It's late January but not too late for New Year's Resolutions to save your brain! Some people think of resolutions as opportunities to get to items on their bucket lists, or to kick bad habits. Ever since I realized that my grandmother died of Alzheimer's disease, I've been working to improve my own brain health, which consists of maintaining cognitive reserve AND doing whatever I can to make sure I am protecting my brain from accumulating injury.
In some ways I resemble many Boomers who fret not about whether we'll live a long life but rather about how well we will live out our life. I may have a little more concern about retiring into golden years than others do because of my family history of Alzheimer's. Naturally, running a clinic that subspecializes in dementias that start before the age of 65 (early-onset) brings those worries to the forefront.
After years of studying dementia through neuroimaging and clinical work, I have only recently recognized my grandmother's lapse into coma from a hemorrhage into her brain as one that is usually caused by Alzheimer's disease. You don't hear about this form of Alzheimer's very often, but one of the effects of Alzheimer's damaging protein deposition in the brain is to weaken the arterial walls until a sudden, large, uncontrolled bleed (think of a collection of blood the size of a grapefruit) ends the person's life. It is called lobar hemorrhage due to amyloid angiopathy, but this stroke-like event does not strike the majority of Alzheimer's patients.
What I've learned through my research or from my colleagues about the prevention and management of dementia is this: Even if we face a family history of Alzheimer's disease and are therefore more vulnerable to dementia, we can prevent the onset of its symptoms, like memory loss and confusion, or its progression.
When it comes to defenses against dementia, most researchers argue that there is such a thing as "cognitive reserve"--a set of conditions that can compensate for and minimize symptoms. Your cognitive reserve can be your shield. One set of findings that has raised optimism among Alzheimer's disease researchers, and especially for me, is that there are quite a few individuals who have Alzheimer's disease plaques and neurofibrillary tangles in their brains at the time of death, yet those same people have not shown significant cognitive impairment that resembles Alzheimer's disease.
For instance, autopsy data show that individuals with higher educational levels can compensate for Alzheimer's disease pathology better than patients with a lower educational level. A person with only elementary school level achievement will therefore be likely to need help with daily functions even when there is only a low level of plaque and tangle present in the brain; on the other hand, someone with a high school educational level or higher seems to show only negligible memory loss or even no symptoms at the same mild stage of microscopic Alzheimer's changes to the brain.
This means that if you or I were to accumulate amyloid plaques and neurofibrillary tangles due to genetic programming beyond our control, we might be able to compensate for those brain changes. Until we know how to eradicate amyloid plaques or neurofibrillary tangles that have already formed, we will seek those activities or medications that will allow us to compensate for their presence.
The intellectual challenge of completing higher education is said to develop brain circuitry to back up the areas that commonly conduct the business of remembering, problem solving, and communication. With a rich network of collateral circuits, then, even if a person has the abnormal proteins of Alzheimer's disease accumulating in her brain, she has more compensatory capacity to prevent outwardly noticeable cognitive impairment. This principle may hold true for non-Alzheimer's dementias, as well.
What if you didn't go beyond formal elementary school education? Researchers have reported that leisure reading, of any type, fiction or non-fiction, can help you bridge the gap. Cognitive reserve -- the accumulation of brain benefits from innate intelligence, advanced education, or other means to construct collateral pathways throughout the brain -- can make the difference in whether two individuals at the same stage of abnormal protein deposition are equally disabled by it. In not evidencing memory loss or a decline in her abilities during her life, my grandmother set a good example of how to build and maintain cognitive reserve over a lifespan. Over the course of the next posts, we will explore each of those activities or practices.
I renew my resolve every January to build an Everlast brain, one that will offer resilience in whatever life has in store for me.
Adapted from The Memory Clinic.
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