The Happiness Lab with Dr. Laurie Santos - Can Happiness Ward Off Dementia?

Episode Date: April 1, 2024

Age is the main risk factor for cognitive decline. So with more people around the world living longer, cases of dementia are set to rise. There's currently no cure - but research suggests that happiness can reduce the impact of this awful illness.  Psychologist Emily Willroth helped write a chapter on this topic for the 2024 World Happiness Report - and explains how making friends, helping others and engaging in fun physical activities can slow cognitive decline, even when the disease has taken hold.  See omnystudio.com/listener for privacy information.

Pushkin. usually the only thing people hear about when it comes to this annual report. But here on the Happiness Lab, we like to go a bit deeper into the well-being science. And so in the next episodes, we'll be diving into what the report says about other pressing well-being issues. Last time, we spoke to John Halliwell, who's been working on the World Happiness Report since its inception. He explained that this year's report focused not just on overall differences in happiness across nations, but also on how happiness differs across age within a single country. So we split the population into those born before 1965,

boomers and their predecessors, those born after 1980, who were then the millennials and Gen Z, and then the intervening group of Gen X. In Eastern Europe, the young are markedly more happy than their parents and grandparents. But in the U.S., it's Gen Z who's having a rough time. I wanted to look more deeply at these demographic quirks around the world. So I tagged in the lead author of a different, groundbreaking chapter in this year's World Happiness Report.

My name is Emily Wilroth. I am an assistant professor at Washington University in St. Louis in the Department of Psychological and Brain Sciences. Emily studies well-being across the lifespan, and specifically what it takes to maintain happiness as we age. Her chapter looks for the first time at the intersection of long-life happiness and dementia. As life expectancy extends around the world, more and more of us will experience the sort of cognitive decline that often accompanies old age. Emily's research has found that happier practices can not only delay the effects of dementia, but can also let us live better lives as the disease develops. It's a fascinating and timely topic, and honestly, one that I hadn't really considered very much before I read Emily's chapter. So I started by asking her,

why do we so rarely talk about the happiness challenges of aging? I think on the one hand, we all want to know how we can live our best lives for our whole life. So what we can do to age healthfully and happily. But oftentimes, I think that we don't focus as much on older adulthood. And I think it's particularly important to understand how we can promote well-being in older adults. And that means both leveraging their age-related strengths, the things that we gain as we age, but then also what kinds of supports and resources we can provide to help people navigate age-related challenges. And I think this is becoming increasingly important as our global population ages. So now in most countries around the world, the average person can expect to live into older

adulthood. And the World Health Organization estimates that by the year 2050, the number of older adults over the age of 65 is expected to double worldwide. So it's going to become even more important for more people for us to understand what it means to age happily. And so when we think of some of the happiness challenges that older adults face, you know, what are some of the things that come to mind for a researcher like you that studies this population? So on the one hand, aging comes with a lot of age-related strengths. We know that a lot of wisdom comes with age. There's some research to suggest that older adults may even be better at regulating their emotions

and might experience more positive emotions as a result. So on the one hand, we know that there might be some well-being benefits of aging and in older adulthood. But there are also a lot of age-related challenges that people need to navigate that can impact their well-being. So for example, many older adults will experience changes to their physical and cognitive health

that impact their ability to participate in activities that are particularly meaningful to them. Many older adults will also experience more losses in terms of loss of loved ones, whether that's parents, spouse, friends. And then we also know that there can be a lot of social changes in older adulthood. Your role in your relationship with your children or grandchildren may change. Retirement can be really positive for many people, but it can also be a major life change that is challenging for others. So navigating this time where our health

is changing, our social roles are changing, all of that can be challenging. But also, thankfully, we have these age-related strengths that are present there too that can be drawn upon to help people age happily. And so one of the things that can really challenge our ability to age happily is when older adulthood winds up becoming synonymous with dementia. And so talk a little bit about the prevalence of dementia and why this is something that well-being researchers really need to focus on even more. So dementia is very common in older adulthood. Dementia is a clinical syndrome that's characterized by progressive memory and thinking impairments. And it impacts approximately one in 10 older adults over the age of 65, and actually one in three older adults over

