social interaction – Mistakes on the Journey to Nowhere

S3E6. Of Fogeys, Coots, Curmudgeons and Codgers

Grumpy Old Men (1993) Walter Matthau & Jack Lemmon

Old Man Yells At Cloud (2002, The Simpsons) Dan Castellaneta

Gran Torino (2008) Clint Eastwood

A Man Called Otto (2022) Tom Hanks

So when did the trope of cranky aging men become a thing? And why do we have so many pejorative words to describe them? Like:

Fogey: a person, typically an old one, who is considered to be old-fashioned or conservative in attitude or tastes.

Curmudgeon: a bad-tempered person, especially an old one.

Codger: an elderly man, especially one who is old-fashioned or eccentric.

Coot: a foolish or eccentric person, typically an old man.

And why do you rarely hear these terms applied to women?

And is there any basis for the stereotype? Do men really become more cantankerous, crotchety, irritable and stubborn as we age?

One theory is that it has to do with a drop in testosterone levels after age 65, but that notion is hotly contested. Other suggested causes include dealing with physical decline, lifetime losses of loved ones, difficulty adapting to changing technology, and dissatisfaction with living arrangements.

The bottom line, though, is that men do appear to get more cranky as we progress in years.

Bummer. 😦

Unfortunately, there is another pathway to curmudgeonhood that is related to dementia.

One of the early signs of dementia is a change in personality. Typical at this stage are increased irritability, reduced frustration tolerance, loss of interest in previously enjoyed activities, social withdrawal and apathy. (Please remember that for any of these to be considered symptoms, they must reflect a significant change from prior behaviors.)

The cause of these shifts is probably related to a weakening of the prefrontal cortex. This area of the brain is responsible for higher level thinking and has a primary role in modulating our emotions. For example, you can make yourself very angry if you can’t find your car keys and you think your neighbor stole them. Conversely, you can calm yourself down by thinking it through, retracing your steps, and realizing that you left them in your coat pocket. In both cases, the situation is the same: you can’t find your keys. Your emotional and behavioral responses, though, are determined by what you believe about that fact. That’s prefrontal power at work.

That is why I am monitoring my own increasing irritability and decreasing frustration tolerance. I used to be bomb-proof: very few things rattled me. And I could work for hours on a project with little progress and still not get frustrated. Now, though, I’m aware that I don’t have the patience I used to have. When doing crossword puzzles, for example, I’m far quicker to google an answer than I was in the past.

Thinking that this shift may have more to do with testosterone levels than it does with prefrontal atrophy is rather comforting in a lesser-of-evils sort of way.

What’s more, I don’t think I currently meet criteria for curmudgeon, coot, codger or fogey. For the most part, I keep my irritations to myself. I’m not firing off emails to my PBS affiliate complaining about a schedule change. I’m not unleashing a torrent of epithets (albeit creative) at other drivers who don’t signal before cutting into my lane. I keep pushing buttons on the remote until my Roku tv gets me to what I want to stream with the captioning on. If I had a lawn, I’d like to think I wouldn’t be chasing kids off of it.

I’m still interested in politics even though I’ve lost the fire in the belly to actively engage in getting out the vote. I enjoy my daily recorder practice sessions, even though I can’t hit all the notes or play certain passages fast enough. I look forward to watching UConn women’s basketball games twice a week in season…even when they lose two games in a row for the first time in 30 years. Come to think of it, if I ever stop watching, please schedule me for an evaluation!

The results of this most unscientific review, then, suggest that my personality is still intact while showing normal signs of aging. It would appear that I’ve got a ways to go before earning the right to be called a curmudgeon!

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S3E5. Isolation vs. Engagement

We were out to dinner with two other couples. I wanted to join the conversation, but when the current speaker finished talking, someone else jumped in before me and changed the subject. Having lost the opportunity, I leaned over my bowl of pasta and tried to slurp a mouthful without spraying red sauce all over my white sweater.

* * *

I’ll be the first to admit that social engagement is my weakest suit among the 5 pillars of brain health (exercise, diet, sleep, cognitive challenge, and social engagement). If I weren’t married to Sally and she didn’t schedule us to be with friends and family on a regular basis, I’d probably meet criteria for a hermit or recluse. That’s why I keep an eye out for research that might provide insight into what is an acceptable level of social engagement and what, for that matter, is even considered a social engagement.

