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Mild cognitive impairment: 3 ways cognitive reserve protects you.

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Sister Matthia was a nun born in 1894 who lived a fulfilling life. She lived communally among other nuns and had a positive and gratitude filled approach towards life. She worked as a schoolteacher for 50 years and her day was devoted to spirituality, helping the poor and needy, teaching, exercise, and hobbies like knitting (she would knit a pair of mittens each day). She did not smoke or consume alcohol and ate in moderation. She had an excellent memory until the day she passed away, just a few weeks before she turned 105. When her brain was studied after her death, it showed clear signs of Alzheimer’s disease. So, how did Sister Matthia thrive for over a century without any Alzheimer’s symptoms, despite having the disease? The answer to that lies in cognitive reserve. 

What is cognitive reserve?

Cognitive reserve is the ability of your brain to maximise its performance through use of multiple brain networks and resolving challenges through numerous methods [1]. These networks can be built over time through varied skill sets to evade cognitive decline. It is like having pockets of rainy-day funds in your brain. Education level, occupation type, language skills, level of social engagement, types of hobbies, mental exercises to improve your memory are some of the measures of cognitive reserve. Sister Matthia was one of the 678 elderly nuns whose cognitive reserves helped her achieve a better quality of life despite varying degrees of cognitive impairment. 

 Cognitive reserve can help protect against Alzheimer’s 

 A 2021 review of 9 studies found that having a high cognitive reserve was associated with 47% less risk of mild cognitive impairment or dementia [2]. A study among older adults looked at 13 leisure activities including knitting, walking, socialising, reading, volunteering, playing board games, taking classes etc. It was found that

 there was 8% lesser risk of dementia for a leisure activity incorporated in daily life [3].

Participating in more intellectually stimulating leisure activities can help protect against dementia, even when education and occupational levels are disregarded. A review of 29,000 participants found that a higher sum of education, occupation, IQ levels and intellectual hobbies decreased the risk of developing dementia by 50%. [4]. This means completing your education, progressing in your career, and learning a new language can reduce your chances of getting dementia by half. Learning a new language is a great way of delaying cognitive impairment, and helps to improve memory as recommended by Jim Kwik, world renowned brain coach whose students include Bill Gates, Elon Musk and Hollywood celebrities. Research states that

those who spoke two languages observed onset of dementia 4-5 years later than those who spoke just one language [5]. 

 Cognitive reserve can keep you smarter 

Increasing physical activity levels at any age can contribute to cognitive reserve. When 75-year-olds with mild cognitive impairments exercised for 90 mins twice a week, they saw an improvement in memory scores and decrease in brain damage [18]. Those playing team sports showed a greater degree of enjoyment due to the added social aspect [19]

 Higher levels of physical activity can increase brain volume, improve growth of new brain cells and strengthen their connections [20].

 It is good to incorporate physical activity early in life. Being physically active in the first 30 years of life is shown to improve cognitive abilities after the age of 60[8] due to preservation of the structural integrity and size of the brain [9]. Higher physical activity levels can also increase thinking speed in older women [10], since it improves blood supply to the brain. Higher cognitive reserve was associated with higher scores in memory tests, even in the presence of Alzheimer’s disease [6].

 Sister Bernadette from the Nun study had excellent scores on cognitive tests at 84 years of age, despite being at an advanced stage of Alzheimer’s disease.

 Participating in hobbies in old age is another way of improving cognitive reserve. 65-year-olds with a variety of hobbies were found to have better memory, language, and higher thinking skills [21]. Playing chess, gardening or meeting family and friends can all help improve cognition. Dancing (90 minutes, twice a week) is a good hobby because it improves movement, muscle coordination, increases brain size, is multi-sensory, activates more brain connections, and improves attention required to remember dance routines [22].

 A study following participants from the age of 8 years till the age of 69 years found that those who had a higher level of education, participated in productive leisure activities, and held skilled jobs, performed better at reading and cognitive tests at the age of 69 years [7]. Keeping your brain active through mental exercises can physically increase the size of brain areas involved in memory and learning. This was seen in London taxi drivers who had to memorize every route in the city [9]. A bigger, more active brain is more resilient to damage in older age.

Cognitive reserve can make you happier 

 Those with high levels of cognitive reserve experience lower levels of apathy in older age [11].

 Even among depressed individuals, higher cognitive reserve was protective towards memory and attention capabilities during low episodes [12].

Those with higher levels of education and verbal fluency were found to have lower severity of depression [13]. They also had higher activity in the brain area that controls mood.

 Cognitive reserve can improve quality of life

 Those who completed higher education and did intellectually stimulating work reported a higher quality of life [14]. Higher cognitive reserve is associated with higher quality of life, even in the presence of disability, helping older adults cope better with the challenges [15]. Those who had a positive mindset and good social connections reported a better quality of life [16]. Having high cognitive reserve meant higher self-esteem and self-reliance [17]. 

