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mental stimulation

how to use activities to build your cognitive reserve -- your protection against the mental decline that often comes with age

Stretching your mind

I recently reported on a finding that older adults whose life-space narrowed to their immediate home were significantly more likely to have a faster rate of global cognitive decline or develop mild cognitive impairment or Alzheimer’s.

Now there are some obvious correlates of being house-bound vs feeling able to travel out of town (such as physical disability), but this relationship between cognitive decline and confined life-space remained after such factors were taken into account. The association is thought to be related to social and mental stimulation.

But I think this association also points to something more specific: the importance of distance, and difference. Different ways of thinking; different contexts. Information (in the broadest sense of the word) that stretches your mind, that gets you out of the grooves of your familiar thoughts.

Last year I reported on a study looking at creativity in problem-solving. That study found that multicultural experiences help you become more creative in solving problems. In particular, creativity was best helped by being reminded of what you’d learned about the underlying meaning or function of behaviors in the multicultural context. In other words, what was important was truly trying to understand behavior that’s very different from your own.

While travelling undoubtedly helps, you don’t need to go to a distant place to learn about different cultures. You can read about them; you can watch movies; you can listen to other people talk about what they know. And if you have those experiences, you can then think about them at any time.

A vital tool in tackling cognitive decline in old age (including the more extreme events of mild cognitive impairment and dementia) is cognitive reserve. Cognitive reserve means that your brain can take more damage before it has noticeable effects. Many people have died with advanced Alzheimer’s pathology in their brain who showed no signs of dementia in life!

Cognitive reserve is most often associated with education, but it is also associated with occupation, bilingualism, and perhaps even music. What it comes down to is this: the more redundancy in your brain, the wider and denser the networks, the more able your brain will be to find new paths for old actions, if the old paths are damaged.

The finding that life-space can affect cognitive decline is also a reminder that we are minds in bodies. I have reported on a number of examples of what is called embodied cognition (the benefits of gesture for memory are one example of this). It’s a good general principle to bear in mind — if you fake enjoyment, you may well come to feel it; if you look at the distant hills or over the sea, your mind may think distant thoughts; if you write out your worries, the weight of them on your mind may well lighten.

I made reference to bilingualism. There have been several studies now, that point to the long-term benefits of bilingualism for fighting cognitive decline and dementia. But if you are monolingual, don’t despair. You may never achieve the fluency with another language that you would have if you’d learned it earlier in life, but it’s never too late to gain some benefit! If you feel that learning a new language is beyond you, then you’re thinking of it in the wrong way.

Learning a language is not an either-or task; you don’t have to achieve near-native fluency for there to be a point. If there’s a language you’ve always yearned to know, or a culture you’ve always been interested in, dabble. There are so many resources on the Web nowadays; there has never been a better time to learn a language! You could dabble in a language because you’re interested in a culture, or you could enhance your language learning by learning a little about an associated culture.

And don’t forget that music and math are languages too. It may be too late to become a cello virtuoso, but it’s never too late to learn a musical instrument for your own pleasure. Or if that’s not to your taste, take a music appreciation class, and enrich your understanding of the language of music.

Similarly with math: there’s a thriving little world of “math for fun” out there. Go beyond Sudoku to the world of math puzzles and games and quirky facts.

Perhaps even dance should be included in this. I have heard dance described as a language, and there has been some suggestion that dancing seems to be a physical pursuit of particular cognitive benefit for older adults.

This is not simply about ‘stimulation’. It’s about making new and flexible networks. Remember my recent report on learning speed and flexible networks? The fastest learners were those whose brains showed more flexibility during learning, with different areas of the brain being linked with different regions at different times. The key to that, I suggest, is learning and thinking about things that require your brain to forge many new paths, with speed and distance being positive attributes that you should seek out (music and dance for speed, perhaps; languages and travel for distance).

Interestingly, research into brain development has found that, as a child grows to adulthood, the brain switches from an organization based on local networks based on physical proximity to long-distance networks based on functionality. It would be interesting to know if seniors with cognitive impairment show a shrinking in their networks. Research has shown that the aging brain does tend to show reduced functional connectivity in certain high-level networks, and this connectivity can be improved with regular aerobic exercise, leading to cognitive improvement.

Don’t disdain the benefits of simply daydreaming in your armchair! Daydreaming has been found to activate areas of the brain associated with complex problem-solving, and it’s been speculated that mind wandering evokes a unique mental state that allows otherwise opposing networks to work in cooperation. Daydreaming about a more distant place has also been found to impair memory for recently learned words more than if the daydreaming concerned a closer place — a context effect that demonstrates that you can create distance effects in the privacy of your own mind, without having to venture to distant lands.

I’m not saying that such daydreaming has all the benefits of actually going forth and meeting people, seeing new sights. Watching someone practice helps you learn a skill, but it’s not as good as practicing yourself. But the point is, whatever your circumstances, there is plenty you can do to stretch your mind. Why not find yourself a travel book, and get started!

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Achieving flow

I’ve recently had a couple of thoughts about flow — that mental state when you lose all sense of time and whatever you’re doing (work, sport, art, whatever) seems to flow with almost magical ease. I’ve mentioned flow a couple of times more or less in passing, but today I want to have a deeper look, because learning (and perhaps especially that rewiring I was talking about in my last post) is most easily achieved if we can achieve "flow" (also known as being ‘in the zone’).

