Preventing Brain Decline Should Begin in Middle Age
In psychiatry, an important subfield is mental disorders in the elderly. Besides the common Alzheimer's disease, the elderly commonly also have depression, anxiety, delusions, or bipolar disorder. Some people had no such problems when young, but in old age develop the corresponding symptoms: as aging sets in, they become depressed, anxious, and irritable, even developing cognitive impairment and relational delusions, always feeling that others are harming or talking about them.
There is an old Chinese saying that old people become "little children," meaning that as people age they become like children, with declining cognition and emotion regulation. According to incomplete statistics, as many as 60–75% of people over 70 have mental disorders. By 2030, China alone will have 50 million Alzheimer's patients. This is related to cerebral atrophy, cerebrovascular disease, and reduced independence and self-care in the elderly, and also to social change that leaves the elderly without their children's company.
Middle-aged people over 40 may feel this deeply, because their parents are entering old age and needing their care. In caring for their parents, they come to realize that their parents are no longer the same: the confidence, brightness, and optimism of youth are fading, replaced by memory decline, anxiety, depression, pessimism, and fear.
Over the last two years I have begun noticing how my own older relatives fare in old age. Except for my maternal uncle, who still rides an old steed in the stable with lofty ambitions, the rest seem to have entered a state of clear "mental decline." My uncle-by-marriage passed away two years ago; before that he had been tormented by Alzheimer's for nearly ten years. My two male cousins and two female cousins took turns caring for him and were still exhausted. Advanced Alzheimer's is very difficult to care for, requiring round-the-clock attention from the children.
The other elderly people over seventy generally suffer from inferiority and anxiety: they worry that their "old-person smell" will disgust their children, that they will become a burden, that their children will abandon them, not support them in old age, or care for them when ill. Because of these worries, they are easily irritable; they are very sensitive to their children's words and deeds and always detect rejection in the clues of daily life. Sometimes they become depressed, sometimes angry; their emotions are unstable, a state much like borderline personality disorder or bipolar disorder.
When a person loses the ability to work and shifts from producer to consumer, they become far more fragile than average. The double blow of aging and illness makes the elderly feel their quality of life is poor; many old people do not actually wish for a very long life. Cerebral atrophy reduces cognitive and understanding ability; lack of family companionship (especially a spouse's) significantly lowers quality of life. Alone, they deepen their suspicions, lacking confidence and patience in relationships, and over time develop relational delusions, suspecting that their caregivers reject them even when no one actually does.
There is an old Chinese saying: "No filial son exists at the bedside of a long-term patient." The elderly are very aware of this. On the one hand, in advanced old age and illness, children may indeed care insufficiently; on the other hand, it relates to the elderly's fragility and sensitivity — no longer as confident as in their prime, they interpret ordinary conversation as rejection. Caring for the elderly therefore requires more patience from the younger generation.
I feel this phenomenon deeply, because apart from dealing with the elderly in my own family and kin, I also treat many elderly cancer patients, whose mental disorders are even more pronounced.
But in fact many elderly people have no mental disorder; they remain able to enjoy life in old age, with intact cognition and understanding and well-maintained relationships. The Dutch brain scientist Dick Swaab once said that in old age, quality of life depends mainly on whether one's brain function remains relatively intact.
For brain function not to decline rapidly, one must value learning, recreation, and socializing.
Zhou Youguang, father of China's Hanyu Pinyin, and Professor Zheng Ji, a founder of general chemistry, both lived past 110; both remained sharp-minded, open-minded, and optimistic, able to work until 110. Both are models of lifelong learning, which greatly helps the continued development of the human brain (recent research shows the brain develops throughout life). Learning not only raises ability but also extends lifespan. Surveys show that the more educated a person is, the longer their survival after a chronic disease such as cancer is diagnosed. Intellectuals on average also live longer than the general public.
Cultural, sports, and recreational activities also stimulate brain development. Normal, healthy, positive interpersonal contact reduces loneliness; elderly people who participate in such activities and socialize through them show far less social-function impairment. The older people get, the more social support they need. Martin Seligman, former president of the American Psychological Association, did large surveys showing that people with positive, optimistic outlooks and good relationships with relatives, friends, and partners generally enjoy higher quality of life, stronger self-care, and longer survival in old age.
People who exercise moderately and regularly read popular-science works or literature also experience slower brain decline; middle-aged and elderly people who study natural sciences such as math, physics, chemistry, and biology help slow brain aging. Smoking, drinking, and high-fat, high-sugar, high-protein, high-salt diets all cause irreversible brain damage. Those whose dinner-to-breakfast interval exceeds 12 hours also have healthier brains.
Middle age is the key period for a second development of personality; how people handle their lifestyle and relationships in middle age determines their quality of life from middle to old age. Previously, Alzheimer's was thought to have unclear causes and poor treatment outcomes, but the latest research shows it is preventable. If people adjust their lifestyle and relationships before entering old age, pursue continuing education, and actively promote brain redevelopment, their risk of Alzheimer's in old age falls significantly. Comprehensive intervention early in the disease also slows deterioration.
Developed countries in Europe, America, Australia, and Japan offer many continuing-education programs for middle-aged and elderly people. Such education not only improves their ability to survive and adapt to a new era, but also slows brain decline. Each round of higher education significantly improves a person's health and quality of life. Both enjoying life and continuing to learn in old age matter greatly; the social cost of continuing education for the middle-aged and elderly is far less than the social benefits it produces, because such education lowers our elder-care costs.