the age of 85. And so what that means is as people live longer, because age is the largest risk factor for dementia, we can expect more dementia cases. For example, by the year 2050, the World Health Organization estimates that there will be 139 million people living with dementia worldwide. And dementia can really impact quality of life by reducing their sense of autonomy, by making it more difficult for them to engage socially with loved ones. And sometimes there's experiences of shame or embarrassment, particularly in the early stages when one starts noticing their new changes

in memory and thinking. And dementia can also impact quality of life for care partners and loved ones of people living with dementia. It can be a distressing experience to see these memory and thinking changes in those that you love. And particularly in later stages of dementia, it often requires a lot of caregiving, which poses

sometimes a challenge for the care partners of people living with dementia. At the same time, I also want to make the point that it is possible to live well with dementia. I think that it's really common to take a sort of deficit-focused medical model view of dementia, where we only look at the challenges and negative experiences, and those are very real, so I don't want to discount those. But if we only look at that side, sometimes I think it can prevent us from seeing people living with dementia as whole people. So many of our listeners will probably know someone with dementia or kind of have heard about it, but can you unpack for us some of the happiness challenges that individuals with dementia face, like in their kind of day-to-day life because of this disease?

So I think we can think of the sort of psychological needs of people living with dementia the same way that we think about everybody's psychological needs and what we all need to feel happy in life. Everyone wants to feel that their life has meaning and purpose, that they can set goals, that they can navigate their day-to-day life and engage in the activities that are meaningful to them, and that they can connect with others. in the activities that are meaningful to them and that they can connect with others. And the memory and thinking impairments that come with dementia can pose challenges to all of those aspects of life. So on the one hand, we know that it's really important for people to experience a sense of autonomy, that we can care for ourselves, that we can direct our own lives. And the memory and thinking impairments that come with dementia can pose a challenge for

autonomy. If the individual is no longer able to engage in some of the sort of typical activities of daily living that they've done in the past and now require assistance or care to do those daily activities, that can impact quality of life. Another important psychological need is our need to connect with others socially. That can be impacted in people living with dementia. It can be sometimes more difficult to follow a conversation. It can sometimes pose challenges in close relationships as those relationships and the nature of them begins to change. And so thinking about that, it's really important to create support systems and

strategies that provide opportunities for people living with dementia to engage, first of all, with their loved ones and maintain those existing social relationships, but also group activities with other people living with dementia and experiencing memory and thinking impairments. So sort of group support systems can be really helpful. And then there's also some really interesting research on intergenerational relationships and some of the positive well-being boosting, happiness boosting effects of connecting older adults living with dementia with younger generations and having that intergenerational social support system as well. But unfortunately, there's currently no cure for dementia. We're just starting to see some biomedical treatments

that might slow cognitive decline in individuals with dementia, but there is no treatment that is going to stop the progression of dementia or alleviate the existing symptoms of dementia. And for that reason, we've really started also focusing on strategies to prevent dementia. And as a psychologist and a well-being researcher, that's really where my side of the science comes in. We know that the way that people live their lives, sort of lifestyle and psychological factors, can have a major influence on who's likely to go on to develop dementia.

So for example, a growing body of research suggests that people with higher levels of well-being are actually less likely to develop dementia. These studies have assessed well-being earlier in the lifespan, so in midlife or early older adulthood, and then followed people across time for years or in many cases decades to see who goes on to develop cognitive decline and dementia. And what these studies have found is that people with higher levels of well-being at the beginning of the study period are the ones who are least likely to develop dementia by the end of the study. And there's several different potential reasons or explanations for this relationship. On the one hand, we know that people with higher

well-being engage in a lot of health protective behaviors that are important for maintaining cognitive and brain health in older adulthood. For example, people with higher well-being are more likely to engage in physical exercise, they're less likely to smoke, and they're likely to have supportive social relationships that can be really protective across the lifespan. We also know that well-being can serve as sort of stress buffering effect or a shield that can protect our bodily systems from the harmful effects of stress. Stress is just a part of life. Everyone experiences stress, but when that stress is chronic or severe or particularly uncontrollable, it can harm a lot of our bodily systems, such as our immune functioning, our cardiovascular functioning, our neuroendocrine system.

