Researchers in 2024 were busy doing research on mental health and aging. And today I'm going to share five pivotal research studies when it comes to mental health and aging from preventing . Dementia and cognitive decline to treating depression . What are the five interesting, ground breaking, important research findings from 2024 that we can start using today in our practice with older adults.

The first is Lancet's 14 modifiable dementia risk factors that came out in the summer of 2024. Lancet is one of the oldest and most prestigious medical journals internationally. Every so often report on modifiable risk factors with dementia until this past year there were, they identified 12 modifiable risk factors for dementia, but in the summer of 2024, they identified 14 modifiable risk factors for dementia disorders, and what they discovered was that When tallied all together.

So when we put an effort to modify these 14 risk factors, our risk for dementia can decrease by approximately 45%. So I'm going to review what those 14 modifiable risk factors are so that by making some lifestyle changes by getting mental health conditions treated when needed, you can work toward preventing dementia.

So here's what the 2024 Lancet Commission recommends that you do to prevent or delay dementia.

One, attend to your education. And if you work in public health, make sure that everybody has access to quality public education. So the better quality, the education, the better the brain health. And this really starts in childhood or even early toddler hood. This is why programs like Head Start are so important to make sure that everybody has access to high quality education.

Then, it doesn't stop there, in midlife and beyond, to continue with cognitively stimulating activities.

Number two is preventing hearing loss or accommodating hearing loss. So reducing harmful noise exposure is really important and making sure that people have access to hearing aids that are affordable when they need them. So hearing health is essential to brain health. Number three is to treat depression. So this is really important because depression, you're going to see later on is, can be both an early sign of dementia and a risk factor for dementia, but it can help to treat depression.

And when we treat depression that helps to reduce the risk of dementia as well. So attend to depression and No, depression is not normal as we get older and treatment is effective for depression among older adults. Number four is to prevent your risk for traumatic brain injury. So when you're riding a bicycle or a motorcycle, wear a helmet. When you're playing contact sports like football, to prevent head injuries and wear a helmet. You want to prevent any experiences that could result in brain injury to the best of your ability. Another is to exercise. The Global Council on Brain Health, in addition to Lancet, recommends that people exercise, and especially strength based exercises like resistance and weight training is really important, as is brisk walking and cardiovascular exercise as well.

Reducing the use of cigarettes or stopping cigarette use and tobacco use is important to brain health as well, and that's one of the modifiable risk factors, as well as no alcohol consumption. In fact, just this week, the Surgeon General, Dr. Vivek Murthy, gave information about the risk and harm of alcohol use. And it used to be thought that we could drink a glass of wine and that the benefits of wine outweighed the risks and that's been debunked. That is not true. What's important about all of these is the sooner you start, the greater the rewards in older adulthood. So we want to be making lifestyle changes as soon as possible, as early as possible in our lives.

Another modifiable risk factor is managing your cardiovascular health. And so if you have a predisposition to hypertension or high blood pressure, then to work with your medical providers on maintaining your cardiovascular health, reducing hypertension maintaining healthy blood pressure and so on.

And to modify your lifestyle like to include exercise and healthy nutrition to make sure that your heart is healthy. There's a saying that healthy heart makes for a healthy brain. There are many different types of dementia. And so one of them being vascular dementia, it's the second most common type of dementia and that's directly related to heart health. Take care of your heart and you can do that by managing your blood pressure. Another way is by managing your cholesterol, which is another modifiable risk factor that the Lancet recommends. So working with your medical provider and your nutritionist and maybe a personal trainer if you can afford it on managing your heart health and cholesterol levels.

Maintaining a healthy weight for your body is also important, and so maintaining your weight and working with your doctor to find an ideal weight for you can help to prevent dementia down the road as well. Everybody has different body shapes and sizes and heights and weights. And so really it's up to you and your doctor to figure out what the ideal and healthiest body weight is for you. Another of the modifiable risk factors is the level of social engagement that you have. So the higher quality, more rewarding social interactions and relationships. The better. So we know that when people have positive social relationships that are deep and meaningful and bring quality and value to your life, the lower your risk of dementia.