Let’s start with some background.

Mihaly Csikszentmihalyi is the man who identified and named this mental state, and he identified 9 components:

  1. The skills you need to perform the task must match the challenges of the task, AND the task must exceed a certain level of difficulty (above everyday level).
  2. Your concentration is such that your behavior becomes automatic and you have little conscious awareness of your self, only of what you’re doing.
  3. You have a very clear sense of your goals.
  4. The task provides unambiguous and immediate feedback concerning your progress toward those goals.
  5. Your focus is entirely on the task and you are completely unaware of any distracting events.
  6. You feel in control, but paradoxically, if you try to consciously hold onto that control, you’ll lose that sense of flow. In other words, you only feel in control as long as you don’t think about it.
  7. You lose all sense of self and become one with the task.
  8. You lose all sense of time.
  9. You experience what Csikszentmihalyi called the ‘autotelic experience’ (from Greek auto (self) and telos (goal)), which is inherently rewarding, providing the motivation to re-experience it.

Clearly many of these components are closely related. More usefully, we can distinguish between elements of the experience, and preconditions for the experience.

The key elements of the experience are your total absorption in the task (which leads to you losing all awareness of self, of time, and any distractions in the environment), and your enjoyment of it.

The key preconditions are:

  • the match between skills and task
  • the amount of challenge in the task
  • the clear and proximal nature of your goals (that is, at least some need to be achievable in that session)
  • the presence of useful feedback.

Additionally, later research suggests:

  • the task needs to be high in autonomy and meaningfulness.

Brain studies have found that this mental state is characterized by less activity in the prefrontal cortex (which provides top-down control — including that evidenced by that critical inner voice), and a small increase in alpha brainwaves (correlated with slower breathing and a lower pulse rate). This inevitably raises the question of whether meditation training can help you more readily achieve flow. Supporting this, a neurofeedback study improved performance in novice marksmen, who learned to shoot expertly in less than half the time after they had been trained to produce alpha waves. There are also indications that some forms of mild electrical stimulation to the brain (tDCS) can induce a flow state.

Some people may be more prone to falling into a flow state than others. Csikszentmihalyi referred to an ‘autotelic personality’, and suggested that such people have high levels of curiosity, persistence, and interest in performing activities for their own sake rather than to achieve some external goal. Readers of my books may be reminded of cognitive styles — those who are intrinsically motivated rather than extrinsically usually are more successful in study.

Recent research has supported the idea of the autotelic personality, and roots it particularly in the achievement motive. Those who have a strong need for achievement, and a self-determined approach, are more likely to experience flow. Such people also have a strong internal locus of control — that is, they believe that achievement rests in their own hands, in their own work and effort. I have, of course, spoken before of the importance of this factor.

There is some indication that autotelic students push themselves harder. A study of Japanese students found that autotelic students tended to put themselves in situations where the perceived challenges were higher than their perceived skills, while the reverse was true for other students.

Interestingly, a 1994 study found that college students perceived work where skills exceeded challenges to be more enjoyable than flow activities where skills matched challenges — which suggests, perhaps, that we are all inclined to underestimate our own skills, and do better when pushed a little.

In regard to occupation, research suggests that five job characteristics are positively related to flow at work. These characteristics (which come from the Job Characteristics Model) are:

  • Skill variety

  • Task identity (the extent to which you complete a whole and identifiable piece of work)

  • Task significance

  • Autonomy

  • Feedback

These clearly echo the flow components.

All of this suggests that to consistently achieve a flow state, you need the right activities and the right attitude.

So, that’s the background. Now for my new thoughts. It occurred to me that flow might have something to do with working memory. I’ve suggested before that flow might have something to do with getting the processing speed just right. My new thought extends this idea.

Remember that working memory is extremely limited, and that it seems to reflect a three-tiered system, whereby you have one item in your immediate focus, with perhaps three more items hovering very closely within an inner store, able to very quickly move into immediate focus, and a further three or so items in the ‘backburner’ — and all these items have to keep moving around and around these tiers if you want to keep them all ‘alive’. Because they can’t stay very long at all in this system without being refreshed (through the focus).

Beyond this system is the huge database of your long-term memory, and that’s where all these items come from. Thus, whenever you’re working on something, you’re effectively circulating items through this whole four-tier system: long-term memory to focus to inner store to backburner and then returning to LTM or to focus. And returning to LTM is the default — if it’s to return to focus, it has to happen within a very brief period of time.

And so here’s my thesis (I don’t know if it’s original; I just had the idea this morning): flow is our mental experience of a prolonged period of balancing this circulation perfectly. Items belonging to one cohesive structure are flowing through the system at the right speed and in the right order, with no need to stop and search, and no room for any items that aren’t part of this cohesive structure (i.e., there are no slots free in which to experience any emotions or distracting thoughts).

What this requires is for the necessary information to all be sufficiently strongly connected, so that activation/retrieval occurs without delay. And what that requires is for the foundations to be laid. That is, you need to have the required action sequences or information clusters well-learned.

Here we have a mechanism for talent — initial interest and some skill produces a sense of flow; this motivating state is pursued by the individual by persevering at the same activity/subject; if they are not pushed too hard (which will not elicit flow), or held back (ditto), they will once again achieve the desired state, increasing the motivation to pursue this course. And so on.