And all of those different bodily systems are important for our risk for developing dementia. And what research suggests is that people with higher levels of well-being, they're less likely to be exposed to the same severe chronic stressors. And when they are exposed to those stressors, they often show a more adaptive or protected physiological response, suggesting that well-being might be a buffer that can sort of stand in the way of those harmful effects that stress typically has on the body. And in turn, for dementia, that means that it may protect the brain and cognition and reduce the likelihood

that an individual experiencing stress will go on to develop dementia. It's such a win-win, right? It's like, you know, when we think about the kinds of things we need to do to prevent, you know, some of these diseases of later in life, some of these things can kind of feel,

honestly, like a bummer, right? You know, we have to like change how we eat or eat much more healthy or whatever. But this is one where it's like, no, no, what you do is you focus on all the things that make you happier in midlife and early in life. And that's going to have this protective effect. It's like, it's something that we all want to be doing anyway, but it also is going to have this effect that we also don't think. Was this kind of shocking to researchers when they first started noticing this sort of connection between well-being earlier in life and reduced dementia later? Yeah. And first of all, I just want to echo your point. I think one of the reasons that it's so exciting to think about well-being as a potential protective factor

is because many of the other things that we know impact dementia risk, such as diet and nutrition, physical activity, quitting smoking, control and cardiovascular risk factors. Those things are really hard. We know that behavior change is hard. Some of those, like the cardiovascular risk factors, require medical interventions, which can be difficult to access, expensive, or have their own limitations.

But improving well-being is something that, hopefully for most people is intrinsically valuable and intrinsically a positive experience. So I think that there's a long tradition in the science of well-being of thinking about the connection between well-being and mental health broadly and physical health. So on the one hand, drawing from this longstanding science of well-being and seeing that more positive psychological factors, greater happiness is associated with better physical health, it's not necessarily surprising that we would see the same thing when it comes to our cognitive health and dementia. But I do think

there are some findings that were surprising to me, at least personally, and very exciting. So for example, my lab did a study looking at the relationship between well-being, cognitive functions, sort of our memory and thinking skills that are typically affected by dementia, and then the actual disease processes that cause dementia. So the neuropathology present in people's brains. And what we found is that well-being was not necessarily related to the amount of disease pathology present, but what it was related to was people's ability to maintain those memory and thinking skills across time, even in the presence of that dementia-causing pathology. So what that finding suggests is that well-being might actually help us to maintain our memory and thinking,

even when the disease is already present in our brains. And to me, that was surprising, but also really exciting, because it suggests that there's these multiple pathways that scientists and medical professionals and individuals can pursue to reduce the likelihood of dementia. Both strategies to prevent the accumulation of those disease processes, but also alongside that strategies like improving well-being that might help us to be able to live well and tolerate a certain level of neuropathology. So there definitely are things we can do to help ward off the impact of dementia. And we'll hear about more strategies we can use to build up our cognitive resilience as we age when the Happiness Lab returns in a moment.

When we think about how to avoid disease, we tend to think of factors that improve our physical health. Things like access to medicine and clean water. Maybe stuff like nutritious foods or sanitary practices. We tend not to think of the impact of stuff like hanging out with a friend, or taking an educational course, or looking at a painting. But Emily Woolroth and her colleagues have learned that one of the cruelest health challenges of our era, dementia, can be tackled in some unexpected ways. When we're thinking about strategies to prevent dementia, some of the things that we have the most control over, we can think about engaging in social activities and fostering our social relationships. That can be one of the

strongest psychosocial preventative factors. And we also know that social relationships and social activity are really good for our well-being. We also know that physical activity and sleep are really important. There's also various factors when we're looking into later life that people can do to lower their risk for dementia. And most of those are related to controlling cardiovascular risk factors. So for example, maintaining healthy blood pressure levels, treating diabetes if it's present, quitting or not starting smoking or excessive alcohol consumption. All these sort of typical health behaviors we know play a really big role in reducing one's likelihood of developing dementia. And more broadly, when we look at strategies to

