Restoring Cognitive Reserve

Building Brain Function Back Up   

There are several known risk factors for the development of Alzheimer’s disease.  Some are non-modifiable such as genetic predispositions and others are modifiable highly related to lifestyle and behavior.

·         Genetics

·         Diet

·         Insulin levels

·         Cognitive reserve

·         Diabetes

·         Omega-3 fatty acid intake

·         B vitamin/methylation factor intake

·         Exercise levels

·         Sleep quality

·         Inflammation

One of the important identified risk factors that is modifiable is cognitive reserve.  In essence, cognitive reserve is the “savings account” of brain resources that have been built up to ensure the brain will still be highly functional with advancing age.   Cognitive reserve is developed by the accumulative effects of “brain exercise” that occurs during early and mid-adult life.  Comparing subjects with the highest levels of cognitive reserve to those with low levels has found that higher levels may reduce the risk of any type of dementia by about 45%.  It also means that having lower levels of cognitive reserve significantly increases the risk of cognitive decline.

It is a natural part of aging for the brain to lose neurons (brain cells) and their connections to other cells that create functions such as memory.  This is analogous to gradually losing muscle mass with advancing age.  As with muscle mass, the higher  the development of brain mass/reserves going into older ages, the less affected brain function will be with the normal age related decline. 

Factors that help cognitive reserves include higher educational attainment, higher occupational attainment and enjoyable and engaging leisure activities.  They literally create brain hypertrophy such as weight lifting does in skeletal muscle or weight bearing exercise does for bone.  What we have to work with after 5-6 decades literally is dependent on what we have built up and then work to maintain.

It is important to appreciate that lower cognitive reserves are like lower amounts of muscle mass.  Generally, someone with either lower muscle mass or lower cognitive reserves can function relatively normal on a day to day basis.  However, as muscle mass is normally lost with age, starting with lower reserves increases the risk of related diseases such as joint degeneration.

The ideal situation with cognitive reserves is to develop and maintain high levels throughout adult life.  However, many persons will find that they are developing some state of cognitive impairment and will be faced with the more challenging task of building cognitive function back up to a fully functional state later in life.  Fortunately, tools have evolved to make this possible.

There are different levels of brain training that can be used for this purpose.  The most sophisticated is neurofeedback, or EEG guided brain training.  The first part of this process is testing with a QEEG brainmap.  This test looks at the brainwave electrical pattern in several different brain areas.  There are multiple changes in brain QEEG brain waves seen in neurodegenerative disease.  The QEEG brainmap becomes the map used to design a training pattern to reactivate and balance brain activity.  This is done with neurofeedback which is brain biofeedback. 

During biofeedback monitoring an activity within the body is done while techniques are used by the individual to learn to improve that body activity.  During neurofeedback EEG monitoring is integrated with stimuli to the brain such as vision and sound such as watching a movie.  If the brain wave pattern is corrected, the person is rewarded with the vision and sound of the movie remaining clear.  If the brain waves wander into the abnormal pattern, the reward is withdrawn stimulating the brain to change and try to restore the reward.

Several studies have examined the ability of neurofeedback to improve cognitive functioning in subjects with cognitive decline. These studies have universally found that neurofeedback significantly improves cognitive function especially with memory function.  In one of the most striking studies 20 subjects, half with Alzheimer’s and half with other forms of dementia were treated with a comprehensive neurofeedback program.  The mean MMSE test score before treatment was 18.8 which is consistent with moderate cognitive decline/Alzheimer’s. 

Follow-up MMSE scores after the series of neurofeedback treatments was 25.2 for the Alzheimer’s group and 23.9 for the other dementia group. 

A secondary problem associated with Alzheimer’s is attention.  This is often impaired and further affects the disease related impairment.  Similarly, favorable changes also occurred in TOVA test scores which measure impairment associated with attention deficit.

The researchers commented on the value of neurofeedback over general forms of brain training.  They found that the pattern of brain wave activation imbalance was unique to each subject and that the neurofeedback training protocol used in each was specific to the imbalance seen in their EEG brainmap.

Cognitive reserves are an important variable in the risk of development of Alzheimer’s and other forms of dementia.  The best time to build-up these protective investments is throughout early and mid-life.  Fortunately for those who have developed the disease and have low cognitive reserves, treatment such as neurofeedback can correct this deficit.