All of which begs the question: are autotelic personalities created or made? Because the development of people who find it easier to achieve flow may well have more to do with their good luck in childhood (experiencing the right support) than their genetic makeup.

Is flow worth pursuing? Flow helps us persist at a task, because it is an intrinsically rewarding mental state. Achieving flow, then, is likely to result in greater improvement if only because we are likely to spend more time on the activity. The interesting question is whether it also, in and of itself, means we gain more from the time we spend. At the moment, we can only speculate.

But research into the value of mental stimulation in slowing cognitive decline in older people indicates that engagement, and its correlate enjoyment, are important if benefits are to accrue. I think the experience of flow is not only intrinsically rewarding, but also intrinsically beneficial in achieving the sort of physical brain changes we need to fight age-related cognitive decline.

So I’ll leave you with the findings from a recent study of flow in older adults, that has some helpful advice for anyone wanting to achieve flow, as well as demonstrating that you're never too old to achieve this state (even if it does seem harder to achieve as you age, because of the growing difficulty in inhibiting distraction).

The study, involving 197 seniors aged 60-94, found that those with higher fluid cognitive abilities (processing speed, working memory, visual spatial processing, divergent thinking, inductive reasoning, and everyday problem-solving) experienced higher levels of flow in cognitive activities, while those with lower fluid abilities experienced lower levels of flow. However, those with lower fluid abilities experienced higher levels of flow in non-cognitive activities, while those with higher fluid abilities experienced lower levels of flow.

High cognitive demand activities included: working, art and music, taking classes and teaching, reading, puzzles and games, searching for information. Low cognitive demand activities included: social events, exercise, TV, cooking, going on vacation. Note that the frequency of these activities did not differ between those of higher fluid ability and those of lower.

These findings reinforce the importance of matching skills and activities in order to achieve flow, and also remind us that flow can be achieved in any activity.

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Finding the right strategy through perception and physical movement

I talk a lot about how working memory constrains what we can process and remember, but there’s another side to this — long-term memory acts on working memory. That is, indeed, the best way of ‘improving’ your working memory — by organizing and strengthening your long-term memory codes in such a way that large networks of relevant material are readily accessible.

Oddly enough, one of the best ways of watching the effect of long-term memory on working memory is through perception.

Perception is where cognition begins. It’s where memory begins. But here’s the thing: it is only in the very beginning, as a newborn baby, that this perception is pure, uncontaminated by experience.

‘Uncontaminated’ makes it sound bad, but of course the shaping of perception by experience is vital. Otherwise we’d all be looking around wide-eyed, wondering what was going on. So we need to shape our perception.

For example, if we’re searching for a particular object, we have a mental picture of what we’re looking for, and that helps us find it quicker. Such predictive templates have recently been shown to exist for smell as well.

‘Predictive templates’ are the perceptual version of cognitive schemas. I have mentioned schemas before, in the context of expertise and reading scientific text. But schemas aren’t restricted to such intellectual pursuits; we use schemas constantly, every day of our lives. Schemas, or mental models or scripts, are mental representations you’ve formed through your experiences, that tell you what to expect from a given situation. This means we don’t have to think too hard when we come up against a familiar situation; we know what to expect.

That also means that we often don’t notice things that don’t fit in with our expectations.

I could talk about that for some time, but what I want to emphasize today is this point that thought begins with perception — and perception begins with the body.

For example, it probably won’t surprise anyone that an educational program for young children, “Moved by Reading”, has been found to help young elementary school children understand texts and math word problems by getting them to manipulate images on a computer screen in accordance with the story. Such virtual ‘acting out’ helped the children understand what was going on in the story and, in the case of the math problems, significantly reduced their attention to irrelevant information in the text. (You can read the journal article (pdf) on this; those who are registered at Edweek can also read the article that brought this to my notice.)

More surprisingly, at the Dance Psychology Lab at the University of Hertfordshire, they’ve apparently discovered that different sorts of dancing help people with different sorts of problem-solving. Improvised dance apparently helps with divergent thinking, where there are multiple answers to a problem. Very structured kinds of dance help with convergent thinking, where you’re looking for the single answer to a problem. The researchers also claim that improvised dance can help those with Parkinson's disease improve their divergent thinking skills. (I’m using the words ‘apparently’ and ‘claim’ because I haven’t seen any research papers on this — but I wanted to mention it because it’s a nice idea, and you can read an article about it and listen to the head of the Dance Lab talk about it in a 20-minute video).

We can readily see how acting out text can reveal details that in reading we might gloss over, and it’s only one step from this to accept that gesturing might help us solve problems and remember them (as I’ve reported repeatedly). But the idea that dancing in different ways might affect how we think? Not so easily believed. But in a recent news report, I talked about two experimental studies that demonstrated how moving your hands makes you less inclined to think of abstract solutions to problems (or, conversely, that moving your hands helps you solve problems physically), and holding your hands close to the object of your perception helps you see details, but hinders you from abstracting commonalities.

This idea that the way you hold or move your body can affect what we might term your level of perception — specific detail vs global — is perhaps echoed (am I drawing too long a bow here?) in a recent observation I made regarding face-blindness (prosopagnosia). That it may be, along with perfect pitch and eidetic memory, an example of what happens when your brain can’t abstract the core concept.