So focusing on your relationships is really key to physical, mental, and brain health. We have two more to go, so stay with me. Another is getting screening for visual impairment or visual vision loss and then accommodating vision loss. So making sure you're getting screenings for your eye health and then wearing glasses when you need to. So the better we see and the better we hear, the better our brains work as well. And then finally is to reduce air pollution exposure. And so this is easier to do if you live in a place that has more green spaces. It's harder to do if you live in urban settings. And so just do your best. All right. So those are the 14 modifiable risk factors from the 2024 Lancet commission.

And like I said, when you add them all up. So if you make all of these modifications and you start to experience improvements in each of these 14 areas, you could prevent or delay approximately 45 percent of your risk for a dementia disorder. So that's good news. Alright, ready for the second groundbreaking research study from 2024?

Before we move on to the next research studies that came out, did you notice some items missing from this list, like the importance of sleep, and anxiety, and post traumatic stress disorder, menopause, and diet? I noticed them too. And so did the Lancet Commission, and so what the Lancet Commission wrote about these is these are all important to consider when preventing dementia, and while they correlate with dementia disorders, they have not yet. been identified or there isn't enough scientific evidence to say that they cause dementia disorders like the list of 14 that I mentioned.

And so stay tuned because more might be coming down the road in coming years. And even later today in this episode, I'm going to share some groundbreaking research and information on anxiety and depression and their relationship to dementia disorders as well. So stay tuned.

Now I want to talk with you about another study that came out and it was in JAMA Psychiatry on using cognitive remediation and transcranial direct current stimulation or TDCS to slow cognitive decline in older adults with a history of major depressive disorder and or mild cognitive impairment.

And so let me explain what cognitive remediation is and then what transcranial direct current stimulation is so that you know what we're talking about and then I'm going to share some findings from this research study. And of course, these research studies will be linked to in the show notes, so be sure to get there and check them out if you want to dive deeper.

All right, so in this study, and if you see me looking away, it's because I'm looking at the study itself, so I'm giving you accurate information. In this study, researchers looked at 375 older adults with remitted major depressive disorder. This means that they recently had major depressive disorder and they could have mild cognitive impairment or not. And then also included people who had mild cognitive impairment alone. They put participants into different groups. One group was a cognitive remediation group. And so this included cognitive exercises that were titrated in difficulty based on performance. So if you did some cognitive tasks and did them well, then you move to a more difficult level. And then if you did those well, you move to a more difficult level, et cetera.

And those were like so asking you to come up with strategies or goal setting to apply cognitive skills in your daily life. And then the transcranial direct current stimulation includes light electrodes stimulating your brain. And they put this device on your head almost if you've ever seen an EEG device on your head.

They have just electrodes targeted, in this study they targeted the prefrontal cortex and and then so they just have electrodes going there and how people describe the feeling is that the feeling is warm or maybe a little itchy or maybe a little tap or, Jolt, but it's not uncomfortable.

It's not loud. And you can do reading activities and other things while you're receiving the transcranial stimulation or transcranial direct current stimulation. And so here's what they found, which was so fascinating. And so they followed these people over four years. And they found that over a four year follow up period, the group that did cognitive remediation and the transcranial direct current stimulation had significantly slower cognitive decline compared to the local like groups or the placebo groups. And Especially with executive function and verbal memory.

And so the benefits were greater in the depression groups whether or not they had mild cognitive impairment compared to the mild cognitive impairment group alone. And so it tended to work best for people with depression.

So what's interesting when they looked at The sort of more immediate results of cognitive remediation plus transcranial direct current stimulation, what they found is at the two month mark, there wasn't much benefit, but as time went on, the benefits compounded. Okay, here's some important things to consider. This study did not separate cognitive remediation from the transcranial direct current stimulation. And so they only looked at them together. But what they, what the researchers suggested is that there's not very, significant research to support cognitive remediation on its own.

So they suspect, or the researchers suspect, that the benefits were more from transcranial direct current stimulation. But there needs to be more research to prove this point.