In the scene I described at the top of this post, I was out with people, yes, but what if I hadn’t said anything at all the entire evening? Does it count as social engagement if you are with people but don’t talk? Does the mere presence of other people trigger whatever mechanisms are protective against dementia? Or does it require the full deployment of cognitive skills like listening for subtext, being tactful, reading faces, and spinning humor from previously unconnected snippets of conversation? In other words, did I get social engagement credit for my dinner the other night even though I didn’t talk a lot? Would I get credit if I went out by myself and interacted with the waitress? Is that enough to stave off cognitive decline?

I talked about this at length in S1E30: People Who Need People. Recently, though, it seems as if the research effort has shifted from how social engagement is protective to how social isolation is a risk factor. It’s an important difference.

In a study released last month, researchers found a 27% increase in dementia among older Americans who were socially isolated. Social isolation was defined as having few relationships and few people to interact with regularly. The study measured this based on whether or not participants lived alone, talked about “important matters” with two or more people in the past year, attended religious services, or participated in social events. Participants were assigned one point for each answer that reflected social activity, and those who scored a zero or one were classified as socially isolated.

That’s a low bar that I can pass as long as Sally is around! In fact, a 2017 study separated out the effect of being married from other forms of social engagement and found that marriage was protective against dementia but the extent of your social networks was not. The inference was that it might be loneliness that is more determinative than frequency of contacts.

Interestingly, a separate study showed that talking on the phone and texting reduces social isolation. The Luddite in me has so far resisted the cell phone’s siren song, but in the pursuit of brain health, I just might have to consider taking up texting at some point in the future.

Another study highlighted the advantages of socially engaging with people of different generations. I’m guessing that doing so forces you to assume different roles, with each one stimulating somewhat different brain regions. If this is the case, grandparents who live near their kids have a big built-in advantage.

Isn’t research fascinating? I’m really looking forward to studies that tease apart the unique contributions of loneliness, isolation and social engagement to your risk of developing dementia.

Finally, a recent large-scale study out of China suggests that social engagement is helpful but may not be necessary if you engage in a number of other protective measures.

The researchers focused on six modifiable lifestyle factors (which should all be familiar to regular readers of this blog):

Physical exercise: Doing at least 150 minutes of moderate or 75 minutes of vigorous activity per week.

Diet: Eating appropriate daily amounts of at least 7 of 12 food items (fruits, vegetables, fish, meat, dairy products, salt, oil, eggs, cereals, legumes, nuts and tea).

Alcohol: Never drinking or drinking occasionally.

Smoking: Never smoking or being a former smoker.

Cognitive activity: Exercising the brain at least twice a week (by reading and playing cards or mah-jongg, for example).

Social contact: Engaging with others at least twice a week (e.g., by attending community meetings or visiting friends or relatives).

It turned out that people living lifestyles that included at least four healthy habits were less likely to progress to mild cognitive impairment and dementia. So it seems it’s possible to protect yourself even without a strong social calendar.

This gives me great hope as I definitely pass muster for at least 5 out of the 6 factors…but I’m still going to try to engage more when Sally schedules me, just in case!

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S2E52. The 2022 ‘Journey Awards’

The end of the year is traditionally a time to compile ’10 Best’ and ‘Best and Worst’ lists, so I thought I’d take a crack at it with some of the best and worst brain health events of the year for each of the 5 pillars of brain health. I thought about calling the list the ‘MOTYs’ for ‘Mistakes of the Year’ awards, but that didn’t seem to leave much room for celebrating the good news, so I went with the ‘Journeys’ instead.

Here they are:

1. Cognitive Challenge

There was plenty of competition in this category: playing computerized games on BrainHQ, traveling to foreign lands, reading books, writing this blog, and learning to play the recorder. As stimulating as they all were, I’m going with learning to play the recorder as the most rewarding cognitive challenge pursuit of 2022. It’s there for me nearly every day and it’s a rush to be able to play a piece or hit notes that I wasn’t able to master a month before. Learning to play meaningful melodies from across my lifespan never gets old. All in all, a pretty nice experience for a guy whose musical aptitude probably falls in the bottom twenty-five percent!

2. Exercise

One of my favorite lifetime brain health pursuits became an unexpected challenge. I was barreling along during the first three months of the year, working out 5-6 days/week, gaining strength, feeling great and losing weight. Then in April we went out to Minneapolis for the NCAA Women’s Basketball finals and I came down with COVID, which knocked me for a loop. It left me with a weakness that persisted for nearly 6 months. Working out was hard and definitely not enjoyable and I never got back into it consistently. My workouts now, when I do them, are shorter and slower. The weights I lift are lighter. So exercise definitely gets the ‘worst performance in a brain health pillar’ Journey Award for 2022.

