moderation – check; make sure you’re getting quality sleep – check; exercise – check; try to keep your mind active – check-ish (though I’m not convinced that’s as effectively done as it can be). Modifiable factors are thought to account for approximately 40% of dementia risk factors. One modifiable factor that’s not as well known as these is social isolation, or the positive flip-side, social connectivity. As another Valentine’s Day and the emphasis on love fade into the past for another year, for the sake of boosting brain health, I would encourage people to think more about the importance of social connection than love. Don’t get me wrong – I love love and it’s undoubtedly a basic human need. However, once the basic human need of being loved and loving someone or something (your hamster?) has been met, then rich social connectivity is the next thing to strive for.

My dad was a smart guy – he got a PhD in Chemistry from Oxford University no less. In his latter years, he made a lot of effort to stave off cognitive decline: he ate the right types of nuts, he carefully controlled his diet like a good scientist would; he did the Times crossword on a daily basis (see my earlier point about questionable effectiveness of brain stimulation efforts); he jogged three miles on the English country roads (imagine single winding lanes, tall overgrown hedges, muddy verges, Range Rovers barreling along like they own the road) until he was in his mid-70’s. It was an all-round impressive effort, one that took a lot of self-discipline. He had seemingly thought of everything and had been a planner his whole life. He may have thought that his brain was too robust to let something like dementia ‘get’ him. But get him it did and while he took many of the recommended actions to maintain his brain health, the one protective factor that he didn’t attend to was social connectivity. He had never been the most social guy, feeling more comfortable with his head in his work rather than in social situations. He enjoyed the comforts of working from home, despite living in an old drafty house in England, that made a woolly hat and mittens part of everyday household attire. Working from home meant that he didn’t need to bother with the potential tedium of other people and travel. Well, while that might have felt comfortable, it probably wasn’t good for his brain.

Our brains are wired to thrive off social interaction. If you think about the adage in neurobiology, “when neurons fire together they wire together”, if there is nothing in the social environment that causes the neurons to fire, then clearly they won’t wire either. That then makes the relative proportion of neuronal degeneration due to normal aging higher as there is relatively little neuronal proliferation to buffer the decline. In the same way that our joints need some gentle impact and our muscles need some appropriate level of resistance to stay at the top of their games, our brains also benefit from the challenge presented by social interaction. Interacting with people around us forces our brains to work: it makes us attend to what people are saying (or actively decide not to); we have to make opinions as to whether someone is talking sense or talking nonsense; we are challenged with retaining information and connecting it to information we already have stored; we have to interpret non-verbal cues and know how to respond appropriately; we are presented with different ideas and different perspectives, different idiosyncrasies, all of which our brains are tasked with interpreting. Without these types of interactions occurring on a regular basis, our brains become too comfortable, unchallenged, and have no need to have a neuroplastic response to understanding the environment. Research has shown that social isolation is associated with dementia, while social connectivity is a preventative factor.

There are so many things we can do in our older years to maintain social connectivity: go out for coffee with a group of friends – but not always the same friends with the same conversations; sit in a cafe and people-watch – the Europeans do this very well; attend a municipal council meeting; go to a religious service; have lunch on a park bench and chat with the dog walkers as they go by; if getting out of the house is difficult, listen to audiobooks, podcasts and webinars; schedule-in having family and friends around so you see different people on a regular basis.

Who knows – nothing is simple when it comes to dementia causation. There are no guarantees. My dad could have been a social butterfly and still got dementia at the same age and to the same severity. Maybe, being more social may have led him to drink more alcohol, which is also associated with the onset of dementia. However, in retrospect, I wish he had not socially isolated himself, for both the family’s sake and his. It may have been the dementia buffer he needed. So don’t feel so bad if you were not flooded with cards and chocolates on Valentine’s Day  – what might be as important as love, is just keeping in regular connection with your fellow human beings – every time you do is a good session of mental gymnastics for your brain.

Written by Tom Grant, Occupational Therapist, MOT

Image by Wolfgang Eckert