Dr Tim Beanland used to do the Telegraph crossword with his father. Now he does Wordle with his wife, as well as the cryptic crossword. As a writer who has an affinity with words, these are the sorts of puzzles Beanland, who is the UK Alzheimer’s Society’s head of knowledge, enjoys. As he ages, though, he knows that he really should be challenging himself more with number, memory, visual, spatial and logic puzzles.
Getting out of his comfort zone, whether it’s walking his border collie Pip in the rain or challenging himself with a harder puzzle, is all part of what will keep Beanland’s brain fit and healthy, and give him the best chance of stemming cognitive decline.
And he thinks we should all be doing the same.
His new book, Mind Games, features more than 150 puzzles of all kinds and degrees of difficulty. It targets different areas of the brain aiming to improve cognition and help stave off dementia.
For the past 13 years, Beanland has worked to try to communicate a complicated topic to the public at a time when scientific understanding of dementia has undergone a huge shift.
Long thought to be the result more of ageing and genetics, the role of lifestyle factors in raising the risk of developing a brain disease is now estimated at 40 per cent.
Everything from physical exercise, smoking, food and alcohol consumption, and sleep habits are now known to impact people’s risk of developing dementia. But it has also become clear that stimulating the brain can help to build up a “cognitive reserve” and resilience against dementia.
The disease with no cure
When Beanland started at the Alzheimer’s Society, his mother was in the process of getting a diagnosis for what turned out to be dementia. It is why he is passionate about the interface between people’s lived experiences and what the experts and research tell us.
Today there are 900,000 people with dementia in the UK. One in three people born today will get dementia over their lifetime. Dementia has become the UK’s biggest killer.
The reason for the increase is down to the demographics of an ageing population. We’re also surviving cancer and strokes more today, which means we’re more likely to live longer and risk developing dementia.
“It’s a sort of side effect of the demographic shift and the better treatments for cancer, heart disease and stroke,” says Beanland. “But it also really emphasises that we don’t have a treatment for dementia, nothing to slow the disease down or a cure. With dementia there’s no survivorship. It’s a devastating terminal condition.”
How brains age
The healthy brain starts to change long before we get into our 60s, which is the age at which dementia risk starts to pick up.
“Working memory peaks at 30,” says Dr Beanland. “A lot of these changes are to do with subtle changes in the synapses that connect the nerve cells, they’re not to do with loss of nerve cells.”
The number of neurons in your brain over your lifespan goes down very gradually. “It’s if you have dementia, because it’s neurodegenerative, that you see the nerve cell numbers start to plummet. The consequences are often then clear on a brain scan.”
So the good news is your healthy brain has a reasonable static number of brain cells and they’re yours to choose what to do with. “And if you do choose to stimulate them you can keep them active.”
Studies of musicians or people learning a new language show that the brain grey matter in the regions being stimulated becomes denser. This is thought to reflect more branching between neurons and formation of more synapses. Stimulating the brain by regular puzzling is thought to do the same.
Dr Beanland likens the brain’s networks, nerves and synapses to a series of footpaths: “If you don’t use them, they get overgrown and unusable.”
So if you stimulate those pathways, they become stronger and more resilient, which means that “if you do then get brain diseases, they’ll be better able to cope”.
Those are the pathways you see in a functional MRI scan, where oxygen is measured. “This is showing you that the connections between the brain cells are firing efficiently. Sometimes the whole brain lights up.”
Senior moments
Forgetting where the car keys are, or forgetting your PIN number, might make you worry about your memory but, says Dr Beanland, “these are normal signs of cognitive ageing. It’s normal for your memory to show a little bit of decline.”
The Alzheimer’s Society sees a lot of people who have these changes and worry they’re developing dementia. “Most often they’re not. They just don’t realise this is likely to be a part of ageing. They don’t understand that dementia is very different. It’s much, much more serious.”
The charity has a symptom-checker on its website, but often it’s a difference of scale.
“It’s not forgetting what row you parked the car in the car park. With dementia, you would not remember if you’d got a car or bus into town.”
Beanland recalls first noticing his mother had a problem: “She’d always been super organised and tidy and suddenly the house was a mess, everything in the fridge was out of date. There were piles of bills and letters. They were all indications that dementia had affected her ability to live daily life. That loss of ability defines dementia, and is very different to the minor annoyances of senior moments.”
What causes Alzheimer’s?
A buildup of proteins in and around brain cells is thought to be the cause of Alzheimer’s. The protein amyloid forms plaques, and another protein called tau causes tangles, in a process thought to begin many years before symptoms appear.
But the presence of tangles and plaques doesn’t necessarily mean that you will develop dementia. Studies have shown that a fair few people get to old age without symptoms only for autopsies to show significant neuropathological changes in their brains.