3. Sleep

There really was only one contender for this award: my month-long experiment to change my circadian rhythm and sleep pattern in preparation for our Mediterranean cruise. It led to quite novel experiences, like going to bed at 6pm and waking up at 2am, but I think it worked. Upon arriving in Greece, I was tired pretty much when I was supposed to be tired and woke up within an hour of when I was supposed to wake up. The results, though, were somewhat confounded by the fact that I didn’t sleep at all on the plane and spent a couple of days recovering from that sleep deprivation. So now that I’ve figured out the circadian rhythm thing, I’ll have to work a little harder on the sleeping-on-the-plane thing next time we travel abroad.

4. Social Engagement

Thank goodness for Sally! She sets my social calendar and keeps me engaged. Without her efforts, I would definitely meet criteria for ‘hermit.’ But I don’t feel as though I’m meeting my obligations here. I enjoy being out with people and I enjoy listening to the conversations, but I’m finding myself talking less, so much so that Sally has commented on it several times. In fact, it’s gotten to the point that I’m not talking as much at home, either. I can’t quite put my finger on what it is. My mind is going all the time, I can hear just fine, I don’t have any word-finding difficulties and I have no problem following conversations. It’s just that I don’t often feel the need to say anything. Isn’t that weird? Becoming more subdued and withdrawn are often listed as warning signs of an impending dementia and fall under the category of ‘personality changes,’ so there’s that. Come to think of it, I get frustrated and irritated more easily than I did a year ago, so maybe this is something to keep an eye on.

5. Diet

This is a no-brainer: the 2022 Journey Award for best brain health dietary contribution goes to granola! (See S2E50: Granola Revisited). On the other hand, there have been several notable lapses in my regimen. I gave up overnight fasting, not for any empirical reason, but just because I lost the will power to do so once I reached my weight loss target. And now Sally and I are treating ourselves to an ice cream sandwich nearly every night. Again, no reason to do that except for the sheer delight of indulging in a guilty pleasure. This year’s Journey Award, though, for the biggest diet disappointment, was my attempt to drink a small glass of red wine with dinner each night. I conducted a noble months-long search for a palatable, organic pinot noir, but alas, to no avail. As good as it was, I just didn’t like it. And to make matters worse, even nursing a 4-ounce ‘dose’ left me a little tipsy. I reviewed the recommendations on drinking red wine and the bottom line was if you don’t already drink, then don’t start. In my case, it appeared that the neuro-toxic effect of the alcohol was greater than the augmentation of resveratrol effect. Since I eat red grapes every morning in my granola and I’m not a fan of supplements, I dropped red wine from the menu.

And that’s my brain health year-in-review best and worst list, the 2022 Journey Awards.

Thank you so much for reading the blog. I hope it’s been helpful, interesting and/or entertaining. If so, I’d appreciate it greatly if you’d recommend it to your friends and family at www.MistakesOnTheJourneyToNowhere.com. It might be a nice change for them from bingeing on Netflix.

Wishing you a happy and brain-healthy New Year!

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S2E44. Greece!

We made it! We’ve spent the last several days island-hopping around Greece and as I write this we’re docking in Dubrovnik. I’ll be honest: I haven’t focused much (if at all) on brain health. I’ll assume you can understand why. Nonetheless, I’ll try to put together a few thoughts before heading out on our next excursion.

I felt I was prepared for the flight last Friday, having adjusted my sleeping and eating rhythms to accommodate 5 of the 7 hours we would cross during the flight. Serendipitously, Greece set its clocks back by one hour for daylight savings time the night we arrived, so I was gifted one more hour of transition time. What was left to absorb, then, was minimal: just 1 hour, or the equivalent of flying from Chicago to New York.

Unfortunately, I wasn’t able to get much sleep on the plane. I used a neck pillow, lavender oil, loose-fitting clothes, and I ate a banana, but all to no avail. The engine noise, fellow passengers conversing loudly, and the impossible task of getting comfortable all conspired against me. Consequently, I was not a happy camper the next morning when we landed in Athens.

The good news, though, is that I don’t think I felt any effect of the time zone changes. Once I caught up on my sleep, I was fine.

Sally, on the other hand—having not made any effort at all to prepare for the time-shift—was…fine!

It seems that for both of us, the quality of the previous night’s sleep was far more impactful than the 7 time zones we had crossed.

Traveling is a brain-healthy activity because it presents a variety of unique cognitive challenges. Going on a cruise provides those opportunities in spades.

