Comment: Too much of a good thing may still be good for your brain

Approximately 5 million Americans live with mild cognitive impairment (MCI) and Alzheimer disease (AD). Age adds a layer of complexity to disease management not present with younger adults, as older adults have a greater likelihood of multiple chronic conditions that can diminish their capacity to function independently. Chronic disease burden increases risk of MCI, while certain lifestyle factors may reduce MCI risk.¹ This implies that preventive strategies for MCI may need to begin in midlife and persist throughout late life.

While we cannot cure MCI or AD, there is increasing evidence that disease risk may be modifiable. Besides age and family history (not modifiable), the strongest risk factors in the literature include hypertension, diabetes, cardiovascular disease, hypercholesterolemia, obesity, low levels of mental and physical activities, decreased social engagement, and poor dietary patterns.^1–3

The present study¹ focused on 256 cognitively normal participants over a median of 4.1 years, of whom 121 (47%) developed MCI. Using medical records and patient-reported history, the investigators were able to tease out medical conditions that increased the risk of MCI (including hypertension, vascular disease, depression, and increasing numbers of chronic medical conditions). More importantly, they were able to discern protective effects from midlife and late-life activities, including arts and crafts, social engagement, and using a computer. While self-reports of how much artistic, social, or physical activities one does 30 years prior could be contaminated with reporting biases, these findings are consistent with other clinicopathologic studies^2,3 that clearly demonstrate the beneficial effects of cognitively and socially stimulating activities on the rate of cognitive decline and the level of Alzheimer pathology.

Long ago, “an apple a day keeps the doctor away” was a common expression, suggesting that eating well could improve health. Perhaps today the expression should expand to include painting an apple, going to the store with a friend to buy an apple, and using an Apple product.