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Published on: May 22, 2014
by Women’s Brain Health Initiative:
There has been a dramatic increase in life expectancy in the past 100 years. In 2000, people on average lived 30 years longer than in 1900. With that increase in life expectancy comes an increase in age-related diseases. Sylvie Belleville, a psychology professor and researcher at Université de Montréal and director of the Montreal Geriatric Institute, points out, “The diseases we have in the last years of life are largely diseases of the brain.”
Alzheimer’s disease is the greatest fear associated with aging for most people. That fear is grounded in the reality that lots of people do get the disease. Statistics tell us Alzheimer’s affects eight percent of people aged 65+, and that percentage rises to 33 percent by the time people reach 80 years of age and above.
Older Canadians’ Top Health Priority – Memory
A study by Dr. Cara Tannenbaum (Université de Montréal) and colleagues in 2005 asked over 1500 older Canadians, “What is your top health priority and on what issue should researchers focus?” The top health priority indicated by a significant majority of respondents was memory. Belleville does not find that response surprising, explaining, “There’s a kind of wisdom that comes with aging, that somehow we have come to accept the fact that we are going to die. But I think that older people just don’t accept the possibility of losing their autonomy and dignity as they age. When they lose their memory, they lose their identity. That’s why memory is such an important topic for older Canadians.”
Alzheimer’s Only 100% Certain After Death
Alzheimer’s is a unique disease in that it is defined pathologically. Belleville explains, “That means that as long as you’re alive and doctors don’t have access to your brain, to look at it under a microscope, they are not able to diagnose it with any certainty.” A definitive diagnosis of Alzheimer’s disease cannot be made until after death, based on finding particular neural pathologies in the brain. When someone is alive, doctors do what is called a clinical diagnosis, meaning that the person meets a number of criteria that are assessed when that person comes to the doctor such as memory and a review of any problems that are impacting their daily lives.
If, after reviewing those “inclusion criteria” the doctor thinks the patient is experiencing memory problems, the doctor will then consider other factors that might be responsible such as depression, a brain tumor or vitamin B12 deficiency. It is only after other possible causes are ruled out that a clinical diagnosis of Alzheimer’s would be made.
Although samples of brain tissue to examine under a microscope for signs of Alzheimer’s are impossible to obtain while someone is alive, it is possible to conduct brain scans while someone is still living that show certain things about the brain. (See the article called “Sex Differences Evident in Brain Imaging” for more about the capabilities of modern brain scans.) In the early stages of Alzheimer’s you don’t see any changes in the brain but by the time the diagnosis is made, you can see significant effects, e.g. shrinkage of the brain overall and of the hippocampus, in particular.
What Keeps Betty White so Sharp?
Everyone experiences cognitive decline as they age but some individuals are particularly resistant to the effects of brain aging and to Alzheimer’s disease. These people remain mentally sharp and vibrant well into old age – think of people like Betty White, Queen Elizabeth II, Mother Teresa and Jacques Cousteau. In some cases, there can be two different people with the same pathological lesions in their brains but one shows signs of dementia in their behaviour and the other appears normal. What can account for these differences? What do the people who have resistance to the effects of brain aging have in common?
These people all seem to be extremely productive scientifically, artistically, or politically (which includes being engaged in their community in any way, not just as a politician). Researchers believe that by continuing to use their brains intensively, those people might have high cognitive reserve (also referred to as brain reserve). People with high cognitive reserve have more neurons and a richer or more effective brain network that helps protect them from the impacts of brain aging and Alzheimer’s disease. Generally, people with high cognitive reserve are more educated, have intellectually stimulating hobbies, have intellectually stimulating careers, have rich social lives and are physically active. You’ll notice that most of these factors are modifiable; that is, they are things that you can do something to change even as you enter old age.
Research indicates that as many as half of the cases of Alzheimer’s disease are caused by modifiable factors such as vascular risk factors, depression, physical inactivity, smoking and cognitive inactivity. Cognitive inactivity accounts for 19.1 percent of modifiable cases. There are things you can do to be cognitively active and increase your brain reserve, helping provide protection against cognitive decline.
You Can Change Your Brain
To see if cognitive performance could be improved with brain training, Belleville’s team in Montreal developed and tested a cognitive stimulation program for people with mild cognitive impairment, who were considered at risk for developing Alzheimer’s disease. The program, called MÉMO, brought in small groups of four to eight people on a weekly basis for 6, 8 or 12 weeks to participate in one- to two-hour sessions that taught different memory strategies.
Participants were then encouraged to practice the new skill they learned throughout the following week, allowing them to apply the strategy in real life situations. MÉMO program participants showed dramatic improvements in memory – and remember, these were not healthy seniors, they were people already showing early signs of dementia.
Neuroimaging has been used to watch what is happening in the brain during interventions of this type. “What we see is that, even in older people, even among people who are in the early stages of Alzheimer’s, there is an increase in activity in alternate regions of the brain during memory training,” describes Belleville. “Memory training is increasing the activity in new regions of the brain, putting in motion a new process to store information and improve memory.” This is evidence that brain plasticity is present even in early Alzheimer’s patients.
There is a lot you can do on your own to integrate new learning and creativity into your life, stimulating your brain and building cognitive reserve. Belleville recommends choosing activities that are pleasurable and interesting for you. To improve your memory and language skills, she suggests joining a book club, learning a new language or writing your autobiography. To improve your attention skills, she suggests playing video games, playing chess or Sodoku. Physical activities and creative pursuits are great as well, such as joining a walking club, doing tai chi, learning to tango or joining a choir.
The brain remains plastic – able to change and grow – well into old age. It’s never too late to introduce new activities into your life to stimulate your brain and build cognitive reserve. Doing so will help you prevent cognitive decline, reduce the risk of developing dementia, and help keep you thriving and independent as you get older.
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