First off, there’s getting oriented on the ship. It took me several days to figure out how to find the important locations: our room, the different restaurants, and the theater. Oh, you could find your way around by reading the signage, but I wanted to be able to do it on my own.

First, I figured out that the various restaurants, although they were on different decks, were all at the back of the boat while the theater and the main lounge were at the front. These landmarks replaced north (theater) and south (restaurants) in my personal navigation system. Then I noticed that the even numbered rooms were ‘west’ and they got higher as you traveled from ‘north’ to ‘south.’ So as long as I could keep an image in my head of where the theater was (‘north’), I could figure out where anything else was whenever I emerged from an elevator.

Conversely, after only 2 days, Sally just knew which way to turn to get to where we were going.

Then there are the excursions with guides who present volumes of information along the way, on-board lectures, adjusting to at least a dozen different accents spoken by members of the crew, and absorbing the sights and vistas themselves. Add to that sampling new foods and meeting new people and you’ve created an intense synapse-stimulating environment.

On the other hand, maintaining a brain-healthy diet just ain’t gonna happen! I’ve been like a kid in the proverbial candy store pigging out at the buffets on sweets, pastries, carbs, meat and more alcohol than I’d consumed in a very long time. Leafy green vegetables? Nope. On the positive side, I am eating a boatload of fish and I’m making an effort to dose myself with fruits every morning at breakfast. I’m not at all looking forward to stepping on the scale when we get home.

We walk a lot on our daily excursions. Even though I don’t find myself breathing hard, I’ll assume that I’m getting my 30-minutes of cardio every day. There is a ¼-mile jogging track around the boat and a fitness center with treadmills and resistance machines, but I’m tired enough at the end of the day without pushing my limits with intentional exercise.

So I hope you’ll excuse me if I leave it at that for now and get back to the task of thoroughly enjoying this trip. I know…it’s a tough job…but somebody has to do it!

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S1E43. No Comment

“Pressured Speech” is a symptom of mania. It happens when your mind is racing at 100 mph and you feel the need to tell everyone all the epiphanies you’re having about how the universe works.

On the other end of the spectrum is “Poverty of Speech.” It’s one of the negative symptoms of schizophrenia and occurs when your brain grinds to a halt and you have very little to say. It also occurs in advanced dementia.

Most of us function somewhere between the two ends of that vast spectrum most of the time.

The reason I’m writing about this is that talking with people is the essence of social engagement, and social engagement is one of the five pillars of brain health.

As I mentioned in Episode 41, I think I’m knocking it out of the park on 4 of the 5 pillars, but that I need improvement in the social engagement domain. This past week, though, I found myself engaging with others on more days than not…and that gave me an opportunity to observe myself.

But before reporting findings, it’s important to establish my baseline because, as you will recall, dementia symptoms are measured against your previously normal behavior and abilities.

I’ve never really been a social person. I don’t think I’ve ever called anyone and said, “Hey, wanna hang out today?” On the other hand, I usually enjoy being with others when the opportunity presents itself.

I’ve never been comfortable meeting new people (is anyone?) and I never learned how to ‘work a room,’ even when my job description called for it. I never learned how to introduce myself to a stranger. I have a congenital disdain for ‘small talk.’

So how on earth did I ever have a career as a psychologist, you ask? No problem! In that role, it was understood that people would seek me out and they would do the talking while I listened… and I was a very good listener.

Same for when we ran the B&B. My wife was the extrovert who would meet people upon arrival and have a glass of wine with them. By the next morning, after I had cooked and served them breakfast, they had a thousand questions for me which I was more than happy to answer.

On the other hand, when I do have something to say, you can’t shut me up! So much so that when I chaired meetings of the Kennett Area Democrats, Sally would frequently have to give me the pointer-finger-drawn-across-the-throat sign to let me know I needed to wrap things up.

So how did I do this week?

As is my style, I found myself more than happy to listen. I didn’t feel pressured to impress anyone or to say anything witty. I had no trouble following conversations, but neither did I feel compelled to compete for the floor. If the conversation moved on to another topic before I had a chance to say my piece, I just shrugged it off with an “Oh, well.”

Now that I’m reflecting upon it, though, it appears that throughout my life it wasn’t unusual for someone in a group discussion to say, “Wayne, you’ve been awfully quiet. What do you think?”

This past week, my mind was going all the time. I was thinking about what I was hearing and enjoying the company. I felt comfortable and relaxed. It’s true that I spoke less than the others in the room or at the table, but that was because I just didn’t have a lot to say.

