Cognitive Reserve: The First Line of Defense Against Dementia


Nothing can cure or slow Alzheimer's disease—but, what if there was a way to stave off its effects on a person's memory and cognition?

Scientists have discovered a biological mechanism, called, ‘cognitive reserve,' that allows the brain to retain its functionality despite the onset of Alzheimer's and other forms of dementia.

The concept of a cognitive reserve arose from the observations of several independent research studies. Researchers found that certain seniors with normal, or minimally-impaired, mental functioning, actually had physical signs of pronounced Alzheimer's disease in their brains. It was concluded that something was protecting these seniors from the effects memory-robbing disease.

Gary Small, M.D., professor of psychiatry and director of the UCLA Longevity Center, likens cognitive reserve to, "having an extra mental battery." He says that a person with a high amount of cognitive reserve can compensate, somewhat, for the brain damage caused by disease and old age.

Hope for a damaged brain

As a person's brain ages, several things begin to happen that can negatively impact their ability to think and remember, according to Small.

Brain cells begin to die, neurotransmitters don't work as well as they did when the person was young, tissues shrink, and protein deposits begin to build-up, interfering with communication between cells (Alzheimer's disease).

One by one, the biological ‘batteries' powering a person's thoughts and memories begin to wear out.

And, in the elderly, dementia is often irreversible.

There are instances where a senior may exhibit signs of mental impairment due to drug interactions or low levels of certain nutrients. These can sometimes be remedied by switching a prescription, or tweaking a diet. But, there is often very little that can be done for a senior who starts losing their memory due to ailments, like Alzheimer's disease, vascular dementia, or Lewy Body dementia.

This is why the concept of cognitive reserve is so promising—its protective effects are thought to be capable of being harnessed by anyone, no matter what the reason for their cognitive impairment.

Building up and tearing down

Collecting diplomas is one of the main ways a person can build solid base of cognitive reserve. According to Small—the amount of education a person has, particularly from the undergraduate level and up—helps fortify them against symptoms of memory loss and confusion.

But, those who decided to forgo getting their master's need not worry. Education is not the only way to fortify the brain against memory impairment.

Small says learning new things and doing mental exercises to help remember names and faces can also help beef up a person's cognitive reserve. In his book, "The Alzheimer's Prevention Program," Small describes one such exercise: LOOK, SNAP, CONNECT.

Designed to help a person remember and associate names with faces, this exercise instructs people to concentrate on a new acquaintance's name (LOOK), take a mental snapshot of their name and face (SNAP), and then synthesize the mental pictures to link the acquaintance's name and face in their mind (CONNECT).

Sue Maxwell, M.S.W., director of Older Adult Services at Lee Memorial Health System, feels that simple lifestyle changes can also help a person's mind become less susceptible to dementia. "Pretend you're in a world where there are no paper and pencils—you have to remember things on your own," she says.

Research has also linked being socially active to having a larger cognitive reserve.

There are certain things experts believe may hinder or deplete a person's mental power cache.

Chronic stress and a sedentary lifestyle are proven brain-drainers. Scientific evidence indicates that stress may as much as double a person's risk for developing Alzheimer's.

A healthier brain at any age

When it comes to cultivating a healthy brain, "It's never too late, and never too early to start," Small says.

There are benefits to starting sooner, but evidence indicates that people can still enhance their brain functioning even when given a short period of time. According to Small, dramatic improvements in cognitive ability have been seen in people in their 60s, 70s, and 80s who adopt a program to stave off dementia.

Doctors even recommend that people who already have signs of cognitive impairment should try to stay as mentally active as possible.

Every little bit helps

What constitutes a mentally engaging activity will vary, depending on a person's level of cognitive impairment.

Small says that any type of stimulation helps, and a caregiver may have to adjust an activity's level of difficulty to fit a senior's capability. For example, if your elderly loved one enjoys reading, but can no longer handle adult books due to their dementia, they may need to downgrade to a children's book.

The existence of cognitive reserve is not yet a well-researched concept and no one is sure of exactly how effective it is at warding off dementia in the elderly. Existing evidence suggests that having an extra cognitive stash is beneficial. But, the advantages can vary from person to person, and generally diminish as their dementia progresses.

Still, Maxwell says that there are proven things people can do to protect their aging brain.

The key, according to Small, is coming up with a plan and sticking to it.

A combination of a healthy brain diet (full of antioxidant-rich fruits and veggies and fish as well as nuts that contain omega-3 fats), exercise, stress management, and mental stimulation will help a caregiver and their elderly loved one preserve their cognitive capacity.

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Hi lew - The article makes sense to me. A cognitive reserve can be compared, I think to a cardiovascular (heart muscle) reserve. If your heart - or any other muscle for that matter, has been built up and is strong, then any disease that affects the muscle and reduces its function, will not be as debilitating as it would have been if the muscle was weaker to begin with. It certainly motivates me to keep mentally active, deal with stress and stay on a healthy diet. I do believe that you can make a difference on your own health. I hope we will see more research about those who have the physical evidence of dementia, but are not very impaired.
I've heard several analogies along the lines of cognitive reserve. There was one about Christmas tree lights that I couldn't follow at all, but the one I could visualize are the pathways in the brain. We don't get a certain number at birth and that's it -- we can continue to develop new pathways throughout life. Learning new things, thinking new ideas, contemplating new art or music or natural wonders -- these new experiences create new pathways. Pathways are pretty specialized, but can be re-purposed. If some pathways are blocked, other pathways can take up their duties. Dementia can strike anybody, and we don't understand how and why that happens. But the more pathways a person has when the pathology starts to destroy some, the better the chance of there being some healthy pathways that can take over. The outward symptoms of the pathology are not noticeable until there aren't enough healthy pathways left to keep functioning normally. That will happen later in a person with lots of pathways than a person with fewer. Makes sense to me.

The behavior neurologist who follows my husband’s Lewy Body Dementia, is of the opinion that new pathways can be created or existing pathways strengthened even after dementia pathology starts destroying some. He is an internationally known researcher at the Mayo Clinic. He tells us that "novelty-seeking experience is therapeutic:" At each visit he asks about vacations, adventures, and any other new experiences we've sought out. We’ve taken him seriously and, since the onset of dementia 9 years ago we’ve cruised Tahiti, taken an Amtrak sleeper car to Glacier National Park, seen the Grand Canyon, driven Route 66, gone to state fairs every year, taken tours to San Antonio, the Amana Colonies, and many sites in South Dakota, including a buffalo range, spent a day looking for eagles along the Mississippi, seen museum exhibits, and gone to concerts to name a few. My husband has energy for less and less, but we are still doing what we can. Has it helped? Who knows? How can we know what he would be like if we weren’t trying to stay intellectually stimulated, eat reasonably healthy, and get exercise? Whether or not it really helps mitigate the dementia, it has made our life richer. It's a no risk strategy as far as I'm concerned -- until the person with dementia truly can't take stimulation any more.
I am intrigued about the "cognitive reserve" article....Does anyone else have any thoughts about this??? Thanks.....