The poster girl for resisting cognitive decline in this way is Sister Mary, a nun who was part of a longitudinal study in the 1980s. In a post-mortem examination, Sister Mary’s brain was found to be riddled with plaques and tangles, just as would be seen in someone who died of Alzheimer’s disease. However, she had shown no signs of cognitive decline.
Specialists concluded, according to Beanland, that “because she led this incredibly mentally active life and was socially engaged, she had built up resilience in her brain. So even as the disease that causes dementia was chipping away at her brain, it was able to offset the symptoms.”
What is brain resilience?
Brain resilience involves at least two components: brain reserve and cognitive reserve. Brain reserve refers to the brain’s structure. A larger brain reserve means more neurons, more branches and more synapses. A person with high brain reserve can sustain greater loss of synapses to ageing, or neurons to disease, before cognitive function is impaired.
Cognitive reserve, meanwhile, refers to the flow of signals around the brain’s nerve networks. Higher cognitive reserve shows up on functional MRI scans as increased network activity.
“In someone with higher cognitive reserve the buffer against ageing, disease and injury is thought to happen in two ways,” explains Beanland. “One is that existing neural networks become stronger because the synapses are more effective.
“The other is that the brain can recruit different networks - a bit like a traffic diversion - to compensate for ageing, injury and disease to maintain normal function in everyday life.”
And while neuroplasticity (the ability to employ alternative networks) falls with age, we now know that neurogenesis - the formation of new nerve cells - can probably still happen in adulthood.
“Neurogenesis might offer one way that cognitive stimulation might build up brain reserve,” Beanland says. “But that is controversial.”
Piecing the puzzle together
When it comes to cognitive resilience, studies have shown that musicians and those who speak another language have healthier grey and white matter. Their risk of dementia is reduced.
Staying in education longer and having a complex job are also believed to build up more brain resilience and therefore reduce the chance of developing dementia.
If none of those things apply to you, the good news is that puzzles are also a good way of getting your mental pushups, tapping into the brain’s lifelong plasticity. A study by the University of Exeter showed that how often people did puzzles was closely linked to their cognitive function. In another study of 488 healthy New Yorkers aged 75 to 85, those who regularly did crosswords showed symptoms of dementia 2.5 years later than non-crossworders.
“While we can’t say that if you do puzzles you’re guaranteed to avoid dementia - to help stack the odds you also need to not smoke or drink too much, eat well and exercise - but if you do puzzles as well and are socially active, we should have fewer people getting dementia,” Beanland says.
What kind of puzzles?
Just as you don’t go to the gym and only do bicep curls, all the evidence suggests you will build up that resilience best if you stimulate different parts of your brain.
In Mind Games, Beanland offers puzzles to test verbal, number, logic and reasoning skills, as well as spatial problems: “They’re all exercising different bits of the brain.”
Parts of the frontal lobe are responsible for planning and setting tasks. The occipital lobe focuses on the initial processing of signals from the eyes. The hippocampus is a small structure that sits inside each temporal lobe and is responsible for learning and forming new memories. “It gets damaged early on in Alzheimer’s, which shows why memory loss is a signature symptom of the disease.”
We know from MRI scans that the brain’s higher functions - vision, language, long-term memory, solving puzzles - require many different parts of the brain to work together. If they are frequently exercised and encouraged to communicate, then the individual areas and the links between them are all strengthened.
Becoming a puzzlehead
If you’re already doing puzzles, then keep at it; do more, different and more complex ones. If you aren’t, now is the time to start.
“A lot of dementia risk factors start to kick in in midlife because the diseases that cause dementia are often grumbling away in your brain for 20 or 30 years before you get symptoms,” Beanland says.
Because of this, the ideal time to pick up some good habits for cognitive function is when you’re between the ages of 40 and 60 - although it’s never too early, or too late.
Lots of us have a perception that we’re rubbish at puzzles, which can stop us from trying. But, says Beanland: “Nobody is born good at anything. We’ve all learnt these things over time from other people.”
If you’re struggling, ask for help. “The social element is important too. Socialising, we know, is also good for brain resilience. And two heads are better than one.”
Unlike physical exercise and alcohol guidelines, there is no government guidance on how much you should be stretching your brain.
“There’s no hard and fast evidence on this. But some experts suggest spending as much time on mentally stimulating activity (not all puzzles) as the UK physical activity guidelines.” That’s a lot: 150 minutes each week.
“If you can do a little every day or every other day, that’s a good start ... If you have a busy life, fit it in when you can.” Mind Games includes a suggested seven-day puzzle programme.
Sadly, we don’t have any magic bullets to slow down the ageing process. “We need to be realistic,” says Beanland, “but there are certain things we can do to stave off or compensate for cognitive decline. Even with dementia, there is hope.”