Lifelong risk factors

At the same time, several longitudinal studies show that a high level of education would have a protective effect. Why? First hypothesis: because it is associated with a better socioeconomic status and a healthier lifestyle, with also, perhaps, less exposure to environmental toxins. Second hypothesis: that of the “cognitive reserve”. As Martial Van der Linden and Anne-Claude Juillerat write, this hypothesis “posits that more educated people perhaps compensate for their neuropathological injuries”. Nevertheless, some data contradicts this.

In 2011, the American Journal of Epidemiology published an article about research carried out by Adina Zeki Al Hazzouri’s(4) group at the University of Miami, on 1 789 people aged 60 to 101 at the beginning of the study. It revealed that the risk of dementia or cognitive impairment without dementia was less than 51 % in persons with a high level of education who had benefited from a high socioeconomic status throughout their lives or, at least, had climbed the social ladder, compared with those who had never left a low socioeconomic level.

According to different works, intellectually stimulating activities slow down the aging of our mental faculties. Probably as a result of stimulating the expansion of our “cognitive reserve”. But let’s be careful and not oversimplify!  While it may be useful to have hobbies, read or play music, participate in organisations (associations, various movements, etc.), be active on a sociocultural (going to the theatre, cinema, etc.) or social level (interaction with friends and family, etc.), no study has ever proven the effectiveness of “brain games” or other magic bullets. “Many specialists of cerebral aging recently wrote an open letter against using cognitive stimulation for mercenary purposes”, Professor Van der Linden reports.

The list of risk factors known to influence brain and cognitive aging is still long. And many other elements can be added to those already mentioned, including stress and psychological distress, a lack of goals in life, insufficient social integration or a feeling of loneliness, head injuries, taking benzodiazepines, sleep disorders, etc. However, this list is by no means exhaustive. Among other things, we can add everything linked to the risk of vascular problems – type 2 diabetes, smoking, high blood pressure, etc.

Cognitive disorders allowed

By attacking the classic biomedical approach, Martial Van der Linden and Anne-Claude Juillerat are also rebelling against one of its consequences: the stigmatisation of aging. Riddled with stereotypes presenting an apocalyptic vision of aging and its problems, it can also be a risk factor in the deterioration of cognitive performance among those faced with it, as revealed by several studies. And, in the case of the diagnosis of dementia, it is also the cause of huge psychological distress for the person in question and their entourage, as well as being the source of social isolation, a loss of dignity and deterioration in quality of life.

Within this context, Martial Van der Linden and Anne-Claude Juillerat plead in favour of a society of “allowed cognitive disorders”, with a particular focus on intergenerational projects. In long-term residential care structures, the elderly have no sense of control over their existence, have no goals or plans, and are excluded from society. This lies at the source of the deterioration in their condition. The culture of these “medicalised hotels”, as Martial Van der Linden calls them, should be reviewed from top to bottom. “These types of structures essentially focus on medical care”, the neuropsychologist informs us. “According to a Belgian study, the residents take an average of 8.4 drugs a day, which often include antidepressants, antipsychotics and benzodiazepines. In addition, behavioural problems are still all too often the subject of pathologisation, whereas in many cases, they are a reaction to the fact that these institutions aren’t focused on the well-being of the residents, who have no say in the matter and whose individuality isn’t taken into consideration.”

(4) Al Hazzouri, A.Z. et al. (2011). Life-course socioeconomic position and incidence of dementia and cognitive impairment without dementia in older Mexican Americans: Results from the Sacramento Area Latino Study on Aging. American Journal of Epidemiology, 173, 1148-1158.