Category: Dementia

Cognitive Reserve

Dr. Holzmacher's Business Logo for online psychotherapyCognitive reserve is a term often used in neuropsychology.  It is invoked to explain the differences in functioning between people with a similar level of dementia.  One person at the fourth level of a senile dementia may be able to live independently, yet another person at this level may require supervision.  Current research suggests that cognitive reserve is not related to human brain size or circumference of the head.  It is related, however, to years of education and the level of one’s physical activity.

Education has been extensively studied for its influence on the incidence of Alzheimer’s Disease.  Large studies on Alzheimer’s risk factors have been performed around the world, and years of education is consistently an important variable.  The greater the years of education, the lower the incidence of Alzheimer’s Disease.  Though it may actually reflect the intelligence of the person, these huge studies rarely obtain IQ scores on thousands of subjects.  Educational attainment is a number that is much easier to acquire than an intelligence quotient, which takes approximately two hours to measure.  Currently, a person’s educational attainment is the single most valuable estimate of dementia risk.

Exercise is another factor that appears to lower the risk of dementia and increase cognitive reserve.  It lacks the practical appeal of education’s influence on cognitive reserve.  Why would straining one’s heart and muscles lead to better cognition?  As mentioned in the Lifestyle section of this website, exercise has a significant impact on the cognitive performance of children.  It is associated with improved academic performance.  For the elderly, exercise is an important aide to stroke recovery. Exercise reduces geriatric memory loss, reduces the risk of Alzheimer’s Disease by 45% (Walsh, 2011), and reduces the risk of other dementing conditions as well.  Exercise programs of one to three months offer significant cognitive benefits, but those lasting more than six months are more beneficial.  The benefits are even more significant if the exercise lasts more than thirty minutes, and combines both aerobic and strength training components.
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Cognitive reserve is definitely not related to the conjecture that most humans use only ten percent of their brain.  This statement is absurd, both academically and evolutionarily.  Watch a child sticking out their tongue while drawing a novel figure.  They are using one hundred percent of their brain capacity.  The brain’s subconscious processing of streaming data is far more than ten percent.  This is neglecting the intentional conscious processing of sensory data that occurs throughout our waking lives.  Evoluntionarily, neurons are the most expensive kind of cells.  They use ten times the energy of a muscle cell by volume.  Mother nature distributes brain cells in a very jealous fashion, and it requires a very high return on investment to make them worthwhile.

It appears that education and exercise are two variables that increases cognitive reserve.  The whole notion of cognitive reserve is a bit sloppy, as it is vague explanation for a complex phenomenon.  As researchers learn more about dementia risk factors, the term may die a natural death.  For example, innate intelligence or a specific type of cognitive activity may underlay the differences in functioning between a similar level of dementia.   Subsequent research may define specific factors explaining the variance that is now broadly labelled as cognitive reserve.  Perhaps the dementia tests themselves are biased towards those with less education, falsely classifying the level of dementia in those with more education.  It is too early to tell.  Much like the use of “dark matter” in astronomy to explain the inexplicable, “cognitive reserve” serves as a patch to bridge this gap in knowledge.  Perhaps it should be called “dark cognition,” as a nod to our friends in astronomy.

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categories Alzheimer's Disease, Dementia, Neuropsychology | | datetime November 11, 2011 4:36 pm | comments Comments Off on Cognitive Reserve

Mild Cognitive Impairment

Dr. Holzmacher's Business Logo for online psychotherapyMild Cognitive Impairment seems less threatening than its predecessors; such as “organic brain syndrome” and “minimal brain dysfunction.”  It sounds more benign than terms that contain the word “brain.”  Mild Cognitive Impairment is not an actual diagnostic code, but it is a term used by researchers and clinicians.  MCI reflects cognitive changes in the elderly that exceeds normal aging, yet does not meet the diagnostic criteria for Alzheimer’s Disease.  It is important to note that people diagnosed with MCI have retained their ability to perform all activities of daily living in an independent fashion.

Mild cognitive impairment has received much attention from the research community in recent years.  The interest is focused on what percentage of those with MCI actually convert to Alzheimer’s Disease.  This is not merely splitting hairs, as it would be a great asset to know which people in this group will actually manifest Alzheimer’s Disease.  Early diagnosis will allow more time for caretakers to plan and prepare.  An early diagnosis may also avoid surprises that utilize the emergency room and/or local law enforcement.

Current estimates of those that convert from MCI to AD are under twenty percent, but the percentage varies wildly within this restricted range.  Most suspected of MCI are brought to the attention of professionals due to a decrease in verbal memory.  Fewer are referred, in this clinician’s experience, from an onset of unusual behaviors.  This is important, because many progressive dementia’s initially present with a change in behavior prior to the onset of measurable cognitive deficit(s).  Measurable is highlighted because these people may actually exhibit a cognitive decline, but it may not be detectable by the current neuropsychological tests in use.  Current lab tests and medical imaging are ineffective at diagnosing MCI, as they are ineffective at diagnosing Alzheimer’s Disease.
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There are no particular medications or class of medications that could be recommended for the treatment of mild cognitive impairment.  As with Alzheimer’s Disease, exercise and keeping mentally active are likely helpful.  The beauty of mental and physical exercise is that even if it does not prevent the onset of AD, at least the person will still retain some benefit.  The early data suggests that effortful cognitive activity is more important than the passive variety.  For example, watching TV is a passive activity and completing a crossword is an effortful activity.

Once the diagnosis has been established, it is recommended to visit the neuropsychologist at least yearly.  Only a neuropsychologist will be able to accurately measure any change in cognitive skills, and differentiate the change from the effects of normal aging.  Remember that over eighty percent of people with mild cognitive impairment never manifest a progressive dementia.  The unfortunate remainder will require ongoing neuropsychological monitoring and behavioral planning.  Report any change in mental or physical functioning to the neuropsychologist and attending physician, as they are in a better position to know what is significant.  Nearly all people with mild cognitive impairment will profit from set routines and compensatory strategies.  Even though MCI sounds less threatening than its previous designations, it is still wise to monitor the disorder and treat symptoms as they arise.

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categories Alzheimer's Disease, Dementia, Memory Disorders, Neuropsychology | | datetime September 11, 2011 2:00 pm | comments Comments Off on Mild Cognitive Impairment

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