So what's really important about this here is that depression is a risk factor. It's a modifiable risk factor for dementia disorders. And this study shows that The transcranial direct current stimulation can be an effective form of treatment for older adults. This is really exciting news because some older adults don't want to do psychotherapy. Many older adults don't want to take additional medications. And now there are more approaches that are showing efficacy for treating depression, which then can reduce risk of dementia disorder. So this is really exciting news. The treatment protocol was eight weeks of pretty intensive treatment.

It started with eight weeks where the participants received cognitive remediation and transcranial direct current stimulation five days a week. And then after , that eight weeks, they transitioned to a twice yearly schedule.

So where they received five booster sessions every six months for four years. This is perhaps another way of treating depression among older adults that has long term benefits. This was a randomized control trial, which is a gold standard for evidence based research.

What we need to do is see this repeated by other researchers so that we can start to generalize it. But it's exciting news for treatments for depression among older adults.

Another study that I want to tell you about came out in October of 2024. found that feeling lonely increases the risk for dementia and cognitive impairment by 31%. The study analyzed data for more than 600,000 participants across 21 longitudinal cohorts, making it a super comprehensive investigation. And they were looking at the impact of loneliness on cognitive function and they found that loneliness increased the risk for dementia. At a magnitude similar to the impact of being physically inactive or smoking. And so they found that feeling lonely increases the risk for dementia and cognitive impairment by 31%. And more specifically it's broken down by loneliness increasing the risk for Alzheimer's disease by 14%. Vascular dementia by 17% in cognitive impairment by 12%. And like I said equating the risk to that of being physically inactive or smoking, which is profound.

And so the researchers here differentiated loneliness from social isolation, they said loneliness is the distressing feeling of having fewer or lower quality social interactions or connections than one desires. So that I think is a key point. Than one desires it's different from social isolation and that social isolation is the lack of social contacts and having few people with whom to regularly interact.

So for example, people can live alone and not feel isolated. And indeed many older adults live alone and do not feel isolated. Whereas there are other older adults who live alone. And do feel isolated. So we can't generalize to people who live alone. And conversely. There are people who can feel lonely while being with others. More and more, it's encouraged to screen for loneliness and isolation in healthcare systems.

And so I'll link to two screening tools that are recommended that are easy to implement. That will help you screen for loneliness and isolation. I teach about them in my comprehensive certificate program on mental health and aging. And I'll link to these two screening tools in the show notes. So then not only do we need to be screening and addressing loneliness and isolation among older adults, we also need to be addressing it like then, so you identify loneliness or isolation now what, and there are some great resources like social prescribing.

There's a physician. And I'll try to find the article and link to it. I posted on LinkedIn a several months ago, but there was.

There was a physician in a Midwestern state who, when she identifies loneliness or isolation, prescribes like gives an actual prescription for her patients. To go to the local coffee shop, where there are lots of get togethers and programs for people like knitting circles and all sorts of informal groups and programs. And so that's an example of social prescribing. Senior centers are another great place. I'll link to an NPR clip where they were talking about a senior center in Korea town in. Los Angeles and how that senior center dispelled myths. And misconceptions about what it means to participate in senior center activities. So I'll link to that in the show notes, I find that sometimes just showing my clients a little preview of what activities might be like, If you're like me, you've heard from many older adults while I don't want to go to a senior center. Those, aren't my people when indeed. It's just a misconception. And so giving a little sneak peek as to what it's like to participate by sharing an NPR clip or an article. Can be helpful. So I'll link to those in the show notes as well. And of course I'm linking to each of these studies. If you want to dive deeper.

Move on to the fourth interesting study that came out in 2024, looking at anxiety and dementia. This study found that chronic anxiety in older adults was linked to an increased risk of dementia. This is a study out of Australia called the Hunter Community Study, that included more than 2, 000 participants, the average age of the participants was 76 years old. And so what they found was that both chronic anxiety meaning that you've had anxiety throughout your life and newly developed anxiety or new onset anxiety were associated with an increased risk of all cause dementia. The association between anxiety and dementia risk was particularly strong in individuals who were diagnosed with anxiety before the age of 70. And that when those people who were diagnosed with anxiety before the age of 70 had that anxiety treated and that anxiety benefited from treatment and reduced, the risk for dementia essentially went away. So the take home message here is that The earlier we can treat anxiety disorders, the better for brain health and overall health, of course. So this study is really important because it shows us that throughout our lifespan, various stages of our life from the time we're born all the way until . Older adulthood influences how we age, and so the earlier we can identify mental health concerns and treat them, the better.