promote well-being and happiness, there's quite a few strategies that the scientific literature has begun to suggest might be effective, but I think it's really important for people to also pay attention to their own feelings and how they respond to these different strategies and sort of notice what works well for them. So for example, there's some research to suggest that engaging in gratitude practices or mindfulness, social activity, getting out in nature, moving one's body, all of these things, there's some evidence to suggest that they can promote happiness and well-being. But that doesn't mean that they promote happiness and well-being

for everybody the same way. And one thing that is nice about trying to improve one's well-being is that we are really the best judges of what's working well for us because we're the best judges of our own well-being and happiness. You know, so many of these happiness interventions are things that we can do at any age, but I'm thinking of my listeners who might be in their 20s and their 30s and 40s. You know, if you had to pick, you know, one type of intervention that might be good at different age ranges, what would you suggest to listeners? So in early life, thinking of teens and 20s, I think staying engaged in education can be really protective. When thinking more about midlife and 30s and 40s,

I'm not going to pick one, I'm going to pick two. I'm going to say, one, we know that social activity is so important. And one thing that I think is really helpful to know about that is a lot of research suggests that it is the quality of social interactions and social relationships, not the quantity that matters. So it doesn't mean that everyone needs to be extroverted and go out to parties and have a million friends, but instead really just nurturing those social relationships that you do have and spending time with close loved ones. The other that I would say for midlife is engaging in physical activity. This is so important for our mental health as well as our physical and cognitive health. And midlife is a really important time to

sort of be prevention focused when thinking about cardiovascular health and ultimately cognitive health. So either maintaining or starting a physical activity routine that is one that you feel like you can maintain across the lifespan. So for some people that might look like typical exercise going to the gym, but for other people that might look like a daily walk or getting out in nature or playing pickleball with friends. So finding something that brings you joy, that gets your body moving in midlife, I think is really important. You mentioned in your 20s, you really want to focus on education. Why is education so important?

This is often not necessarily something I would think would matter for happiness or sort of dementia prevention, but what does education help us do psychologically? Yeah. So we see a really strong protective effect on high quality education in lowering the likelihood of cognitive decline and dementia in late life. And there's several reasons why that might be. We know, for example, that cognitive activity is really important for cognitive and brain health. And so early life education might set the foundation for that. And it also may simply be, so many people have dementia-related neuropathology, the disease processes that cause dementia, without necessarily experiencing the clinical

syndrome of dementia. And one reason for that might be that if we are consistently engaged in cognitive activities, we are sort of able to maintain those memory and thinking impairments even in the presence of that pathology. We call that cognitive resilience, and research suggests that education and in particular high quality education is one of the biggest factors associated with cognitive resilience. So for many people it's going to be inevitable at least now with where our biomedical treatments are that dementia related neuropathology will accumulate but education is one of the things that we can sort of arm ourselves with or arm ourselves with

or protect ourselves with that will allow our memory and thinking abilities to continue and to maintain those cognitive functions in the presence of this disease process. And so as we think about these tools and strategies we should begin engaging in, there's also this question of when we need to start them. What do we know about the kind of early history of some of these preventative measures sort of dealing with dementia down the line? That's a great question. On the one hand, you can imagine that maintaining and increasing well-being as early as possible and then maintaining it across the lifespan might be the most protective, right? There's probably no better time to start increasing well-being than the present and then maintaining that across time.

And given the mechanisms that we think are at play with the link between well-being and dementia, I think that approach makes a lot of conceptual sense. Health behaviors and their impact on health is cumulative. The harmful effects of stress on our bodies that well-being might buffer are cumulative. So from that perspective, starting early and that well-being might buffer are cumulative. So from that perspective, starting early and maintaining well-being across the lifespan might be the most beneficial. But then on the other hand, when thinking of going to implement these well-being interventions to improve cognitive outcomes and reduce dementia risk for the greatest number of people, I think that's still an open scientific question, whether we should be intervening in midlife or more proximal to when we start to see cognitive change well-being and putting your mental health first, no matter where you are in the lifespan, is likely to be effective.