Sally noticed and asked if I was feeling ok. That tells me I must have been talking even less than usual. I didn’t have a good answer for her. Was I tired from my workout or not getting my afternoon nap? Maybe. Is my cognitive processing speed slowing down so I’m not finding relevant content to offer in a timely fashion? Possible.

In any event, it bears watching.

So, with nothing more to say on the topic at this time (!), I’ll close with two tangentially related quotes that come to mind:

Better to remain silent and be thought a fool than to speak and remove all doubt. –Abraham Lincoln

Talk less…smile more. –Aaron Burr in the musical ‘Hamilton.’

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S1E41. A Brain-Healthy Lifestyle Is…

…a full-time job!

When I first started learning about brain health back in May, I would come across the phrase ‘lifestyle changes’ pretty often. It referred to the likelihood that if you were a typical American, you would probably have to adopt several changes to your current lifestyle if you wanted to ward off cognitive decline and dementia.

These were things like changing your diet to minimize intake of sugars and saturated fats, and getting off your butt and exercising several times each week.

I thought: “Piece of cake…I can do this!”

I’ve been implementing those ‘lifestyle changes’ for about six months now and…you know what? Those changes make up the better part of my day! Don’t get me wrong. I’m not complaining. I enjoy implementing the recommendations… but it’s turned into a full-time job.

Here is an accounting of what my new ‘lifestyle’ looks like from the perspective of the number of hours per day devoted to each of the five pillars of brain health:

1. Exercise: 1.7 hours. I’m working out six days each week. My workouts themselves take between 40-60 minutes, so I’m easily surpassing the 150-minutes/week brain health recommendation. But let’s add to that total my cool-down time (when I drink a pint of pomegranate juice mixed with filtered water) and the time it takes to shower. That gives me about 12 hours/week, or 1.7 hours/day devoted to my exercise regimen.

2. Diet: 2.0 hours. I’m still learning how to eat right which means that I’m still researching diet recommendations and recipes. Then there’s the grocery shopping, prep time (I’m now making my own granola and sauerkraut), cooking, and the actual eating. I’d say that this consumes an average of 2 hours each day.

3. Cognitive Challenge: 6.0 hours. I start my day by doing crossword and jigsaw puzzles. Figure 2½ hours there. I try to get half an hour of recorder practice in daily (but don’t always succeed) and then Sally and I listen to a vinyl album each night after dinner. Let’s call it 1 hour daily for music. Add another hour for reading books. I would like this to be a daily routine, but so far it’s more likely to be binge-reading the week before book club meets. I’ll add an hour for on-line activities like social media and reading the newspaper. Finally, I spend about half an hour each day thinking about, researching and writing this blog. If my math is correct, that adds up to 6 hours/day.

4. Social Engagement: 1 hour. This is my brain health weak spot. Compared to Sally who is out-and-about most of the day nearly every day, I am a veritable recluse. But I do manage to get together with others about twice each week. Although I work out in our apartment’s fitness center, there is rarely anyone else there. Same for when the pool was open. On nice days, my jogging path is the ⅓ mile loop around the building and I wave or say hello to everyone I see. On rare occasions, I will share the elevator with someone. None of this adds up to a ‘relationship,’ though, nor does it meet the criteria for ‘social engagement.’ So let’s be generous and round up to an average of 1 hour/day of ‘real’ social interaction with someone other than Sally.

5. Sleep: 9 hours. No…I don’t get 9 hours of sleep each night. It’s more like 7-8. But we do get in bed at 10:30pm and usually get up around 7:30am. This allows for time to fall asleep, wake up a few times in the middle of the night, lie awake for a little while in the morning before getting up, and still log the recommended 7-9 hours of solid sleep. It also facilitates our intermittent fasting schedule which has us stop eating at 7:30pm which is 3 hours before going to bed.

Here’s what it all adds up to:

1.7 Exercise

2.0 Diet

6.0 Cognitive Challenge

1.0 Social Engagement

9.0 Sleep

There you have it: 19.7 hours per day devoted to my newly-adopted brain healthy lifestyle. That leaves about 4 hours free for other pursuits. In the spirit of full disclosure, though, I’ll admit that I allocate about 1½ of them to my nap!

Now the question is: What will I do with all that free time? 😀

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S1E34. The End Of Alzheimer’s Program

This week, I read the book so you don’t have to. Here are my take-aways:

Dr. Dale Bredesen is a leading advocate of a comprehensive approach to treating symptoms of dementia. The book The End of Alzheimer’s Program is an update of his 2017 publication The End of Alzheimer’s: The First Program to Prevent and Reverse Cognitive Decline and includes lessons learned from 8 years of treating patients with the protocols he developed.

