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Mental Health
By Robert Firpo-Cappiello

Why Patients with Dementia Could Benefit from Cooking

After a diagnosis of Alzheimer's disease, a renowned cookbook author continues cooking with help from friends. Their tips may be useful for others with dementia.

Illustration of two women cooking in the kitchen
Illustration by Wesley Bedrosian

Paula Wolfert knew something was wrong.

In 2010, at age 72, the award-winning cookbook writer noticed an unsettling development: Her previously sharp memory—for exotic ingredients, complex recipes, and the names of hundreds of friends she'd made traveling the world—was slipping. Now she struggled to remember the foreign languages she'd mastered; even reading English became a challenge. The words seemed to be "floating on the page," she told friends.

At first Wolfert's closest friends, and even some doctors, dismissed her memory lapses as age related. Wolfert wasn't convinced, and as her memory continued to decline, she sought advice from a neurologist who took her medical history, conducted memory and cognitive tests, and had her undergo an MRI. Based on these results, the neurologist diagnosed her with mild cognitive impairment, which can be a precursor to Alzheimer's disease.

After a lifetime of inspiring home cooks and acclaimed chefs such as Alice Waters and Thomas Keller with groundbreaking cookbooks that include Couscous and Other Good Food from Morocco (Harper & Row, 1973) and The Cooking of the Eastern Mediterranean (HarperCollins, 1994), Wolfert had acquired a reputation as an innovative thinker who was passionate about what she believed in. When she was a child, a psychologist told Wolfert's parents that the little girl was a "renegade."

That spirit has remained strong in the face of her diagnosis and decline in cognitive abilities. "Despite her struggles, Paula wants to continue cooking as long as it is safe," says Emily Kaiser Thelin, author of Unforgettable: The Bold Flavors of Paula Wolfert's Renegade Life (Grand Central Life & Style, 2017). The two women spent hours talking, reviewing recipes, and working in the kitchen together as Thelin crafted the hybrid biography/cookbook. "Paula told me, 'This illness takes forever, and I'm determined to make it take as long as it can.'" (Wolfert no longer gives interviews, but a close circle of friends and associates, including Thelin, occasionally speak on her behalf.)

For Wolfert, coping with cognitive impairment—and the eventual confirmation that she has Alzheimer's dementia—has meant not just eating well (she's long embraced a Mediterranean diet that focuses on lean meats and fatty fish, fresh fruits, and vegetables) but also continuing to cook. Now, though, she's cooking in a new way, one that helps her maintain the physical activity and social support that are increasingly recognized as important in dealing with dementia. "While Paula can no longer follow recipes," Thelin says, "she's still able to improvise basics, especially with someone else in the kitchen to help. She focuses on simple ingredients such as wild-caught salmon and mackerel and a rainbow of fresh vegetables, and simple techniques such as steaming to create bountiful lunches for herself."

Cook Book called Unforgettable
Courtesy Grand Central Life & Style

Wolfert also meets with friends at a local community center where she hosts a "memory cafe," an informal social gathering for people with Alzheimer's and other forms of dementia or cognitive challenges and their caregivers. She also travels to Washington, DC, as a spokesperson for the Alzheimer's Association. As her grandmother once told her, you can't win a war if you're not willing to fight.

Wolfert's neurologist, Catherine A. Madison, MD, director of the Ray Dolby Brain Health Center in San Francisco, has encouraged Wolfert's healthy eating habits and efforts to remain engaged socially. She also has persuaded Wolfert to meditate and exercise. Under Dr. Madison's guidance, Wolfert started jogging for 20 minutes on a treadmill, meditating for 15 minutes using an app, and attending yoga and qigong classes. Her friends have been amazed at how the previously exercise-averse Wolfert has taken to these new physical activities.

A few small studies suggest that cooking may be beneficial in the fight against cognitive decline. Larger studies, however, suggest that it may be the socializing aspect of cooking and other interactive activities that is more important.

