Dr Ben Shüz
One of the most striking barriers to changing behaviour, to reduce dementia risk, is the fact that there is such a huge distance in time between what we’re doing now and when we might get the outcome. This is a problem that is very common to a lot of health behaviours. If I’m increasing my physical activity now, there might be a few short-term benefits - I’ll lose some weight, I’ll gain muscle tone. But the big beneficial outcomes, they’re very far in the future - so I may not get heart disease, or I may not get type two diabetes. If you’re already at high risk for those things, you still have a pretty large delay in when the, what we call reward, will come about. And that’s very different from health risk behaviours. You get immediate reward from eating a Danish. Smokers get an immediate reward when they smoke a cigarette. If you have a glass of wine, it immediately tastes good, and the cost will come later. So one of the major barriers in reducing dementia risk is really the difference in onset of costs - it’s no fun starting to be more physically active, it’s no fun changing your diet, and the rewards, which may or may not come after 20, 30, 40 years in the future, not getting dementia. And we’re pretty bad at dealing with, what we call, delayed gratification. That is, if we’re not immediately gratified or rewarded for what we’re doing, we have problems in keeping up behaviour changes. So I’d see that probably as one of the major cognitive barriers to changing behaviour in order to prevent dementia.
改变行为从而减少认知症风险的最明显的障碍之一是，事实上，在我们现在做的事情和我们可能得到结果之间有一个巨大的时间距离。这是一个很常见的很多健康行为的问题。如果我现在增加我的体力活动，可能有一些短期的好处 - 我会减肥，我会获得肌肉紧张。但是大的有益的结果是在很遥远的未来- 我可能不会得到心脏病，或者我可能不会得到2型糖尿病。如果你已经面临这些事情的高风险，你仍然有一个相当大的延迟将会发生，我们称之为奖励。这与健康风险行为非常不同。你会通过吃丹麦酥皮立即得到奖励。吸烟者在吸烟时会立即得到奖励。如果你喝一杯葡萄酒，你可会享受美酒的好味道，而付出的代价来得晚。因此，减少认知症风险的主要障碍之一是，减少认知症风险真正开始付出代价事件上的差异 - 没有乐趣开始更多的身体活动，改变你的饮食是没有乐趣和奖励，可能或可能不会在未来20、30、40年得认知症。当我们在处理我们称之为延迟的满足，感觉是非常糟糕的。也就是说，如果我们不能立即从我们正在做的事情感到满意或得到回报的话，我们坚持进行这种行为的改变就会有问题。所以我认为这可能是改变行为以预防认知症的主要认知障碍之一。
There are some challenges with regards to health behaviour change, when we look at different age groups. The behaviours that are recommended might differ. Different behaviours are more or less important at different stages in our lives but, most importantly, what we think we can or should do changes a lot during our lifetime. For example, we know that, in many older adults, experiences such as increasing difficulties walking up the stairs, increasing difficulties remembering things, increasing difficulties concentrating, are attributed to old age per se, so people think, “Ah, I can’t climb up the stairs. That’s probably because I’m getting old,” or “I keep forgetting things. That’s probably because I’m getting old,” but it may actually be early signs of an illness. So, by thinking that changes in our health are a natural part of ageing, we tend to be less motivated to do anything about it, because, after all, you can’t change your ageing process, can you? But if we think about those things as risk factors, and as things that can indicate that something could go wrong, we might be more inclined to do something about this. So this is a very, very important risk factor or barrier to behaviour change that we find in older age. In younger age groups, barriers to successful behaviour change have to do with what I’ve been talking about before, and that is the delay in gratification that we get from engaging in a health behaviour. So we may not get a heart attack in 20 years, we may not get type one diabetes in 20 years, but that’s not particularly relevant when I’m in my 40s, and it’s even less relevant when I’m in my 20s, because that is all so far away. So these might be some of the more specific barriers that are related to different age groups.
当我们观察不同的年龄组时，在健康行为变化方面遇到一些挑战。被推荐的行为可能不同。不同的行为或多或少在我们生活的不同阶段是重要的，但最重要的是，我们认为我们可以或应该做的改变，在我们的一生中很多。例如，我们知道， 许多老年人当走上楼梯时困难增加，记忆的事情变得更加困难，更加难以集中奖励时，往往将这些事情归因于年纪大了，所以人们认为，“啊，我不能爬上楼梯了。这可能是因为我变老了，” 或 “我老忘事 。这可能是因为我变老了”， 但这些可能实际上是疾病的早期迹象。所以，如果认为我们的健康的变化是老龄化的一个自然部分，我们往往会没有动力去做任何事情，因为毕竟是你无法改变你的衰老过程的，你能吗？但是，如果我们将这些事情看作是风险因素，并且是可能出错的事情，我们就会更倾向于做这方面的事情。所以这是一个非常非常重要的风险因素或我们发现在年龄较大时改变行为的障碍。在年轻的年龄组，其成功进行行为改变的障碍与我在前面一直在谈论的有关，那就是我们从健康行为得到满足的延迟。所以我们在20年内可能不会有心脏病发作，我们可能在20年内不会得1型糖尿病，但是当我40岁时，这不是特别相关，而且当我20多岁时，相关性更低，因为所有都离得还这么远。因此，这些也许是与不同年龄组相关的一些更特殊的障碍。
Well, there’s good news. It’s really never too late to change your health behaviours. There are a couple of really fantastic studies that I like to use as examples in my lectures. There’s a great study from Sweden, in which researchers followed up a group of elderly - and with elderly, apologies, the researchers meant women aged 65 and over - and they were able to follow them up for a period of a year, and then they were able to get mortality data off those participants later on. That is, they were able to track changes in their physical activity over a year and then see whether people who changed their physical activity were more or less likely to die earlier over a long period of time. And the interesting thing they found is that people who were not active at the beginning of the year, but became active over the course of that year, had the same reduced mortality risk as those older women who had been active in the first place. And the same holds true for ceasing to be active. Those women who ceased being active over the course of the year had a very similar increase in risk of mortality over the course of that time span than the women who had not been active in the first place. So that shows us it’s really never too late to change health behaviour.