He rejects the notion of a single cause of Alzheimer’s and other dementias in favor of a holistic approach that focuses on the things your brain needs to function and the things that get in the way of its doing so. The program seeks to protect your brain and ward off cognitive decline by using diet and behavioral changes to support its essential activities while minimizing toxins that impair its ability to function properly.

He argues that the effort to find a drug that eliminates beta amyloid, for example, is misguided. You have to ask “How did it get there in the first place?” It turns out that beta amyloid is produced as part of the brain’s immune system to combat toxic invaders. So a remedy that is available to you right now is to identify the toxins (both chemical and biological, like rogue microbes that escape from you intestines and break through the blood-brain barrier) that are affecting you and eliminate them. Once you’ve done that, your brain’s immune response will not be triggered as often and you will not produce as much amyloid. It turns out you can manage a lot of this through diet.

Moreover, your brain has a natural way of removing beta amyloid after it has been created. It happens when you sleep. Therefore getting 7-9 hours of sleep each night can help ward off cognitive decline.

Bottom line: to a great extent, you can determine your own cognitive future by adopting a brain healthy diet and adding behavioral elements like exercise, sleep hygiene, stress management, cognitive challenge and social interactions.

Sound familiar?

He makes his case with meticulously documented references to the existing and emerging body of research and supplements it with case studies of people who were able to reverse their cognitive decline using his program. At times, it reads like an episode of “Grey’s Anatomy” or “House” where the doctors are unable to cure the illness until someone discovers that a rare toxin is causing the symptoms. They eliminate the toxin and the patient recovers.

As it pertains to dementia, the idea that you can reverse symptoms is pretty radical and flies directly in the face of the old notion that dementia is an unavoidable part of aging. As Dr. Bredesen documents, though, there are a large number of dementias that can be traced back to chemical, environmental or behavioral causes that can be rectified.

Which brings us to his program. It begins with an extensive battery of tests to identify the pathogens that might be affecting you as well as determining your levels of good chemicals and compounds. Once these factors are identified, you can design a diet that will correct imbalances and eliminate neurotoxins at their source. Progress is documented through ongoing testing and tweaks are made as you chart your reactions to the changes you have implemented.

Most of the book is spent going into great detail about how your diet affects long-term brain function. I’ll admit, I glazed over at the extended paragraphs laden with scientific terminology describing the chemical compounds and intra-cellular functions that were involved. Although he says he intends the book for consumers, it seems his real audience is physicians who he hopes will adopt his program. I can see how the book would be a great resource for someone who is guiding you through the process, but it definitely contains way too much information for most of us. Nonetheless, there are plenty of general recommendations and steps you can take to get started.

The chapters on exercise, sleep, stress management and cognitive challenge are informative, brief and a lot more digestible than the diet section!

Finally, Dr. Bredesen emphasizes that dementia is a process that takes years to develop. Your brain does its best to ward off attackers and to clean up the detritus after each daily battle. Over time, though, debris piles up and at some point the accumulation begins to take a toll on your cognitive functioning.

The good news is that most of this seems to be reversible if you start working on it soon enough.

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S1E30. People Who Need People

One of the 5 pillars of brain health is being socially active. I’ve been remiss in barely mentioning it at all in the previous 29 posts, but there’s a good reason: I’m terrible at it and I haven’t yet figured out how to do it better.

Conceptually, it makes sense that spending time with and engaging with others would be protective against cognitive decline. It forces you to use your entire brain to constantly adapt and adjust to a changing situation. Positive interactions release untold numbers of good chemicals throughout your body. It’s easy to imagine how the opposite of social engagement — isolation — would lead to a downward spiral. The research is pretty definitive.

But I haven’t come across any helpful guidance about how much social engagement is necessary to reap the cognitive benefits it offers. Do I need to join a square dancing group? Volunteer at a food kitchen? Visit with friends more? And if so, how many times per week and for how many hours? It doesn’t appear to be like exercising where I can work out for 150 minutes each week and know that I’ve met my quota.

The reason I am raising these questions is that, as I mentioned above, I’m not good at establishing new relationships. I’m not good at chit-chat and icebreaker conversations. I dread new social situations for days in advance…which is quite strange when you consider my employment history.

As a B&B proprietor, I was constantly meeting new people who would pay good money to drive 2½ hours to stay at our place and talk with us. We used to joke that we were really selling friendship, not beds and pancakes. As a psychologist, my day was a steady stream of meeting new people and rapidly earning their confidence. And I loved it!

