Prescribing the Internet to Prevent Dementia
July 15, 2023
By Seema Gupta, MD, MSPH
Clinical Assistant Professor, Department of Family and Community Health, Joan C. Edwards School of Medicine, Marshall University, Huntington, WV
SYNOPSIS: In an ongoing longitudinal survey of a nationally representative sample of dementia-free adults age 50 to 64.9 years, regular internet users experienced approximately half the risk of dementia compared with non-regular users.
SOURCE: Cho G, Betensky RA, Chang VW. Internet usage and the prospective risk of dementia: A population-based cohort study. J Am Geriatr Soc 2023; May 3. doi: 10.1111/jgs.18394. [Online ahead of print].
More than one-third of adults age 45 years and older feel lonely, and nearly one-fourth of adults age 65 years and older are considered to be socially isolated.1 Social isolation is defined as the objective physical separation from other people, such as living alone, in which one engages in few social relationships or there is little interaction with others (lack of social connections). Social isolation can lead to loneliness in some people, while others do not need to be socially isolated to feel lonely.
According to the CDC, loneliness and social isolation in older adults are serious public health challenges affecting many Americans, placing them at higher risk of premature death from all causes; higher rates of depression, anxiety, and suicide; and about a 50% higher risk of dementia.2 Current evidence suggests using the internet for various purposes can help lower the risk of cognitive decline.3 Using computers and the internet provides cognitive stimulation and might contribute to the accumulation of cognitive reserve that is proposed to play an important role for maintaining cognitive health in aging.
This technologically acquired cognitive reserve could neutralize some of the brain aging processes and lower the risk of dementia. However, it is necessary to evaluate the long-term cognitive benefits of internet usage. Furthermore, access to the internet and competence in using it is not uniform across the nation, often adversely affecting communities of color and low-income populations. Thus, it is unknown whether the disparities in cognitive health may widen. Finally, it also is unclear if too much internet use can negatively affect dementia risk.
Cho et al followed 18,154 dementia-free adults age 50 to 64.9 years for a maximum of 17.1 years (median = 7.9 years) using the Health and Retirement Study. Researchers examined the association between time-to-dementia and baseline internet usage, as well as the interactions between internet use and education, race/ethnicity, sex, and generation. They also examined the association of the risk of dementia with daily hours of internet use.
Cho et al found regular internet use was associated with approximately half the risk of dementia compared to non-regular usage (cause-specific hazard ratio, 0.57; 95% CI, 0.46-0.71). This association was found regardless of educational attainment, race/ethnicity, sex, or generation. However, the authors found excessive daily internet use appeared to adversely affect dementia risk. The estimated association between daily hours of internet use and dementia risk demonstrated a U-shaped relationship, where participants who used the internet 0.1 hours to two hours appeared to experience the lowest risk, which increased after two hours, with 6.1 hours to eight hours of use showing the highest estimated risk of developing dementia.
COMMENTARY
The technological reserve through digital engagement can develop and maintain cognitive reserve and function as resiliency against anticipated physiological brain aging. In short, this deeper cognitive reserve can lower the risk of dementia. Cho et al demonstrated that older patients can approximately halve the risk of dementia by simply regularly using the internet. We recognize dementia is not a normal or inevitable part of typical brain aging. There are several modifiable risk factors that could reduce the risk of dementias, or slow its progression. These include appropriate physical activity and diet, managing chronic health conditions (e.g., hypertension, diabetes, depression, and obesity), and avoiding smoking and binge drinking. These new findings suggest using the internet regularly for 0.1 hours to two hours daily for older patients might be considered another modifiable risk factor to lower dementia risk. Social connections matter for our cognitive health, especially for older adults. It also is important to note the researchers found no evidence indicating internet use contributed to socioeconomic disparities in the burden of dementia.
Maintaining a healthy lifestyle and managing related chronic conditions is good for our patients’ overall physical health, facilitates and improves brain health, and may help lower the risk of dementia (or slow its progression). Current results emphasize physicians can play a significant role in closing the digital divide when it comes to the cognitive health of older patients. It might help alleviate social isolation, too.
REFERENCES
1. National Academies of Sciences, Engineering, and Medicine. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. Washington, DC: The National Academies Press; 2020.
2. Centers for Disease Control and Prevention. Loneliness and social isolation linked to serious health conditions. Page last reviewed April 29, 2021.
3. Amini R, Chee KH, Mendieta M, Parker S. Online engagement and cognitive function among older adults. Geriatr Gerontol Int 2019;19:918-923.
In an ongoing longitudinal survey of a nationally representative sample of dementia-free adults age 50 to 64.9 years, regular internet users experienced approximately half the risk of dementia compared with non-regular users.
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