好消息是改变你的健康行为真的永远不会太晚。有几个真正了不起的研究，我喜欢在我的演讲中做例子。有一项来自瑞典的伟大研究，研究人员随访一群老年人 - 抱歉，研究人员的意思是指65岁及以上的女性 - 他们随访了她们一年，然后他们获得了这些参与者的死亡率数据。也就是说，他们随访了他们一年多的身体活动的变化，然后观察改变他们的身体活动的人是否或多或少可能在较长时间内早死。他们发现的有趣的事情是，那些在年初不活跃，但在那一年后来变得活跃的人，与那些一直活跃起来的老年妇女的死亡率降低程度相同。这同样适用于停止活动的情况。那些在一年中停止活动的妇女在这段时间内死亡的风险与没有活跃的妇女相比有非常相似的增加。这向我们表明改变健康行为从来没有太晚。
There are also really great studies in very old, older adults, aged 85 and over, both in stationary care and living at home, in which researchers found that increases in physical activity had a very, very beneficial effect on everyday functioning and activities of daily life. So no, it’s never too late to do anything about that and change behaviour.
It’s really tricky to know whether and when we’re reducing our dementia risk, because there is no established biomarker, and there is no one thing that will tell us that we’re actually doing something good for our health, and that we’re doing something good to reduce our risk of dementia, but we know a lot about the risk factors for dementia, so we know that, if we’re doing something about those, we’ll be reducing our dementia risk. So, if we are following behavioural recommendations to reduce the risk for cardiovascular mortality, if we’re engaging in the behaviours that are recommended to reduce the risk for type two diabetes, and those kinds of things, we know that we are reducing the risk factors for dementia, even though there is no really good way of telling whether it actually does reduce the risk.
知道我们是否以及何时在降低认知症风险是真的很棘手，因为没有已确立的生物标志物，没有一个事情会告诉我们，我们实际上在做一些对我们的健康有好处的事情，对减少认知症风险有好处的事情，但是我们知道很多关于认知症风险因素，所以我们知道，如果我们做和那些有关的事情，我们将减少我们患认知症的风险。 因此，如果我们遵循行为建议来降低心血管死亡风险，如果我们参与推荐降低二型糖尿病风险的行为，以及那类事情，那么我们知道我们正在降低风险 认知症的因素，即使没有真正好的方法来告诉它是否真的降低了风险。
So some people might think that dementia is a natural part of ageing, which it is not, and therefore might think that doing anything against dementia is really futile. This kind of belief is one of the major barriers to changing health behaviours in old age, because many people think that health related changes in older age are a natural part of ageing, when they’re not. So many people could think that, “oh, my memory’s fading a bit, I have difficulties in remembering a phone number” - that these are natural things that occur with ageing. They may be, but they may also be indicators of dementia, so it’s always worthwhile having those checked out. And we know that from different health behaviours as well. People may think, “I’m having difficulties climbing up that flight of stairs, I’m finding it increasingly difficult to bend down, but that’s a natural part of ageing, I can’t do anything about that.” And they’re actually morbidly obese. So thinking that something is a natural part of ageing can prevent us from actually doing something against it, and recognising that your memory changes, recognising health changes in general, are always something that you should take seriously and never think that they are a natural part of ageing.
因此，有些人或许认为认知症是老龄化的一个自然部分，因此可能认为对认知症做任何事情都是徒劳的。这种信念是改变老年人健康行为的主要障碍之一，因为许多人认为老年人健康相关的变化是老龄化的自然部分，其实不是这样的。因此很多人可能会认为，“哦，我的记忆已经减退了一点，我在记电话号码时遇到了困难” - 这些都是随着年龄增长而发生的自然事情，他们可能是因为这个原因，但这些也可能是认知症的指标，所以总是值得将那些检查出来的。我们也知道那些也来自于不同的健康行为。人们或许会认为，“我爬楼梯很困难，我发现越来越难弯下腰，但这是老化的一个自然的部分，我不能做任何事情来改变这些。”他们实际上是病态肥胖。因此，认为某事是老化的一个自然部分会阻止我们切实做些事情来对抗它，并且认识到你的记忆变化和一般的健康变化总是你应该认真对待的事情，永远不要认为它们是老化的一个自然部分。
So if I were to give you a take home message, it’s this: don’t think that as you’re getting older everything is getting worse. So, many health-related problems that we’re experiencing as we’re getting older are actually health problems. They’re not part of natural ageing. If you’re worried about these kinds of things, see your GP or talk to someone. Not all the changes that we experience as we’re getting older are normal. Some of them might indicate illnesses. But, at the same time, there is good news, which is that it is never too late to change health-related behaviour. We know from research that, even in old age, increasing physical activity, changes in diet, can be really beneficial for your health. And, even though there is no dedicated biomarker or good indicator of your dementia risk, we know what the risk factors are. So, if you’re doing something about those, if you’re keeping healthy, you’re actually doing something good for your brain health and for your risk of dementia as well.