A large retrospective analysis conducted by researchers at University College London, published in PLOS Medicine in 2019, looked at data from more than 10,000 mid-to-late-life participants in the Whitehall II study, which began in 1985 and required participants to complete cognitive tests five times between 1997 and 2016. The analysis of cognitive test results and other health records strongly suggests that greater frequency of social interactions at age 60 is associated with higher cognitive performance in later life and a lower risk of developing dementia.

These results echo those of earlier work, such as a research review published in the Journal of Aging Research in 2012 that suggests that physical activity, intellectual stimulation, and socialization improve cognition and overall well-being in people with age-associated cognitive impairments and may provide a similar benefit for those with dementia.

In one of the first studies to examine the role of cooking in brain health, published in the American Journal of Recreation Therapy in 2003, Suzanne Fitzsimmons, MS, a nurse practitioner and former instructor in therapeutic geriatric care at the University of North Carolina Greensboro, and the late Linda L. Buettner, PhD, former professor of gerontology and therapeutic recreation, found that cooking in a safe environment helped reduce passivity and agitation in adults in assisted living who had varying degrees of dementia.

"Cooking has a powerful meaning for older adults," says Fitzsimmons. "For some, it can be integral to feelings of self-worth and identity." The cooking programs that Fitzsimmons led for adults in group settings—inspired by the theory that maintaining roles and activities people are used to is key as they age—have been shown to increase appetite, encourage people to join a social gathering, and relieve stress.

"I was amazed that even participants who had not cooked for a long time took to the kitchen without much prompting—they seemed to be in their element," says Fitzsimmons, who has retired from teaching. "And some of the very low-functioning participants surprised us: After making butter, they independently spread it on bread. This may not sound like much, but these older adults had been fed by staff for more than a year. After participating in the program for a few weeks, they were able to eat finger foods independently. They also started communicating more, especially with cooking partners, recalling fondly what they cooked and telling family members what they had accomplished."

Encouraging people with dementia to cook comes with safety hazards: sharp tools, open flames, spills, forgetting to turn off burners or ovens, and other risks. That's why therapeutic cooking programs—and any attempt to reproduce them at home—must include supervision and must match cooking chores to people's level of functioning. More complex tasks might include making shopping lists and cutting stems off strawberries. Simpler tasks would be stirring ingredients in a bowl, shaking a sealed container of ingredients, wiping surfaces, clearing a table, and drying dishes.

While the benefits of staying active and socially engaged and eating a healthy diet are increasingly clear, the science behind the recommendations is still evolving. "We don't know for certain what particular mechanisms are at work to bring about these benefits," says Dr. Madison. "Every person is unique. The complex relationships between our own biology and genetic expression, environment, and diet make research in neurodegenerative diseases particularly challenging."

As for Wolfert, she worked with Thelin and "Team Renegade" to review and test recipes, plan photo shoots, and participate as fully as possible in the publication of Unforgettable. "When we were shooting recipes for the book, Paula tasted every dish we prepared," says Thelin. "More often than not, she would insist she could not remember anything about the dishes. But we learned to roll with it, to cherish the unpredictable moments when memories would shake loose, such as the time I prepared cassoulet for her and she vividly recalled and described watching a French housewife prepare cassoulet for her 50 years earlier." But as with everyone diagnosed with cognitive impairment, Wolfert's future remains uncertain.

"While the inevitable progression of Paula's Alzheimer's dementia has made cooking challenging for her, I've been endlessly amazed by how she has found fresh inspiration in new passions, including taking to exercise well into her seventies," Thelin says. "It's quite something how the diagnosis has, in surprising ways, widened her world through the memory cafe and in her work with the Alzheimer's Association."

Read More

Download a one-page sheet called Alzheimer's Disease: The Basics. Read about cooking safety tips and simple recipes for Alzheimer's patients.

Alzheimer's Resources