Our own personal experience, supported in a recent study of scene perception, indicates that we can’t do both. At any one time you must make the choice: to focus on details, or to focus on the big picture. So this is contextual, but it’s also individual — some people will be more inclined to a detail strategy, others to a global strategy. Interestingly, this may change with age. And also experience.

One aspect of cognitive flexibility is being able to control your use of detail and global perception. This applies across the board, in many different circumstances. You need to think about which type of perception is best in the context.

In the realm of notetaking, for example, (as I discuss in my book Effective notetaking), your goal makes a huge difference to the effectiveness of your notetaking. The more specific the goal, the fewer notes you need take, and the more targeted they are. Generally speaking, also, the more specific your goal, the faster you can read/select.

But of course there’s a downside to being fast and targeted (there’s always a downside to any strategy!) — you are likely to miss information that isn’t what you’re after, but is something you need to know in a different or wider context.

There’s something else interesting about speed of processing: we associate faster processing speeds with higher intelligence, and we associate concentration with faster processing speeds. That is, when we’re concentrating, we can read/work faster. Contrariwise, I believe (though I don’t think there’s any research on this — do tell me if you know of any), if we can force ourselves into a faster mode of operation, our concentration will be better.

So fast is good, but risks missing relevant information — implying that sometimes slow is better. Which leads me to a thought: is another way of looking at Csikszentmihalyi’s famous “flow” the idea that flow is achieved when you get the speed just right? And can you therefore help yourself achieve that flow state through physical means? (Inevitably leading me to think of t’ai ch’i.)

Some thoughts for the day!

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Building Cognitive Reserve

  • Both age-related cognitive decline and brain damage like Alzheimer's can be countered by high levels of cognitive reserve.
  • Cognitive reserve is built throughout your life, but it's never too late to make a difference.
  • You can build cognitive reserve through active learning, intellectual work, being actively bi- or multi-lingual, or regularly engaging in mentally stimulating activities.
  • To maintain (or grow) cognitive abilities, it's important both to resist the brain's tendency to shrink (brain atrophy) , and to keep it flexible (neuroplasticity).
  • Brains shrink with disuse, and grow with use.
  • Brains stay plastic through change — in activities, in strategies, in perspective.

Brain autopsies have revealed that a significant number of people die with Alzheimer’s disease evident in their brain, although in life their cognition wasn’t obviously impaired. From this, the idea of a “cognitive reserve” has arisen — the idea that brains with a higher level of neuroplasticity can continue to work apparently normally in the presence of (sometimes quite extensive) brain damage.

A comprehensive review of the research into cognitive reserve, involving 29,000 individuals across 22 studies, concluded that complex mental activity across people’s lives almost halves the risk of dementia. Encouragingly, all the studies also agreed that it was never too late to build cognitive reserve.

As you might expect, the more years of education, the greater the cognitive reserve. But education isn’t the only means of building cognitive reserve. Basically, anything that’s mentally challenging is likely to build reserve. Research supports the following as builders of cognitive reserve:

  • Education
  • Occupational complexity
  • Bilingualism
  • Social engagement
  • Regular cognitive activities, such as reading, writing, attending lectures, doing word games or puzzles, playing games such as bridge or chess.

Will cognitive reserve stop me getting Alzheimer's?

This is not to say that the highly educated will never get Alzheimer’s! Obviously they do. In fact, once those with a high level of cognitive reserve begin to show signs of the disease, they are likely to decline faster. This isn’t surprising when you consider it, because the physical damage is so much greater by the time it becomes observable in behavior.

The point of having cognitive reserve is not to prevent Alzheimer’s, in the sense of “it’ll never happen”. When we talk about “preventing” Alzheimer’s, we're really talking about delaying it. The trick is to delay it so much that you're dead before it happens!

So, cognitive reserve is desirable because it protects you against the damage that may be occurring in your brain. If you’re lucky, it’ll protect you long enough to see you through your life.

Brains are plastic, all through life

Cognitive reserve is weighted toward the past — how much you’ve built up over your lifetime — but you shouldn’t ever forget that it’s an ongoing issue. If you stop all activities that reinforce neuroplasticity, your brain is likely to enter a downward spiral, with physical deterioration resulting from and feeding into a deterioration in your motor,sensory, and cognitive systems.

As the popular mantra has it: Use it or lose it.

It’s the opposite face of expertise. You know how top musicians continue to practice everyday. Although they have tens of thousands of hours of practice under their belt, although they have reached the highest level of performance, they cannot afford to stop. This isn’t simply about improving; this is about maintaining their level of expertise. As soon as you stop, your performance starts to deteriorate.

Of course, if an expert stops working in her area of expertise, she will still maintain abilities that are far and above ‘normal’. But the point is that you can’t maintain the same level of performance without working at it.

This is true at every level. If you haven’t ridden a bike for twenty years, you’re not going to leap on it and be as good as you were thirty years ago. If you haven’t spoken your native language in twenty years, you’re not going to suddenly get into a conversation in it with all the fluency you once had.

If you stop paying attention to taste, your appreciation of taste will dull (you’re not interested, why should your brain bother putting energy into it?). If you stop trying to distinguish what people are saying, you’ll become less able to distinguish words. If you stop walking outside the house, you’ll become less capable of movement. If you stop thinking, you’ll become less able to think.

