Category: Neuropsychology

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

The Psychological Model

Dr. Holzmacher's Business Logo for online psychotherapyThe medical versus psychological models of treatment are often discussed during psychological training.  The word “model” refers to the theoretical framework that each profession uses as their guiding principles.  Both medical and psychological models focus on signs and symptoms of illness.  The medical model relies heavily upon independent tests to prove or disprove if a patient is ill.  The psychological model also uses tests to prove or disprove whether a patient is ill.  It is at this point of agreement that the two models diverge.

The chasm that divides one model of treatment from the other is the subjective experience of the patient.  To most medical doctors, if the tests do not reveal a problem, then the patient is often perceived as hypochondriacal or even malingering.  To a psychologist, if the patient believes they have a problem, then they really do have a problem.  The subjective experience of the patient is considered most important, and objective measures less so.  For example, people often claim they are experiencing pain, even though objective tests did not discover damage to the organism.  The psychologist will note that there does not appear to be organic damage, yet the patient remains in obvious distress.  Psychologists are trained in the scientific method, which encourages constant skepticism.  A well trained psychologist should always keep in mind that no test is one hundred percent reliable, and there are always limitations regarding the extent of their validity.  In the example above, there may be actual organic damage to the patient causing their pain, but the current state of the art lacks a test to reliably identify the organic damage.

An obvious limitation to the psychological model is a patient that is unconscious, or their communication ability is compromised to the extent that they are unable to make their needs known to others.  Both medical and psychological models must rely upon objective tests to evaluate these type of patients.  There is no alternative.  When the patient regains consciousness, and is at least vaguely aware of their environment, then their subjective experience again becomes very important.  For example, patient’s who wake from a stroke to discover that they are unable to communicate often manifest great agitation.  Quite often, they are not aware of their own lack of expressive ability and believe others are making a game of pretending to not understand their verbiage.  The objective tests qualify and quantify the extent of damage to their brain, but the subjective experience is that loved ones and staff are playing an elaborate trick.
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The explosion of “alternative” medicine suggests that traditional medicine might be missing something.  Those patients that are attracted to alternative medicine do not completely eschew the traditional medicine model.  Consumers of alternative medicine still believe that substances outside our bodies have curative powers.  They tend to avoid products of traditional pharmaceutical companies in favor of medicinal preparations from other cultures or even antiquity.  The model of treatment is essentially the same, it is merely a change in the manufacturing and distribution of the medicines.  Clearly this group of consumers has health needs not adequately addressed by the traditional medical model, yet it remains to be seen if the “alternative” style of medical treatment is any more effective.

To paraphrase Andrew Still, anyone can find disease, but it takes a healer to find health.  The various qualities and techniques to become a “healer” are still less than scientific.  The failure of traditional and alternative medical models to address the subjective needs of the patient may be the missing link that completes the true healer.  Twenty years of clinical practice have convinced the author that people’s complaints are only loosely based upon reality, and this holds true for the author as well.  Humans have resisted efforts to equate mental and physical health with empirical evidence reminiscent of mechanical laws.  Empirical evidence should be the cornerstone of medical and psychological practice, yet the entire edifice is not created with these laws alone.  Understanding the subjective experience of the patient is a gift, both to the patient and their family.

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categories Neuropsychology, Psychology, Stroke | | datetime September 26, 2011 10:40 am | comments Comments Off on The Psychological Model

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