Dementia, cognitive ageing and decline – am I bovvered?

Dementia Awareness Day is on the 15 September. For many people dementia is a very distressing condition involving the loss of cognitive abilities such as clear thinking, communicating and remembering. A deterioration in cognitive abilities affects most people as they grow older but this doesn’t mean that everyone goes on to develop dementia.

I recently attended the 2012 World Congress on Active Ageing, held in Glasgow. Lots of interesting papers and presentations and a lot of emphasis on the benefits of physical activity in helping to prevent cognitive decline as we grow older and maintaining good mental health and well-being. Why is it then that rates of physical exercise among people of all ages are so low? Surely everyone wants to stay mentally sharp and happy as they grow older?

But perhaps it’s not as simple as that. For starters, poor mental health is not an inevitable part of growing old. There is a lot of evidence to show that the majority of people in later life have very good mental health and cope well with the challenges that growing old can bring (although this is not reason for reducing spending on mental health services for older people because the numbers of older people with conditions like dementia and depression will continue to grow). I suspect many of these people do not do the recommended amount of exercise they are supposed to or eat their five a day. Some of them may even drink alcohol, or heavens forbid, smoke. Their sense of well-being, with or without “lifestyle choices” such as these, may feel perfectly satisfactory without any significant physical exercise, thank you very much.

But surely if they are leading sedentary lifestyles just watching TV or reading the paper they would want to stay mentally sharp? Apparently not. According to research from the Centre for Cognitive Ageing at Edinburgh University there is very little evidence to show that cognitive deterioration in later life is associated with a decrease in life satisfaction or well being. That finding corresponds with research that the Mental Health Foundation has been involved in looking at quality of life issues for people with dementia which suggests that a good quality of life can be maintained despite having a diagnosis of dementia. In other words, as with other disabilities or long term conditions, with the right support many people can adapt and live well despite cognitive deterioration and dementia.

This all may sound counter-intuitive and somewhat flies in the face of descriptions of dementia as being a “living death” or a “long goodbye”. Perhaps the negative impact of cognitive decline and dementia is felt much more keenly, and worried about more, by people whose vocational tools are heavily dependent upon high cognitive functioning such as people in professional occupations, and less so in roles and occupations which are more mechanical, repetitive or habitual. A famous study of nuns suggested that the nature of their lifestyle made it relatively easy for nuns with symptoms of dementia to continue to function successfully within their community. If this hypothesis is correct, the people who will experience the worst mental health in the face of cognitive decline and dementia as they grow old include many who are most involved with those issues at present, such as health and social care professionals, researchers and academics, service planners and policy makers, journalists reporting on the topic, and the author of this blog.

It would be trivialising the problem to say cognitive decline and dementia are a case of ‘where ignorance is bliss’ but perhaps the issues is as much to do with the poor care and support that people with dementia often receive and the stigma that is placed upon it as it is with the actual illness itself."