And so, so far, we've been talking about ways that we can engage our well-being to prevent dementia later on. You know, what do we know about what we can do to use well-being practices to improve dementia kind of once the disease has already started? Because I think sometimes when people get these diagnoses or, you know, family members or caretakers hear this, it's like this kind of game over idea. I think it's really common for us to take a deficit-focused approach to thinking about dementia, thinking about the things that are lost, both at the individual level. It can be scary for an individual to get a diagnosis of dementia or for a loved one to get a diagnosis of dementia. And so it's really easy to focus only on the challenges without also thinking about all of the opportunities that that individual still has to experience a meaningful, purposeful, joyful life. And we're also guilty of doing this from

the sort of medical system care standpoint. So oftentimes in memory care facilities, it'll be common to focus on unwanted behaviors or distress and reducing those without thinking about strategies to increase joy or happiness or purpose or well-being among individuals living with dementia. But increasingly, there is greater awareness that it is possible to live well with dementia. And there are several strategies that can increase the likelihood that someone with dementia continues to experience high levels of well-being. So first we can think about the environment that the individual is living in. There is some research to suggest that older adults in general and individuals living with dementia prefer to do

what's called aging in place or remaining at home as long as possible in a comfortable, familiar environment where they're able to maintain some of their typical day-to-day routines and some autonomy or agency over their day-to-day life. Sometimes this isn't always possible or safe for an individual to continue to live at home. Right now, the traditional, most typical model of care would be for that individual to move into a nursing home type facility or a memory care facility. And there we can think about different strategies to make that environment as familiar and home-like and as comfortable as possible. So rather than feeling like a hospital, feeling more like a home. And then several countries around the world are trying new,

more innovative care models. For example, there's a model called Dementia Villages, where individuals living with dementia live in home-like atmospheres and apartments within a community that has grocery stores and libraries and some of the typical things that you would expect a community or a neighborhood to have, but within one safe community of other individuals living with dementia, as well as care partners and caregivers. We can also think more at the individual level about different interventions or strategies that can be beneficial for well-being. So for example, there's some research to suggest that cultural arts interventions are really effective at increasing the well-being of people living with dementia. And this can involve creative

endeavors like creating art, drawing and painting, dancing and movement therapy has been shown to be effective, but it can also be about experiencing art and culture, whether that is viewing visual art, listening to music, seeing theater productions. All of these different ways of engaging with arts and culture can be helpful for helping individuals living with dementia continue to experience the same joys of life that all of us appreciate, as well as reminiscence therapies, which are opportunities for individuals living with dementia to recall meaningful memories and tell those through different storytelling means. Intergenerational interventions that bring together older adults living with dementia with younger generations. And that

opportunity to connect across generations can be really protective for well-being. You mentioned one of these activities that I really love, this idea of reminiscing activities or life storybooks. What's a life storybook? And how could a family member who wanted to do this with one of their loved ones who was experiencing dementia, how could they engage with something like this? So it can often be helpful to use physical cues. So things like photo albums or familiar objects to help remind people of memories that are personally meaningful to them. You can also ask about, you know, if you're thinking about your family member living with dementia, you can ask them to tell you stories maybe that you haven't even heard before. And it can be really beneficial for a lot of reasons.

It gives the individual living with dementia the opportunity to reflect back and sort of preserve some of these memories and to connect socially with the person that they're telling these stories to. and to connect socially with the person that they're telling these stories to. And in thinking about sort of the well-being of the loved ones, it can be also really helpful to document and record these stories, whether that's to write them down, to record them digitally. All of these different strategies can help preserve the personhood of the person with dementia and also provide these really valuable keepsakes and memories and stories for their loved ones. Another thing you talked about in the report is the possibility that we can start using technology better to help with dementia and sort of to help individuals with dementia live better lives.