 There is always time to build cognitive reserve

 Shlomo Breznitz, Ph.D. is a psychology professor with over 40 years of experience and has worked with London School of Economics, Berkeley, Stanford, National Institutes of Health, recommends a cognitive fitness regime to keep your brain fit for life. He proposes addition of simple lifestyle habits like taking a new route to a destination, using your non dominant hand often, travelling, and exploring subjects you need improvements on to help keep your brain active [23].

 Your brain is resilient and is welcoming towards change at every life stage. Cognitive reserve is about enriching your brain. If you are preparing for a drought, planting a variety of fruits and vegetables will contribute to a better survival and meal variety, compared to planting just one type of crop. Similarly, acquiring different types of skills throughout life will help you better navigate life in old age. 

References

  1.       Stern, Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. Journal of the International Neuropsychological Society: JINS, [online] 8(3), pp.448–460. 
  2.       Nelson, M.E. et al. (2021). Cognitive Reserve, Alzheimer’s Neuropathology, and Risk of Dementia: A Systematic Review and Meta-Analysis. Neuropsychology Review.
  3.       Scarmeas, N. et al. (2001). Influence of leisure activity on the incidence of Alzheimer’s Disease. Neurology, 57(12), pp.2236–2242. 
  4.       VALENZUELA, M.J. et al. (2005). Brain reserve and dementia: a systematic review. Psychological Medicine, 36(4), pp.441–454.
  5.       Anderson, J.A.E. et al. (2020). Does bilingualism protect against dementia? A meta-analysis. Psychonomic Bulletin & Review.
  6.       Li, X. et al. (2021). Influence of Cognitive Reserve on Cognitive Trajectories: Role of Brain Pathologies. Neurology, [online] 97(17), pp.e1695–e1706.
  7.       Almeida-Meza, P. et al. (2022). Moderating Role of Cognitive Reserve Markers Between Childhood Cognition and Cognitive Ageing: Evidence From the 1946 UK Birth Cohort. Neurology. [online]
  8.       Greene, C. et al. (2019). In the Long Run: Physical Activity in Early Life and Cognitive Aging. Frontiers in Neuroscience, 13
  9.       Cheng, S.-T. (2016). Cognitive Reserve and the Prevention of Dementia: the Role of Physical and Cognitive Activities. Current Psychiatry Reports, 18(9).
  10.   Pa, J. et al. (2022). Effects of Sex, APOE4, and Lifestyle Activities on Cognitive Reserve in Older Adults. Neurology.
  11.   Altieri, M., et al. (2020). The Relationships Between Cognitive Reserve and Psychological Symptoms: A Cross-Sectional Study in Healthy Individuals. The American Journal of Geriatric Psychiatry, 28(4), pp.404–409.
  12.   Ponsoni, A. et al. (2020). The effects of cognitive reserve and depressive symptoms on cognitive performance in major depression and bipolar disorder. Journal of Affective Disorders, 274, pp.813–818.
  13.   Huang, C. et al. (2019). Cognitive reserve-mediated neural modulation of emotional control and regulation in people with late-life depression, Social Cognitive and Affective Neuroscience, 14, pp.849–860.
  14.   Ihle, A. et al. (2022). Cognitive Functioning Mediates the Association of Cognitive Reserve with Health-Related Quality of Life. Sustainability, [online] 14(2), p.826.
  15.   Lara, E. et al. (2017). Cognitive reserve is associated with quality of life: A population-based study. Experimental Gerontology, 87, pp.67–73.
  16.   Ghosh, D. et al. (2020). Determinants of the Quality of Life Among Elderly: Comparison Between China and India. The International Journal of Community and Social Development, 2(1), pp.71–98.
  17.   Opdebeeck, C. et al. (2017). COGNITIVE RESERVE IS ASSOCIATED WITH QUALITY OF LIFE, SELF-ESTEEM, AND SELF-EFFICACY IN LATER LIFE. Innovation in Aging, 1(suppl_1), pp.877–878.
  18.   Suzuki, T. et al. (2013). A Randomized Controlled Trial of Multicomponent Exercise in Older Adults with Mild Cognitive Impairment. PLoS ONE, [online] 8(4), p.e61483.
  19.   Pedersen, M.T. et al. (2017). Effect of team sports and resistance training on physical function, quality of life, and motivation in older adults. Scandinavian Journal of Medicine & Science in Sports, 27(8), pp.852–864. 
  20.   Domingos, C. et al. (2021). Effects of physical activity on brain function and structure in older adults: A systematic review. Behavioural Brain Research, [online] 402, p.113061. 
  21.   Wang, H.-X. et al. (2012). Late Life Leisure Activities and Risk of Cognitive Decline. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68(2), pp.205–213.
  22.   Rehfeld, K. et al. (2018). Dance training is superior to repetitive physical exercise in inducing brain plasticity in the elderly. PLOS ONE, 13(7), p.e0196636. 
  23. AgingCare.com (2012). The Memory Challenge: 8 Ways to Construct Cognitive Reserve. [online] Agingcare.com.
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