Abdullah was always good for a laugh.
The 72-year-old attorney loved to tell jokes, and that ready humor made it easy for him to mix with people.
But in the months after he was diagnosed with mild cognitive impairment, something changed for Abdullah, and there was nothing funny about it.
“On a few recent occasions, I’ve been told by the person I’m telling the joke to that I’d already told them that joke,” he says. “It’s so embarrassing.”
So he quit telling jokes, and eventually began to avoid social events.
“He’s wasn’t enjoying those situations anymore,” says Dr. Kelly L. Murphy, a clinical neuropsychologist at Baycrest and a psychology professor at the University of Toronto. “It only highlighted the changes he perceived in himself.”
It’s an-all-too common tendency for people with MCI, as they lose confidence in themselves and begin to pull back from activities they used to enjoy. And it’s a pattern that Murphy and her colleagues at Baycrest are working hard to help people break.
They say isolation and inactivity can accelerate cognitive decline and increase the risk of progressing to dementia.
That’s why they give people with MCI the encouragement and strategies they need to stay involved in favorite activities or take up new ones that can help keep physically, cognitively and socially engaged.
“We are social animals; we need to be with other people,” Murphy says. “It’s makes a big difference in our health and well-being.”
What’s behind the “decision to withdraw”
In fact, that’s one of the first lessons that the experts at Baycrest learned when they set out well over a decade ago to develop a ground-breaking program for people with cognitive impairment.
The program, called “Learning the Ropes for Living With MCI,” is offered at Baycrest in Toronto, and also licensed to be presented at other locations in Canada and the U.S.
Early on, Murphy and her colleagues wanted to understand how people with MCI felt that cognitive loss was most affecting them in their daily life.
So they brought together focus groups to talk about the impact of MCI, and two clear themes emerged. People with cognitive impairment felt less confident in themselves, and as a result, they were taking part in fewer leisure activities.
“There was a lot more negative self-judgment and decision to withdraw,” says Murphy, who also is co-author of the book “Living with Mild Cognitive Impairment.”
It doesn’t take much to trigger that withdrawal. In the case of Abdullah, the embarrassment of repeating jokes he’d already told was enough to turn him from raconteur to recluse.
His story is one of several that Murphy and her co-authors share in the book. They tell of Consuela, an 80-year-old homemaker who was ready to give up playing bridge competitively because her skills were slipping.
“I’m having trouble keeping track of what’s going on, and I don’t want to let my partner down,” she says. “It’s stressful, and it’s not fun being faced with my shortcomings like that.”
Or there’s Antionetta, a 69-year-old retired teacher who began to clam up in social settings. “I just don’t talk anymore,” she says. “I stay quiet when I’m in a group. I just listen.”
The exact opposite of what you should do
Murphy says these insights from the focus groups were consistent with what they were seeing in their program, and also consistent with research that shows people with cognitive impairment reduce the range of travel from their home, and spend more time at home in general.
Unfortunately, the isolation that results is one of the worst possible things for someone already experiencing cognitive decline.
“Research shows that greater participation in leisure activities can actually reduce dementia risk, so taking part less often in leisure activities is the exact opposite of what you should be doing if you have MCI,” Murphy and her co-authors, Drs. Nicole D. Anderson and Angela K. Troyer, write in the book.
“It is important to find a variety of activities you enjoy doing, and participate in them often,” they write.
The Learning the Ropes program is tailored to help people with MCI stay or become more active in leisure pursuits.
The presenters emphasize the importance of leisure activities in health and well-being and help people with MCI work through the barriers that keep them from being more active. The participants also learn where they can go to get more information about activities they may be interested in.
At a recent Learning the Ropes session in Toronto, about 40 people with MCI and their partners shared the different ways that they’re finding to be more active. One man encouraged the others to go dancing.
“It’s great exercise and you meet a lot of people,” he said. “There are places that offer dancing, with or without lessons.”
Another woman said she’d begun visiting a local dog park, and found that enjoyable. “I have a group of friends I’ve met that I didn’t know before,” she said. While the dogs romp in the park, she and her new friends chat, and when someone in the group suggested that is a good form of cognitive stimulation, she drew a laugh by saying, “It’s just gossip.”
Doing just a little bit better
Murphy says with the right encouragement and information, people with MCI can find ways to be more active, and it’s important that they do. The more, the better, she says.
“When I talk to them, they are doing something, and that’s great,” she says. “When I ask them how much, it’ not enough. They need a little more.”
And doing even a little bit more is a worthy goal. Murphy says one of the messages of the Learning the Ropes program is that small, incremental improvements in health behaviors offer a real benefit.
“We’re not trying to boil the ocean here,” she says. “We’re trying to do a little bit. We just want to help people make some small, positive move forward.”
For one person, that next step forward might be taking up a sport like tennis or golf. For another, it might be trying tai chi or chair yoga or learning to play a musical instrument or joining a choir.
The book “Living with Mild Cognitive Impairment” suggests any number of activities you might want to consider. See the information box here for examples.
As for what activity you should choose, that’s up to you. There’s no clear evidence that one particular activity offers a greater benefit than another. Just pick one that you think you’d enjoy and try it.
“One does not seem to be better than another,” Murphy says. “If I can promote my health by going to the library or by seeing friends, that doesn’t mean it doesn’t have the same impact as something else. It lets people do what they want, but they need to do something. Doing something is important, and can have an impact on brain health. It’s never too late.”
Breaking down the stigma of MCI
It always pleases Murphy when that message gets through, and people in the Learning the Ropes program tell her that they are re-engaging in leisure pastimes.
“We see ourselves as ambassadors for aging well and breaking down the stigma associated with cognitive decline, and we want our participants to embody that,” she says. “I have people come to me after the program and say, ‘I’d stopped going to my book club, or socializing with friends or eating at the golf club, and now I‘m doing to those things again.’”
And as you make the effort to engage, you may find people are more accepting and receptive than you expected.
Murphy recounts the story of one woman who told her, “I just tell people, ‘You know, my memory doesn’t always work well and I forget things. So here I am, and if I forget something you told me, don’t take it personally.”
A similar approach ended up working for Abdullah, the jocular attorney who we began this story with.
“He started telling is friends, ‘Stop me if I told you this joke before,’” Murphy says. “He was greeted with warmth and he enjoys socializing again.”