But it’s obviously different when you are playing a role and not just being you, which led to my reflecting upon who I really am when it comes to being with people.

Bottom line, I’m actually kind of a loner. I had close relationships in high school and college and still maintain some of those friendships to this day. I enjoyed being with many of my co-workers over the years, but there was never anyone I would call and ask if they wanted to hang out, much less open up to if I was having a personal problem. My wives, first Roberta and now Sally, provide(d) more than enough companionship for me.

Marrying Sally broadened my social network considerably. One of the prime determinants of our recent move was to be closer to her relatives and the friends she introduced me to when I entered her life. I thoroughly enjoy being with them and look forward to each gathering.

But is that enough?

I read a few published studies when preparing this post and I was surprised to see how ‘social engagement’ was being defined in the research. In one study it was operationalized as the sum of 5 factors. You earned 1 point for each ‘yes’ answer to the questions on this 5-point scale. 0-2 was considered low social engagement while 4-5 was considered high:

1. Are you married?

2. Do you live with someone?

3. Do you have someone you can ask for help when you have problems or difficulties?

4. Do you have someone to talk to when you need to share some of your thoughts?

5. Do you participate in social activities?

By this measure, I meet the criteria for high social engagement…and the protective cognitive benefits that come with it. If — heaven forbid — I were to lose Sally, though, I’d go from a ‘5’ to a ‘0’ overnight.

This scale, however, seems to be a better measure of social isolation than of social activity. Another study attempted to measure social engagement by asking participants to report how often they:

1. Go to restaurants, sporting events or play bingo

2. Go on day trips or overnight trips

3. Do unpaid community or volunteer work

4. Visit relatives’ or friends’ houses

5. Participate in groups

6. Attend church or religious services

The greatest benefit in slowing cognitive decline accrued to those who engaged (on average) in each of the six categories several times each month. Your score went up if you did any of them each week or every day.

Using this scale, Sally has it made! Me? Not so much. 😦 But at least now I have a sense of direction.

And on that note…I’ll leave you with this for your listening enjoyment.

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S1E14. That Was Then. This Is Now.

I wrote this about my parents when I was 22:

‘They’ve been grandparents almost two years now. Grandparents twice over, that is, and a third expected momentarily. As I stepped through the doorway I was met by a heavy-sweet menagerie of home-cooked aromas. Outside, it was a crisp spring afternoon. Inside, it was a trifle too warm. They had both mellowed in recent years, but just now, for the first time, I felt as though I were entering a grandparents’ home. They’re growing old.’

When I wrote that closing line, I meant ‘old’ as a pejorative, not as a compliment.

My father was 52 at the time. He died at 60. My mother lived to be 85, developing dementia a few years before she died.

Paul Simon wrote this lyric into the song ‘Old Friends’ when he was 27 years old:

“Can you imagine us

Years from today

Sharing a park bench quietly?

How terribly strange

To be seventy”

Sally and I are 70. We quietly share park benches. It’s not strange at all.

On the other hand, Paul Simon will be 80 in October.

Our view of aging is curious, isn’t it? How must today’s 20-somethings view us? If we asked Paul McCartney today, would he say that 84 is the new 64?

In any event, heading toward our ninth decade, the goal is to be active, engaged, wise and interesting…a group of adjectives we don’t normally associate with the degenerative effects of dementia. The good news is that there appear to be things we can do to increase our chances of achieving those goals and of sidestepping our worst nightmare. In fact, we can now reduce our risk of dementia by some 40% by adopting a brain-healthy lifestyle. We can fight back against the prejudices and preconceptions of our younger selves!

Spoiler alert: I’m not one for miracle cures or for buying into ‘secret information that you can’t find anywhere else.’ As a former psychologist and researcher, I trust the science and want to see multiple studies heading in the same direction before I accept a conclusion as valid. So here are 4 recommendations for which there is a body of evidence supporting their efficacy:

Take care of your heart. Your brain depends upon blood flow to provide nutrients and remove debris. There are 400 miles of blood vessels in your brain. You want every inch of them pumping at peak efficiency to prevent neuron damage and maintain synaptic connections. Adopt a heart-healthy diet; keep your stress levels in-bounds; keep your blood pressure and cholesterol levels in check.

Exercise. The current guideline is about 150 minutes of ‘huffing & puffing’ each week (e.g., 30 minutes/day x 5 days). Walking is fine, but you need to work up a sweat and breathe hard. Obviously, this is good for your heart, but I also suspect that its moderating effect on cognitive function is also related to the fact that it engages so many areas of your brain.

