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Stan Goldberg
Medicine, Walking, Painting, and Puzzles: A New Paradigm for Dementia Intervention

Medicine, Walking, Painting, and Puzzles: A New Paradigm for Dementia Intervention

While physicians routinely prescribe Donepezil (Aricept), Galantamine (Razadyne), and  Rivastigmine (Exelon) for patients who have Alzheimer’s or other forms of dementia, they often ignore the clout of activities such as walking, knitting, woodworking, and puzzles. It may be time to expand prescriptions to include activities.


As we age, we lose neurons and synaptic connections because of illness, disease, or age-related conditions. In the past, most neurologists thought that once a cell died, a new one could not replace it, nor could new connections be generated between cells. However, recent research has shown that new neurons (neurogenesis) and new synaptic connections (synaptogenesis) can be developed even in the brains of people with dementia.

The key appears to be the enhancement of neuroplasticity, the ability of the brain to create new cells and connections. Various studies suggest that certain types of activities are more beneficial than others: physical activity, creative activities, and cognitive acts. While exercise is believed to enhance neuroplasticity by providing increased blood flow to the brain, less research has been devoted to how creative and cognitive acts increase neuroplasticity. Although we do not know how they accomplish this task, studies have shown that there is a relationship, one that providers and caregivers should not ignore.

Cognitive and Creative Acts that Change the Brain

The positive effects of cognitive and creative activities on mental health and brain functioning have been evident to practitioners and caregivers for years. They may not know why a patient becomes more social after working on a puzzle, but the effects of the activity are apparent. What has been elusive is finding guidelines for selecting what should be used.

Although rarely cited by professionals treating patients with dementia, the answer has been available since 2013 in an article by Bryon Goodwin and Kristen Miller. Their research aimed to provide educators with an understanding of what skills should be taught to students so they can become creative. After looking at the research, they settled on six.

1. Ability to provide multiple answers based on available information.

2. Constant analysis of what is being created.

3. Willingness to redraft and start over again.

4. Ability to engage in complex and creative problem-solving activities.

5. Ability to combine convergent and divergent thinking.

6. Willingness to ask  “what if?” questions.

Goodwin and Miller probably never realized that these six skills were identical to those needed for cognitive acts.

Creative-Cognitive Activities

Skills that are important for painting, knitting, and sculpting are identical to those necessary for working on finances, learning how to build a deck, and many other cognitive activities. Trying to separate “cognitive” from “creative” activities wastes time for practitioners and caregivers. A better approach is determining how many of Goodwin and Miller’s skills are found in an activity. Ones that contain many of the elements should be prescribed, those that don’t should either be eliminated or drastically reduced (e.g., knit more, watch fewer reruns of Law and Order). Since the benefit to the brain comes from using the skills and not the quality of the outcome, there should be no concern about producing a laughable watercolor painting rather than a Monet masterpiece. It’s the process, not the product, that is beneficial for brain health.

Below are 12 types of activities that may have a significant positive effect on slowing down the effects of dementia since each requires the use of Goodwin and Miller’s six skills.

            1. Modify Existing Activities

            2. Add something new to a routine

            3. Engage in an activity that constantly changes

            4. Begin new activities regularly

            5. Listen to music differently

            6. Exercise your brain with puzzles

            7. Work on creative writing

            8. Challenge the brain with video games

            9. Use non-electronic games

            10. Participate in discussions

            11. Purposefully get lost

            12. Create “what if” scenarios

The Takeaway

We may not be able to prevent dementia. But we can slow its progression by selecting activities that incorporate Goodwin and Miller’s six skills. Maybe prescriptions should be something like the following:

            200mg of xx, taken twice daily

            30 minutes of walking 3 times a week

            1 hour of knitting 3 times a week

            30 minutes spent creating a unique recipe 2 times a week

            45 minutes of puzzles

            1 afternoon a week, playing bridge or chess


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