If you just do the same things over and over again, giving your brain no reason to make or reinforce or prune connections, then it won’t bother doing any of that. Why should it? Brains are energy-hounds. If you don’t want to expend the energy making it work, it’s going to sit back and let itself shrink.

Maintaining cognitive abilities as you age begins with attitude

Recent evidence suggests that being cognitively active in middle and old age may help you develop new networks when existing networks start to fail. This is consistent with evidence that older adults who maintain their cognitive abilities do so by developing new strategies that involve different regions.

In other words, if you start to have difficulties with anything, your best strategy is not to give up, but to actively explore new ways of doing it.

So, we should be aiming for two things in preventing cognitive decline. The first is in ‘growing’ brain tissue: making new neurons, and new connections. This is to counteract the shrinkage (brain atrophy) that tends to occur with age.

The second concerns flexibility. Retaining the brain’s plasticity is a vital part of fighting cognitive decline, even more vital, perhaps, than retaining brain tissue. To keep this plasticity, we need to keep the brain changing.

Here’s a question we don’t yet know the answer to: how much age-related cognitive decline is down to people steadily experiencing fewer and fewer novel events, learning less, thinking fewer new thoughts?

But we do know it matters.

What activities help build cognitive reserve?

Research hasn't systematically compared different activities to find out which are better, but the general message is that any activity that engages your mind is good. But the degree of challenge does make a difference.

One small study involving older adults found that those who randomly put in a "high-challenge" group showed significantly more cognitive improvement and more efficient brain activity, compared to those assigned to the "low-challenge" group. Moreover, even among the high-challenge group, those who spent more time on the activities showed the greatest improvements.

The high-challenge spent at least 15 hours a week for 14 weeks learning progressively more difficult skills in digital photography, quilting, or a combination of both. The low-challenge group met to socialize and engage in activities related to subjects such as travel and cooking. A control group engaged in low-demand cognitive tasks such as listening to music, playing simple games, or watching classic movies.

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Mental stimulation

  • Growing evidence points to greater education, and mentally stimulating occupations and activities providing a cognitive reserve that enables people with developing Alzheimer's to function normally for longer.
  • There is also evidence that physical exercise and mental stimulation protect against the development of Alzheimer's, by preventing accumulation of beta-amyloid.
  • Physical exercise and mental stimulation also seem to help protect against age-related decline in cognitive function, possibly for similar reasons — by stimulating growth of new blood vessels and keeps existing vessels open and functional.
  • Mental stimulation is not only gained by more obvious intellectual pursuits, but also by activities as simple as talking to people or going to the theater.
  • Education also seems to help seniors retain their mental flexibility, enabling their brains to change strategies as age effects make different strategies more effective.

The evidence that diet, physical exercise, and mental stimulation all help prevent age-related cognitive decline and reduce the risk of mild cognitive impairment and Alzheimer’s, is now very convincing.

Studies of mice and (rather intriguingly) beagles, have provided evidence that ‘enriched’ environments — ones that provide opportunities for regular exercise and mental stimulation — reduce or prevent age-related cognitive decline, and reduce the risk of Alzheimer’s.

Studies of genetically engineered mice have also now shown how an enriched environment protects against Alzheimer’s — by preventing accumulation of beta-amyloid, and helping these peptides to be cleared away.

It’s been suggested that the benefits of physical and mental activity, which now seem undeniable, may simply be a matter of blood flow — that physical and mental activity stimulates growth of new blood vessels and keeps existing vessels open and functional.

These findings from animal studies have been supported by a number of human studies.

Physical exercise

A large, six-year study of adults aged 65 and older found that physical fitness and exercise were both associated with a significantly lower risk of dementia. Encouragingly, for those who are more frail, even modest amounts of exercise (such as walking 15 minutes a day) appear beneficial, and the more frail the person was, the more they benefited from regular exercise.

Education

Findings from two long-running studies of aging and cognition — the Nun Study and the Religious Orders Study — have revealed that formal education helps protect people from the effects of Alzheimer’s disease.

Note that I said “from the effects”. Education doesn’t prevent or delay the disease from developing, but it does provide a “cognitive reserve”, which allows the individual to function normally in the presence of brain abnormalities (the presence of an Alzheimer’s pathology is thus only evident when the brain is autopsied post-mortem).

As you would expect, the more years of education, the greater the cognitive reserve — the less effect the same number of plaques have on cognitive performance. It’s worth noting that the populations in these studies are all relatively well-educated — even the least educated had some college attendance — suggesting that the effect of education would be even more marked in the general population.

However, there is some evidence that, once the disease progresses to the point that it has noticeable effects, those effects progress faster. This is thought to be simply because the damage is so much greater by the time it becomes observable in behavior.

A general population study still in train has provided preliminary findings indicating that prevalence of mild cognitive impairment also is less common among those with more education.

Higher education also seems to help protect older adults from cognitive decline in general. One reason is clearly the cognitive reserve aspect, but an imaging study has also revealed another reason. In young adults performing memory tasks, more education was associated with less use of the frontal lobes and more use of the temporal lobes. For older adults doing the same tasks, more education was associated with less use of the temporal lobes and more use of the frontal lobes. Previous research has indicated frontal activity is greater in old adults, compared to young; this study therefore implies that this effect is related to the educational level in the older participants. The higher the education, the more likely the older adult is to recruit frontal regions, resulting in a better memory performance.