How can technology help us here? First, we can think of assistive technologies, so things that can help individuals remain safe while also maintaining their autonomy. So, for example, GPS has been used as well as object locators to help an individual who may be spending time alone to be able to find important objects in their house, whether that is a telephone, for example. Technological devices that can help with things like administering medication and remembering to take one's medication can be really helpful and important. But in addition to these more assistive technologies, we can also think of technology-enabled interventions. So, for example, there's some research to suggest that robotic pets can

actually serve as a really important well-being intervention for older adults living with dementia to be able to engage in sort of care practices with a robotic cat or dog, for example. So we can think of technologies both in how they can help keep people safe while allowing them to maintain independence and autonomy, but we can also think of them as ways to intervene and enhance quality of life and the opportunities to engage in meaningful activities. I think of this so much, you know, after the COVID-19 pandemic. I remember that time towards the end of 2020 when, at least to contact my older relatives who are maybe more vulnerable from disease and video conference and chat. And I think that that allows for so much more intergenerational contact, which can be so critical for social connection, especially as we live further away from our relatives and so on. Is this the kind of thing that you think that technology can be used better for in the future? Absolutely.

So I think technology, we've all seen over the past few years how technology can help us connect. we've all seen over the past few years how technology can help us connect, whether that means connecting with our loved ones, whether that means meeting new people, or just increasing sort of the frequency of social contact. And we know that social contact is so important for health and happiness. I think that we still have a lot to learn about what types of technology-enabled communications are best and for whom, right? So whether that be video chat or telephone communications, but anything that can connect us more often with the people that we love is likely to be beneficial for health and happiness, including in individuals living with dementia. So as we think about all these strategies that we can use to maybe prevent dementia

and also help individuals with dementia live their best lives, do you have any recommendations for people in midlife who are trying to reduce their stress and focus on their happiness, but are dealing with these age-related changes in people that they love? You know, are there ways that we can kind of

protect our stress or best practices for kind of handling a dementia diagnosis in an older loved one? It can be really challenging when someone that we love is diagnosed with dementia. And if we are a care partner providing care for an individual living with dementia, that can also come with its own unique challenges. It can be emotionally distressing to see these changes in our loved ones. And although there can be purpose and joy found in caregiving, we also sometimes can see caregiver burnout or stress among care partners.

And so I think it's really important to lean back on your own social support network, whether that is other loved ones that you can spend time with or that can help with the caregiving aspects, or whether that's connecting with new people who have shared a similar life experience for that sort of social support and perspective from someone else who has been in your shoes. No matter what age we are and no matter what difficult life experiences we're going through, no matter what difficult life experiences we're going through, putting our happiness and placing some importance on that and taking time to prioritize ourself and our well-being, to be able to manage the stressors that we're experiencing is really important. And so just empowering yourself to be able to sometimes think about

what's going to impact your own well-being and happiness and engaging in the activities and self-care practices that help you to maintain your own mental health. I think that's so important because I think we can get so caught up in what we can do to help our older relatives that we sometimes put ourselves under stress, which isn't great for our happiness and our cardiovascular health and those kinds of things too. Has engaging in this research made you a little bit more hopeful about your own cognitive resilience? I'm curious how you've changed your behaviors and your mindsets kind of knowing more about this research. I think that it's a really

helpful reminder to put my social relationships first, to put opportunities to move my body first, and to really incorporate that into my daily life. Even as someone who researches this stuff, it's really easy to get caught up in day-to-day routines and stressors and deadlines and things like that. And so it is a nice reminder doing this research that putting my well-being first is an investment into my future and into the future of my loved ones. I know many of you listen to this show because you want to enhance your daily lives right now. But it turns out that following the advice we share on this podcast, practices like making friends or being kind to others can help you build resilience to a disease that could strike

many, many decades from now. I find that amazing, and it's certainly something I'd never thought about before reading Emily's chapter in the World Happiness Report. But we're not through with the report's insights just yet. In our next episode, we'll turn to a different chapter from the report, one that focuses on the other end of the age spectrum. We'll tackle the happiness challenges facing the young, and we'll try to figure out why children and teens in some countries are really struggling, and what we can do to fix out why children and teens in some countries are really struggling and what we can do to fix this sad trend.

That's next time on The Happiness Lab with me, Dr. Laurie Santos.