Crossword controversies

Over and over, perhaps ad nauseum, I have been talking about the evidence-based lifestyle changes that can reduce our risk of getting Alzheimer’s disease and/or slow its progression.  These include getting frequent aerobic exercise, eating a Mediterranean-style diet, staying intellectually and socially engaged, getting adequate (but not too much sleep), and controlling cardiovascular risk factors including diabetes, high blood pressure, high cholesterol, smoking, and obesity. All of these measures are most effective if started in or before middle age and have much less value if started after the onset of cognitive impairment.  

Let’s concentrate here on intellectual activity.  There is clear evidence that life-long learning builds cognitive reserve and delays the onset of cognitive loss without much if any slowing of the progression of the amyloid plaques and neurofibrillary tangles. Intellectual activity appears to make the brain more resilient to the neuropathological ravages of Alzheimer’s. What about doing brain games and crossword puzzles? There really is little strong evidence that these games help. One paper claims to show that subjects who did crossword puzzles were slower to begin cognitive impairment than those who didn’t do crosswords. “Crossword puzzle participation at baseline delayed onset of accelerated memory decline by 2.54 years. Inclusion of education or participation in other cognitively stimulating activities did not significantly add to the fit of the model beyond the effect of puzzles.” (J.A. Pillai et al, 2011) At autopsy, there was no difference in the two groups in number of plaques and tangles. The brains looked the same, but those who did crosswords had a slower trajectory until near the end when they appeared to catch up with the non-puzzlers. See the graph this paper below. Although I can’t help seeing it as a giant fly, the graph tells me that the crossword doers started out at a higher cognitive level. Perhaps they are more inclined to do crosswords because they are already smarter. Chicken or egg?

More recent studies have shown little if any benefit from doing crossword puzzles alone. To quote Lisa Genova from her excellent book Remember: The Science of Memory and the Art of Forgetting, page 224: “There is no compelling evidence that doing puzzles or brain-training exercises does anything to decrease your risk of Alzheimer’s. You’ll improve at doing crosswords, but you’re not building a bigger, Alzheimer’s resistant brain. You don’t want to simply retrieve information you’ve already learned, because this type of mental exercise is like travelling down old, familiar streets…. You want to pave new neural roads. Building an Alzheimer’s-resistant brain through cognitive stimulation means learning to play the piano, meeting new friends, traveling to a new city, or reading this book.” It is more effective to build new brain pathways and synapses.

If you like to do crosswords as I do, then by all means keep doing them.  I try to make it a learning exercise rather than just retrieving words from memory.  Towards the end of the week when the clues get hard, I stop and look up that lake in Africa I have never heard of, or that inventor of the mechanical computer, Charles Babbage.  I try to learn something new from every puzzle, and I suspect that is helping to sprout some new connections in my brain.

Whatever you do, keep on learning. Learn in ways that are enjoyable to you. Read new books, keep a journal, try learning a new language, try out new ideas on friends and family, and yes, if you like crossword puzzles, keep on doing them.