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Literacy and Brain Health: People Who Can’t Read Are Three Times More Likely to Develop Dementia

By | November 14th, 2019

It’s generally accepted that exercising your mind through reading, crossword puzzles and even learning a new language benefits your brain as you age. But what happens to people who never acquired literacy, or the ability to read and write? New research suggests that individuals who are illiterate are three times as likely to develop dementia compared to people who are literate.

Past research has focused on how years of education, and high reading level, can lower the risk of developing dementia—or make patients develop it much later on.

But not many studies have concentrated on early life educational experiences, and how that can impact late life cognitive health, says Dr. Miguel Arce, postdoctoral research scientist in neurology at Columbia University Vagelos College of Physicians and Surgeons, who worked on the study.

“Specifically, we were looking at illiteracy and seeing how that relates back to dementia risk as well as changes to cognition over time,” Arce told Being Patient. “We decided to focus on that, given there’s been quite a bit of research showing that years of education can seem to be protective, to reduce your dementia risk. But it was unclear, if even just acquiring the ability to read and write, if that could bring some kind of benefit.”

The researchers worked on the study with participants in a Washington Heights/Inwood Columbia community aging project.

The study, published in Neurology, focused on 983 older participants with low levels of education (they had gone to school for only four years or less), who were living in northern Manhattan. A large number of the study participants had been born in the Dominican Republic, in rural areas, where they had limited education.

The researchers divided the participants into two groups: those who were literate (about 746 people), and those who were illiterate (237 people). They measured the participants’ cognitive abilities through memory and thinking tests.

When they started the study, participants who were illiterate already showed a higher prevalence of having dementia. 35 percent of people who couldn’t read had dementia at the beginning, compared to only about 18 percent of people who could read.

That gap increased even further four years later. Nearly half of people who were illiterate—48 percent—ended up having dementia, compared to 27 percent of people who were literate. The researchers concluded that not being able to read doubled the risk of developing dementia during the study.

“Our results showed that illiteracy was associated with an increased risk of developing dementia, both at the beginning and over time,” Arce said.

Though illiteracy may seem like an issue of the past, and rates are declining especially among youth, it still affects a large number of people around the world. Over 700 million adults across the globe are illiterate, according to Project Literacy. And just in the U.S., 32 million adults are illiterate, according to the United States Department of Education.

Can Literacy Protect the Brain from Dementia?

While there’s currently no way to stop the progression of neurodegenerative diseases like Alzheimer’s or dementia, doctors stand behind tried-and-true lifestyle changes as being the number one factor to lower your risk of developing them—and possibly even slow them down.

One recent study found that a combination of personalized lifestyle changes, from diet and exercise to improved sleep and supplements, slowed cognitive decline. The researcher on that study, Dr. Richard Isaacson, Director of the Alzheimer’s Prevention Clinic at New York-Presbyterian and Will Cornell Medicine, says that a third of dementia cases could be preventable with lifestyle changes.

Scientists and doctors have touted aerobic exercise, a Mediterranean diet and improving cognitive function by challenging your mind as evidence-based steps to protecting your brain health.

When it comes to keeping your mind sharp, research has found that of course, reading and writing may help improve memory. But speaking several languages has also shown to have a protective effect. One recent study found that the cognitive flexibility and linguistic ability involved with speaking several languages was a strong predictor of dementia risk.

Reading Interventions in Later Life

But researchers still aren’t sure whether an intervention of sorts for people who are illiterate could help lower their increased risk of developing dementia. 

“The rates are illiteracy are going down over time in both developed and developing countries,” Arce said, “but hopefully this study helps reinforce” the idea that interventions could be helpful.

“If we were to intervene later in life, mid-life, if we teach them how to read and write, could that help?” Arce said. “Could it reduce that risk later on? From my understanding, there are no programs devoted to that for dementia risk.”

He noted that the next steps for their research involve exploring the underlying biological mechanisms in the brain that help explain why illiteracy may lead to a higher dementia risk. And the researchers may also investigate whether reading interventionsor teaching people at middle or older age how to read and writecould have any protective benefits.

For now, he hopes doctors use the findings to help them identify patients who may need dementia care sooner.

“In terms of clinical implications, I think this research is important for physicians and neurologists who are working with individuals who have low years of education,” Arce continued. “It’s good to not assume patients’ level of literacy, and to find ways to build rapport with the patient to ask if they’re illiterate. If so, that may mean they’re at an increased risk of developing dementia and should be monitored more carefully.”

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