Challenge yourself cognitively. Read books. Learn new skills. Change your routine. Solve puzzles. Take on-line courses or, better yet, once we are COVID-clear, take courses in person. There seems to be a ‘use-it-or-lose-it’ aspect to how well our brains age, so try to be open to new experiences and challenges.

Socialize. We are social animals and engaging with others engages our brain in ways well beyond any other activity. Just take a moment to think about all the ways you use your brain when sitting down for a meal with a group of friends. The complexity of negotiating a social context is stunning, invigorating, challenging…and fun!

That’s roughly where the research stands today. You can reduce your risk of developing dementia by about 40% if you adopt a lifestyle that also happens to be associated with increased longevity. You get double the bang for the buck: more years and better years.

Bottom line: We don’t have to accept the dire predictions of our younger selves. We can marshal the resources that got us this far to get us through the final years of our journey in good stead. It’s definitely worth a shot.

All of which gives a brand new meaning to Bob Dylan’s 1964 lyric:

“…I was so much older then

I’m younger than that now.”

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S1E10. How It All Fell Apart

In March of 2019, I was on track to be the next chair of the Chester County (PA) Democratic Committee. Two years later, I’m not even a member of the organization. How did that happen?

More importantly: Why did it happen? The answer to that question makes a big difference.

Up until now, I’ve explored specific mistakes related to specific brain networks such as memory and language. But there are also global effects related to an oncoming dementia that can generate errors on a grander scale.

As our processing speed slows or as specific deficits develop, it takes more effort to attend to business as usual. The effects can be very subtle. We might get frustrated more easily, or feel more fatigued more often. Some of us will lose interest in things we’ve long enjoyed, while others will start to withdraw from social activities.

Now let’s take a look at what happened to me over the course of the past two years.

In March of 2019, I had a falling out with the Chair of the County Democratic Committee and resigned my position on the executive board. This was not planned and it immediately ended any chance I had to be elected County Chair.

Surprisingly, however, I felt relieved. I realized that–for the first time in my life–I had taken on more than I could comfortably handle. In retirement, I was feeling more stressed by my volunteering obligations than I ever had as a full-time employee or business owner!

Two months later, I resigned my seat on the Kennett Square Borough Council. The reason was pretty straight-forward: Sally and I were planning to travel a lot in the second half of the year and I wouldn’t be around to do my job. I thought it only fair to resign so that my fellow Council members could appoint someone to complete the 8 months remaining in my term who would take over my workload.

Again, I felt immediate relief after my resignation, even though relief was not my goal.

(By the way, Sally and I thoroughly enjoyed our trips in the second half of the year!)

At this point, having resigned two positions, I was still Chair of our local Democratic committee, the Kennett Area Democrats, and I was still a committee person responsible for my precinct.

In January of 2020, instead of further lightening the load, I took on a new assignment when I became the campaign chair for our candidate for State Representative. Once again, I was a full-time volunteer.

I thoroughly enjoyed the work, embraced it and learned a great deal from the experience. I was busier than ever, but not feeling the pressure.

My job as campaign chair ended on election day in November.

In December, I resigned my position as the Chair of the Kennett Area Democrats. It had been my intention ever since I was first elected three years earlier to guide the organization through the 2020 election and then step down. And so I did.

Let me pause here for a moment to provide some important context. As I’ve explained in earlier posts, cognitive impairments are defined as declines from previous levels of functioning, so it’s important to know a little something about my history.

Interestingly–or maybe ‘strangely’ is a better word–my life pattern has been to change my career (not just my job) every ten years. It seems my interest and enjoyment have an expiration date assigned to them. My careers as the manager of a performing arts center, as a B&B owner, and as a clinical psychologist all lasted just about 10 years, more or less.

Each time I shifted, I embraced my new life with all my heart and soul and never looked back, never regretted the change, and lost interest in the old job. Now it appears to be happening again as I transition out of my career as a political activist, which began in October of 2010, a month after the death of my first wife.

The final separation came this past week when I resigned as the committee person for my precinct. During recent Kennett Area Democrats’ monthly ZOOM meetings, I realized I was losing interest in the organization. And then when a motion I offered was defeated, I thought: ‘I don’t need this aggravation and I don’t have the fire in my belly anymore to fight for this stuff. I’m done.’

Other than Sally, writing this blog is now my only passion.

So…what do you think? Does what I’ve described sound reasonable? Or is it a series of rationalizations to mask what’s really happening to me? Am I experiencing signs of cognitive decline on the journey to dementia? Or am I just beginning my 5th career?

Time will tell.

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