An earlier brain-scan study also provided support for the theory that the brain may change tactics as it ages, and that older people whose brain is more flexible can compensate for some aspects of memory decline.

Results from a large study of older adults from a biracial community in Chicago suggest that the benefits of education are not necessarily education per se. Although both education and occupation were associated with Alzheimer's risk in this study, their effects were substantially reduced when cognitive activity was taken into account.

In keeping with these findings, several smaller studies have also provided evidence that other aspects of mental activity are also associated with a reduced risk of cognitive decline and dementia.

Mental activity

People with Alzheimer's have been found to be more likely to have had less mentally stimulating careers, and those who are more active in high school and have higher IQ scores are apparently less likely to have mild memory and thinking problems and dementia as older adults.

A study of 469 people aged 75 and older found that those who participated at least twice weekly in reading, playing games (chess, checkers, backgammon or cards), playing musical instruments, and dancing were significantly less likely to develop dementia. Although the evidence on crossword puzzles was not quite statistically significant, those who did crossword puzzles four days a week had a much lower risk of dementia than those who did one puzzle a week.

Another study of 700 seniors found that more frequent participation in cognitively stimulating activities, such as reading books, newspapers or magazines, engaging in crosswords or card games, was significantly associated with a reduced risk of Alzheimer’s disease.

And more recently, a comprehensive review of the research into 'cognitive reserve', involving 29,000 individuals across 22 studies, concluded that complex mental activity across people’s lives almost halves the risk of dementia. Encouragingly, all the studies also agreed that it was never too late to build cognitive reserve.

Looking at the question of cognitive decline in general, a large-scale British study of people aged 35—55 found that those who scored highest on tests of cognitive ability made regular cultural visits to theatres, art galleries and stately homes. Other activities were also associated with higher cognitive ability (in order of importance):

  • reading, and listening to music
  • involvement in clubs and voluntary organisations
  • participation in courses and evening classes

Interestingly, the association was stronger among men.

Another study, of people aged 30—88, has found that those who were fluent in two languages rather than just one, were sharper mentally. This was true at all age groups, but bilinguals were also much less likely to suffer from the mental decline associated with old age. The participants were all middle class, and educated to degree level.

Social networks

There has been some evidence suggesting that simply talking helps keep your mind sharp at all ages, and that older people with more extensive social networks are less likely to suffer cognitive impairment.

More recently, a study has provided evidence that social networks also offer a 'cognitive reserve' that protects people from the ravages of Alzheimer's disease. To determine social network, participants were asked about the number of children they have and see monthly; about the number of relatives, excluding spouse and children, and friends to whom they feel close and with whom they felt at ease and could talk to about private matters and could call upon for help, and how many of these people they see monthly. Their social network was the number of these individuals seen at least once per month.

Post-mortem analysis revealed that, as the size of the social network increased, the same amount of Alzheimer’s pathology in the brain (i.e., extent of plaques and tangles) had less effect on cognitive test scores. In other words, for persons without much pathology, social network size had little effect on cognition. However, as the amount of pathology increased, the apparent protective effect on cognition also increased.

What you can do

The thought that your education, occupation, degree of physical fitness, and social involvedness, over the years, affects your risk of losing cognitive function, may relieve your anxieties or depress you. But if it depresses you, take heart from a recently-reported pilot study involving people aged 35–69. These people had some mild memory complaints but performed normally on tests. Nevertheless, in a mere two weeks, a program combining a brain healthy diet plan (5 small meals a day; diet rich in omega-3 fats, antioxidants and low-glycemic carbohydrates like whole grains), relaxation exercises, cardiovascular conditioning (daily walks), and mental exercise (such as crosswords and brain teasers) resulted in these participants' brain metabolism decreasing 5% in working memory regions, suggesting an increased efficiency. Compared to the control group, participants also performed better in verbal fluency, and felt as if they were performing better.

 

References

See research reports

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Strategies

Preventing Dementia: Mental stimulation

Stimulating activities

A 5-year study1 involving 488 people age 75 to 85 found that, for the 101 people who developed dementia, the greater the number of stimulating activities (reading, writing, doing crossword puzzles, playing board or card games, having group discussions, and playing music) they engaged in, the longer rapid memory loss was delayed. Similarly, a study2 involving 1321 randomly selected people aged 70 to 89, of whom 197 had mild cognitive impairment, has found that reading books, playing games, participating in computer activities or doing craft activities such as pottery or quilting was associated with a 30 to 50% decrease in the risk of developing memory loss compared to people who did not do those activities.

Moreover, two activities during middle age (50-65) were also significantly associated with a reduced chance of later memory loss: participation in social activities and reading magazines. The value of social activities is consistent with another, small, study3 that found that social networks, like education, offers a 'protective reserve' capacity that spares individuals the clinical manifestations of Alzheimer's disease. As the size of the social network increased, the same amount of Alzheimer’s pathology in the brain had less effect on cognitive test scores. For those without much pathology (plaques and tangles), social network size had little effect on cognition.

