Explain this: if Alzheimer’s disease
is caused by the accumulation of sticky amyloid plaques and
neurofibrillary tangles that kill neurons (as the leading theories of
the disease hold), then how can holding a job that poses minimal
cognitive demands and watching a lot of TV raise your risk of
developing the disease? Nothing in neuroscience suggests that either
activity speeds the formation of plaques or tangles—or, conversely,
that mentally-demanding jobs and spending your leisure time in more
intellectually-engaging pursuits blocks their formation.
New research is leading to an inescapable conclusion. Being extra brainy when you enter old age has no effect
on the basic pathological processes that attack the brain. Sorry. But
here’s what it does do: when that pathology kicks in (or even when less
insidious, normal brain-aging starts to impair memory and neuronal
processing speed), a brain that has a “cognitive reserve” can take more
hits before showing the effects than a brain with less cognitive
reserve.
Think of it
this way: if a cyber-thief siphons $100 a week from your bank account,
you’ll have enough to pay the bills longer if you start with a large
balance than if you start with a small one. Cognitive reserve is your
brain’s bank balance.
This is very different from the commonly-held belief that mental activity slows
the rate of cognitive decline, as Timothy Salthouse of the University
of Virginia, a veteran of studies on aging and cognition, pointed out in a 2006 analysis.
This “mental exercise” hypothesis rests on studies finding that higher
mental activity, such as reading and doing crossword puzzles, is
associated with better cognitive function in old age. That does not
mean, however, that older adults who stay more mentally active are
slowing their rate of cognitive decline. Instead, it is becoming
increasingly clear, they enter old age (i.e. their 30s, which is the
decade when cognitive function starts heading south, accelerating in
your 50s) with a cognitive reserve, a sort of mental cushion. That
starts them off far enough above the threshold where impaired mental
function affects the ability to think and remember that a normal
decline leaves them pretty much okay for a longer period. That
cyber-thief’s $100-per-week leaves the well-endowed with enough to pay
the bills for many years.
But here’s
the awful part. In the most mentally-engaged elderly, such as
professors who enter their 60s or 70s with smarts to spare, the rate of
mental decline is typically just as steep as in dullards. True, a brain
functioning far above the average will still be pretty good even with
the equal rate of decline—but these people notice their diminishing
capacities nonetheless. Sadly, therate of mental decline is not
affected by cognitive exercise, Salthouse wrote back in 2006, arguing
that there is “little scientific evidence that engagement in mentally
stimulating activities alters the rate of mental aging.” The belief
that it does is “more of an optimistic hope than an empirical reality.”
The latest study, too, supports the cognitive-reserve idea. People with greater
thinking, learning and memory abilities are able to delay symptoms of
Alzheimer’s disease—but not necessarily the underlying pathology: their
brains still suffer neuron-killing plaques and tangles, but they
function adequately longer than people with a smaller cognitive
cushion. As Catherine M. Roe and colleagues at the Washington
University School of Medicine write in Archives of Neurology in a paper being posted this afternoon, “a greater pathological burden is required to show an effect on cognition among persons with more education.”
They studied
37 people with Alzheimer’s and 161 healthy individuals, noting their
education history and giving them cognitive tests. They were then
tested for the presence of the beta-amyloid plaques considered a marker
of Alzheimer’s. Even in people with lots of beta-amyloid plaques, the
more years of education they had had the better they did on the test.
“The results support the hypothesis that cognitive reserve influences
the association between Alzheimer disease pathological burden and
cognition,” the authors write. Translation: the smarter you are, the
more beta-amyloid plaques your brain can tolerate before showing
symptoms of Alzheimer’s.