The view is clear from the top.
Socioeconomic mobility may protect you from dementia – as long as it’s upwards.
It’s well known that education, cognitively demanding jobs and a higher SES are protective, at least against Alzheimers.
Now a Japanese prospective cohort study of over 9000 people has found that a rising social trajectory over the life course is even better for your overall dementia risk than a stable high-SES existence.
The team used data from the Japan Gerontological Evaluation Study, participants aged 65 and up from all over Japan. From survey answers they were classed into six SES transition categories: upward, stable-high (well off, no movement), upper-middle, lower-middle, downward and stable-low. Lower-middle acted as the reference category.
The main outcome was risk of dementia incidence (data came from a national registry) and loss/gain of dementia-free life.
Those with upward and downward transitions had the lowest and highest rates of mental illness respectively, in an unsurprising by-the-by.
Upward-movers had the lowest dementia risk: 44% lower than the lower-middles, with a greater benefit for men than women. They were followed by the stable-highs, downwards and stable lows, who had a 45% higher risk.
The climbers also clocked up the biggest gain in dementia-free years, compared with the reference: 1.8 years measured at age 65.
It’s interesting that this study comes out of Japan, with its unique cultures around work, station and satisfaction.
Everyone is raving about Perfect Days, Wim Wenders’ Palme d’Or-winning film about a happy Tokyo toilet cleaner who takes pride in his daily work and for whom “now is now” – and whose father, incidentally, has dementia.
The Back Page hasn’t yet seen it, but not so long ago watched the documentary Jiro Dreams of Sushi about an ageing but single-minded chef who embodies the principle of shokunin: not seeking advancement but working the same job every day of your life and trying to do it better. (It’s his expectation that his sons follow him exactly rather than choose their own path, be it upward or downward from their inherited Michelin-starred peak, that creates the tension.)
Jiro Ono himself, though he may seem like the still stone in a moving stream, is a case study in Japanese social mobility: at nine years old he was living on the streets, with sushi an unimaginable luxury. When the film was made he was an energetic 85 years old; he is now 98 and only retired last year.
The study found that SES transitions mediated the development of other risk factors for dementia. Given what we know about education and cognitively demanding jobs, it makes intuitive sense a brain capable of navigating and overcoming social and economic barriers, as Jiro did, may be one that doesn’t quit easily.
Which means that even if you, readers, could prescribe a course of social ambition and relentless self-improvement to your patients, it probably wouldn’t work.
Nonetheless, penny@medicalrepublic.com.au could use your tips on climbing the socioeconomic ladder.