This supports another study4 involving 469 people aged 75 and older, that found that those who participated at least twice weekly in reading, playing games (chess, checkers, backgammon or cards), playing musical instruments, and dancing were significantly less likely to develop dementia. Although the evidence on crossword puzzles was not quite statistically significant, those who did crossword puzzles four days a week had a much lower risk of dementia than those who did one puzzle a week.

Similarly, a study5 of 700 seniors found that more frequent participation in cognitively stimulating activities, such as reading books, newspapers or magazines, engaging in crosswords or card games, was significantly associated with a reduced risk of Alzheimer’s disease. On average, compared with someone with the lowest activity level, the risk of disease was 47% lower for those whose frequency of activity was highest.

In the first comprehensive review6 of the research into 'cognitive reserve', which looks at the role of education, occupational complexity and mentally stimulating activities in preventing cognitive decline, researchers concluded that complex mental activity across people’s lives almost halves the risk of dementia. All the studies also agreed that it was never too late to build cognitive reserve. The review covered 29,000 individuals across 22 studies.

A review7 of research on the impact of cognitive training on the healthy elderly (not those with mild cognitive impairment or Alzheimer's disease), has found no evidence that structured cognitive intervention programs affects the progression of dementia in the healthy elderly population.

Post-mortem analysis of participants in a large, long-running study8 has provided more support for the idea that mental stimulation protects against Alzheimer’s. The study found a cognitively active person in old age was 2.6 times less likely to develop dementia and Alzheimer’s disease than a cognitively inactive person in old age. This association remained after controlling for past cognitive activity, lifetime socioeconomic status, and current social and physical activity. Frequent cognitive activity during old age was also associated with reduced risk of mild cognitive impairment.

Research involving genetically engineered mice9 has found that mice whose brains had lost a large number of neurons regained long-term memories and the ability to learn after their surroundings were enriched with toys and other sensory stimuli, pointing to the importance of maintaining cognitive stimulation as long as possible. Similarly, another mouse study10 found that short but repeated learning sessions can slow the development of those hallmarks of Alzheimer's, beta amyloid plaques and tau tangles. And another11 found that an enriched environment, with more opportunities to exercise, explore and interact with others, dramatically reduces levels of beta-amyloid peptides.

Education & iq

A study12 involving some 6,500 older Chicago residents being interviewed 3-yearly for up to 14 years (average 6.5 years), has found that while at the beginning of the study, those with more education had better memory and thinking skills than those with less education, education was not related to how rapidly these skills declined during the course of the study. The result suggests that the benefit of more education in reducing dementia risk results simply from the difference in level of cognitive function.

Another study13 has come out supporting the view that people with more education and more mentally demanding occupations may have protection against the memory loss that precedes Alzheimer's disease, providing more evidence for the idea of cognitive reserve. The 14-month study followed 242 people with Alzheimer's disease, 72 people with mild cognitive impairment, and 144 people with no memory problems.

Another study14 has come out confirming that people with more years of education begin to lose their memory later than those with less education, but decline faster once it begins. Researchers note that since the participants were born between 1894 and 1908, their life experiences and education may not represent that of people entering the study age range today.

A study15 of 312 New Yorkers aged 65 and older, who were diagnosed with Alzheimer's disease and monitored for over 5 years, found that overall mental agility declined faster for each additional year of education, particularly in the speed of thought processes and memory, and was independent of age, mental ability at diagnosis, or other factors likely to affect brain function, such as depression and vascular disease. It’s suggested this may reflect the greater ability of brains with a higher cognitive reserve to tolerate damage, meaning the damage is greater by the time it becomes observable in behavior.

The Nun Study16 found that nuns who completed 16 or more years of formal education or whose head circumference was in the upper two-thirds were four times less likely to be demented than those with both smaller head circumferences and lower education.

Post-mortem study17 of the brains of 130 participants in the Religious Orders Study found that the relationship between cognitive performance and the number of amyloid plaques in the brain changed with level of formal education. The more years education you had, the less effect the same number of plaques had on actual cognitive performance. It’s worth noting that this considerable difference was observed in a population where even the least educated had some college attendance; presumably the difference would be even more marked in the general population.

A long-running Finnish study18 has found that compared with people with five or less years of education, those with six to eight years had a 40% lower risk of developing dementia and those with nine or more years had an 80% lower risk. Generally speaking, people with low education levels seemed to lead unhealthier lifestyles, but the association remained after lifestyle choices and characteristics such as income, occupation, physical activity and smoking had been taken into account.

An analysis of high school records and yearbooks from the mid-1940s19, and interviews with some 400 of these graduates, now in their 70s, and their family members, has found that those who were more active in high school and who had higher IQ scores, were less likely to have mild memory and thinking problems and dementia as older adults.

An analysis20 of 184 people with dementia found that the mean age of onset of dementia symptoms in the 91 monolingual patients was 71.4 years, while for the 93 bilingual patients it was 75.5 years — a very significant difference.

A study21 of 122 people with Alzheimer's and 235 people without the disease found that people with Alzheimer's are more likely to have had less mentally stimulating careers than their peers who do not have Alzheimer's.

A study22 of 173 people from the Scottish Mental Survey of 1932 who have developed dementia has found that, compared to matched controls, those with vascular dementia were 40% more likely to have low IQ scores when they were children than the people who did not develop dementia. This difference was not true for those with Alzheimer's disease. The findings suggest that low childhood IQ may act as a risk factor for vascular dementia through vascular risks rather than the "cognitive reserve" theory. 