So if you're experiencing an anxiety disorder in midlife, Young adulthood, adolescence, middle age, older age, the earlier we can identify mental health concerns like anxiety disorders and treat them, the better our health outcomes. And so in this case, the earlier we can identify and treat anxiety, the better the health outcomes down the road.

Especially when it's identified early and addressed early.

Okay, and the final study that I want to talk about is a study that reviewed with a meta analysis of ADHD among older adults. And I want to just highlight some ways that ADHD may be different among people 60 years old and older compared to younger people with ADHD.

And the reason I'm sharing this article is because a couple of weeks ago, the New York Times talked about ADHD among older adults, but actually didn't include older adults. They talked about middle aged adults. And so I want to set the record straight by talking about ADHD among older adults.

Contrary to popular belief, ADD persists throughout life. It just, it doesn't end because we get older, though the symptoms can transform with age.

So physical hyperactivity in childhood might become more mental hyperactivity in people 60 years old and older. Where impulsivity in younger adults' life, what might be more physical in people 60 years old and older, it might be impulsivity in decision making. Where younger people might experience inattention in people 60 years old and older, it might manifest as being more forgetful or difficulty organizing daily tasks.

And this can get tricky because sometimes we could misattribute ADHD symptoms among people 60 years old and older for a cognitive disorder when it's actually ADHD. And so this is where identification of the condition and treatment is really important. And so this is why it's also important to talk about how ADHD might manifest differently in people 60 years old and older versus younger people.

So I'm gonna link to this review and In a few weeks, I'll be doing another longer episode on ADHD among older adults. But like I said, you can link to each of these studies in the show notes below. And I hope that you stay tuned because my goal is really to give you actionable, useful, helpful information that's credible and evidence based related to mental health and aging so that if you are providing mental health care to older adults, you have the most up to date information and resources.

And if you're caring for an older loved one you have information to help you figure out what's normal with aging and not so that you can help your loved one connect to care when they need it. All right, I have a special guide for you. It's called the Mental Health and Aging Clinician's Guide to Mental Health and Aging.

So if you're a clinician, I'd love for you to download this guide. It's at mentalhealthandaging. com. You can download it wherever you're listening to this episode. And I look forward to seeing you in future episodes.

All right. So let's recap the five takeaways from 2024 is groundbreaking research. One is that there are 14 modifiable dementia risk factors that you can modify starting today to reduce or delay your risk for dementia.

Second there are compelling new treatments for depression among older adults, including that transcranial direct current stimulation. That's showing really interesting results for older people. Third is the importance of social connection. Fourth is the connection between anxiety and dementia and how important early identification and treatment of anxiety is. to reduce our risk for dementia, and fifth is recognizing how symptoms of ADHD may manifest differently in older adults and the importance of differentiating ADHD symptoms from other mental health conditions or cognitive disorders.

I am so delighted that you're here with me today. My goal is to give you accurate, up to date resources and information so that if you're a mental health provider, you provide the best care possible to older adults, and that if you're a family member caring for a loved one, you know when it's time to connect your older loved one to mental health care and the treatments that are available to help them .

It is only with your help that we will meet the mental health needs of older adults. So thank you for being here and doing your part. So if you want to dive deeper, go to the show notes and you'll get links to all of the articles that I discussed today.

But I also have a free guide for you. It's called the Clinician's Guide to Mental Health and Aging. You can get that today for free at mentalhealthandaging.com/guide Also, we have tons of continuing education programs all focused on meeting the mental health needs of older adults.

So if you're in the market for earning CEUs, head on over to our website and see all the different offerings that we have from one hour Continuing education courses to 15 hour courses. So take a look. You can go to https://courses.mentalhealthandaging.com/. All right, I'll see you next time for more mental health and aging.

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