Thread by @hyderabaddoctor

"Retirement" from work as a risk factor for #Dementia: experience of 5 recent patients

1. I saw 5 new cases of dementia last month, which apparently started within 6 to 18 months after retirement from work. All were cognitively normal until retirement.

#MedTwitter #Alzheimer

2. Memory impairment was the most prominent symptom. Over a period of time, other symptoms such as impaired calculation, speech impairment, losing sense of direction, poor judgement and inability to do daily activities without assistance, also started. Symptoms were progressive.

3. A diagnosis of Alzheimer's disease was made on the basis of detailed neuro-psychological assessment, brain scans and other appropriate investigations.
Two patients had comorbid #depression. Three patients had #sleep disorders- two had #insomnia and one had excessive sleep.

4. What factors could be responsible for sudden #Cognitive decline post-retirement?
Reduced #mental activity- During working life, one's #brain is constantly engaged. Brain use is greatly reduced post-retirement. Lack of brain activity is a major risk factor for dementia.

5. Loneliness: During working life, one meets several people, including co-workers & general public. Interaction with people and social life offer protection against cognitive decline.
Post-retirement, there is little scope to meet people and this loneliness can hasten dementia.

6. Reduced physical activity: Work involves walking and travel. One can cover 5000-6000 steps during a routine days' work. Post-retirement, there is reduction in physical activity, which can hasten cognitive decline.

7. #psychological disturbances: Post-retirement, one may have lower self-esteem. This is because some people feel less wanted. For ex- one of my patients was a bureaucrat, meeting several people daily and solving their problems. He was no longer "in demand" post-retirement.

8. #anxiety & #depression are common comorbid illnesses and may hasten cognitive decline.
Sleep disorders, either lack or excess of sleep, are known to increase dementia risk. Sleep disorders can increase post-retirement as the daily sleep habits can change in this period.

9. What can be done to lower the risk of post-retirement cognitive decline?
*Keep mentally busy- crossword puzzles, sudoku, reading, writing, singing
*Find an alternate part-time job: may not be for money but for love & passion for something
*Engage in physical activity- walking

9a.
*Form a group and interact with each other on a daily basis, avoid being lonely for long periods.
*Discuss with family or friends if any anxiety is there about finances or health. Seek Psychologist's help if needed
*Learn a new hobby
*Proper nutrition
*Maintain sleep hygiene