References
  1. Hall, C.B. et al. 2009. Cognitive activities delay onset of memory decline in persons who develop dementia. Neurology, 73, 356-361.
  2. Geda, Y.E. et al. 2009. Cognitive Activities Are Associated with Decreased Risk of Mild Cognitive Impairment: The Mayo Clinic Population-Based Study of Aging. Presented April 28 at the American Academy of Neurology's 61st Annual Meeting in Seattle.
  3. Bennett, D.A., Schneider,J.A., Tang,Y., Arnold,S.E. & Wilson,R.S. 2006. The effect of social networks on the relation between Alzheimer's disease pathology and level of cognitive function in old people: a longitudinal cohort study. Lancet Neurology,5, 406-412.
  4. Verghese, J., Lipton, R.B., Katz, M.J., Hall, C.B., Derby, C.A., Kuslansky, G., Ambrose, A.F., Sliwinski, M. & Buschke, H. 2003. Leisure Activities and the Risk of Dementia in the Elderly. New England Journal of Medicine, 348 (25), 2508-2516.
  5. Wilson, R.S., de Leon, C.F.M., Barnes, L.L., Schneider, J.S., Bienias, J.L., Evans, D.A. & Bennett, D.A. 2002. Participation in Cognitively Stimulating Activities and Risk of Incident Alzheimer Disease.

    JAMA, 287,742-748.
  6. Valenzuela, M.J. & Sachdev, P. 2006. Brain reserve and dementia: a systematic review. Psychological Medicine, In press
  7. Papp, K.V., Walsh, S.J. & Snyder, P.J. 2009. Immediate and delayed effects of cognitive interventions in healthy elderly: A review of current literature and future directions. Alzheimer's & Dementia, 5 (1), 50-60.
  8. Wilson, R.S., Scherr, P.A., Schneider, J.A., Tang, Y. & Bennett, D.A. 2007. The relation of cognitive activity to risk of developing Alzheimer’s disease. Neurology, published online ahead of print June 27.
  9. Fischer, A., Sananbenesi, F., Wang, X., Dobbin, M. & Tsai, L-H. 2007. Recovery of learning and memory is associated with chromatin remodelling. Nature, 447, 178-182.
  10. Billings, L.M., Green, K.N., McGaugh, J.L. & LaFerla, F.M. 2007. Learning Decreases Aß*56 and Tau Pathology and Ameliorates Behavioral Decline in 3xTg-AD Mice. Journal of Neuroscience, 27, 751-761.
  11. Lazarov, O.et al. 2005. Environmental Enrichment Reduces Aβ Levels and Amyloid Deposition in Transgenic Mice. Cell, 120(5), 701-713.
  12. Wilson, R.S., Hebert, L.E., Scherr, P.A., Barnes, L.L., de Leon, C.F.M. & Evans, D.A. 2009. Educational attainment and cognitive decline in old age. Neurology, 72, 460-465.
  13. Garibotto, V. et al. 2008. Education and occupation as proxies for reserve in aMCI converters and AD: FDG-PET evidence. Neurology, 71, 1342-1349.
  14. Hall, C.B., Derby, C., LeValley, A., Katz, M.J., Verghese, J. & Lipton, R.B. 2007. Education delays accelerated decline on a memory test in persons who develop dementia. Neurology, 69, 1657-1664.
  15. Scarmeas, N., Albert, S.M., Manly, J.J. & Stern, Y. 2006. Education and rates of cognitive decline in incident Alzheimer’s disease. Journal of Neurology Neurosurgery and Psychiatry, 77, 308-316.
  16. Mortimer, J.A., Snowdon, D.A. & Markesbery, W.R. 2003. Head Circumference, Education and Risk of Dementia: Findings from the Nun Study.Journal of Clinical and Experimental Neuropsychology, 25 (5), 671-679.
  17. Bennett, D.A., Wilson, R.S., Schneider, J.A., Evans, D.A., de Leon, M.C.F., Arnold, S.E., Barnes, L.L. & Bienias, J.L. 2003. Education modifies the relation of AD pathology to level of cognitive function in older persons. Neurology, 60, 1909-1915.
  18. Ngandu, T. et al. 2007. Education and dementia: What lies behind the association? Neurology, 69, 1442-1450.
  19. Fritsch, T., Smyth, K.A., McClendon, M.J., Ogrocki, P.K., Santillan, C., Larsen, J.D. & Strauss, M.E. 2005. Associations Between Dementia/Mild Cognitive Impairment and Cognitive Performance and Activity Levels in Youth. Journal of the American Geriatrics Society, 53(7), 1191.
  20. Bialystok, E., Craik, F.I.M. & Freedman, M. 2007. Bilingualism as a protection against the onset of symptoms of dementia. Neuropsychologia, 45 (2), 459-464./li>
  21. Smyth, K.A. et al. 2004. Worker functions and traits associated with occupations and the development of AD. Neurology, 63 (3), 498-503.
  22. McGurn, B., Deary, I.J. & Starr, J.M. 2008. Childhood cognitive ability and risk of late-onset Alzheimer and vascular dementia. Neurology, first published on June 25, 2008 as doi: doi:10.1212/01.wnl.0000319692.20283.10 .
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