Now we are launching a new Author Speaks Series to provide a platform for leading scientists and experts writing high-quality brain-related books to reach a wide audience. We are honored to start the series with an article by Larry McCleary, M.D, former acting Chief of Pediatric Neurosurgery at Denver Children’s Hospital, and author of The Brain Trust Program: A Scientifically Based Three-Part Plan to Improve Memory, Elevate Mood, Enhance Attention, Alleviate Migraine and Menopausal Symptoms, and Boost Mental Energy (Perigee Trade, 2007).

Without further ado, let’s enjoy Dr. McCleary’s article:

Brain Evolution and Why it is Meaningful Today to Improve Our Brain Health

You may feel overwhelmed by the stream of seemingly contradictory suggestions regarding the best way to maintain mental clarity as you age. Based on an analysis of seminal factors in the development of modern brain anatomy, I believe it is possible to make some very compelling recommendations for growing big brains, enhancing their function, and making them resistant to the aging process. These may be loosely categorized as factors pertaining to the mental or physical attributes of the brain. Although they are not truly independent entities, such a conceptualization provides a basis for the generation of brain healthy prescriptions. Diet, physical exercise, and stress reduction enhance neuronal resilience. Sleep and mental stimulation are vital for cognitive ability, learning, and memory.

Diet: Follow a modern shore-based/marine diet including seafood in its most general sense, non-starchy vegetables of all colors, berries, and eggs. Other sources of lean protein containing long-chain omega 3 fatty acids such as free range beef, chicken, bison, or elk are nutritious alternatives.

Physical exercise (Think ‘fight or flight’ activity.): Include all types. Aerobic activities such as swimming, bicycling, walking, or hiking for promotion of vascular health and weight control; resistance training for promotion of neurotrophic factors, naturally occurring compounds that make brain cells more resistant to aging, such as IGF-1 (Insulin-like growth factor-1) and BDNF (Brain-derived neurotrophic factor); and balance, coordination, and agility training such as ping-pong, balance beam, trampoline, and jumping rope to enhance cognitive speed and motor skills.

Stress Control: From an evolutionary perspective, stressors (such as meeting a cave bear) and intense physical activity (running or fighting) were brief in duration and usually occurred together. Modern stressors (psychological or emotional stress) tend to be unremitting and are generally uncoupled from the physical (fight or flight) component, meaning stress develops without any associated physical activity. Such intense physical pursuits are now called exercise. Not surprisingly, exercise is a perfect physiologic antidote for stress due to its beneficial impact on cortisol (the ‘stress’ hormone) and blood pressure and should be incorporated into any program of stress reduction.

Adequate sleep: The body needs rest, but the brain requires sleep. Acute or chronic sleep deprivation causes devastating short and long-term consequences to brain anatomy (synaptic loss) and function (memory and learning difficulties). Off-line information processing and memory consolidation are additional sleep-related benefits.

Mental stimulation: Brain-training, a cognitively challenging lifestyle, novelty, and socialization are vital for the promotion of neuronal plasticity and neurogenesis (the formation of new nerve cells and neuronal connections), the enhancement of specific brain functions such as memory, and the development of cognitive reserve –additional mental processing potential that may be brought online when needed.

The combination of these recommendations, each of which was instrumental in the transformation from primitive to modern nervous systems, provides a template for the most logical approach for enhancing mental function and resisting neurodegeneration as we travel through life.

The Evolutionary Rationale

The human brain clearly has the genetic potential for dramatic expansion. This was illustrated about 1,500,000 years ago. Enlargement from 900 grams to almost 1300 grams required less than a million years to complete – a mere speck on the evolutionary timeline. Why and how it happened are open questions. What remains undisputed are the magnitude of the change and the impact it had on human capabilities. The rapid volumetric explosion primarily involved the frontal lobe region, a portion of the brain that, until recently, was referred to as the ‘silent’ brain because of its relative lack of any discernable functionality. The frontal lobes are now viewed as the ‘conductor of the orchestra’ because they have been recognized as being responsible for articulating the ‘big picture’ and coordinating other brain regions, as needed, to execute the ‘game plan.’ The Prefrontal cortex (PFC), the most anterior portion of the frontal cortex, has dense connections with all the other regions it oversees. It is generally considered the most plastic cortical region because its synapses are continually being torn down and reconfigured in response to real-time experiences. Plasticity allows the brain to ‘think on its feet.’ Expansion of PFC enabled the cognitive preeminence of modern day humans over all non-human primates. The plasticity of the PFC and its massive connectivity with other brain regions rely entirely on the production and maintenance of point-to-point nerve cell connections, or synapses.

In addition to being a thinking machine, the brain is also a flesh and blood organ that must comply with the laws of metabolism and physiology. Insight into both its ‘mental’ and ‘physical’ properties is vital for comprehending key aspects of brain health and function. Much has been written about the facilitation of brain growth by cognitively demanding tasks such as tool use and hunting. However, there is a component of circular reasoning in this argument. For it to participate in such mentally demanding endeavors, the brain would have relied on the prior existence of sophisticated neuronal circuitry. I suggest a nutritional basis for the dramatic cerebral expansion, with enhanced functionality (such as development of tool use and hunting strategy) being the natural responses of a larger, more plastic organ to novelty and environmental challenges. The common link between the evolutionary cerebral expansion and modern brain health/function resides in the massive wiring demands inherent in both processes. This marked amplification in neuronal connectivity is made possible by the enhanced production of synaptic membranes (nerve cell membranes in the regions of points of nerve cell contact).

How was it possible to fuel the production of major increases in neuronal number and synaptic density? This required the concordant expression of genetic potential (likely driven, in part, by the provision of an uninterrupted energy supply) and proper nutritional content – meaning high, sustained caloric and nutrient density. Just as a certain level of fat mass is a prerequisite for expansion of the female body to support a successful pregnancy, a persistent supply of nutrient dense calories is essential for brain expansion. In times of frequent starvation, this was a substantial nutritional demand. To fully appreciate how energetically expensive brains are, consider that modern brains comprise about 2.3% of the body mass, yet consume almost one quarter of the available energy. Newborn brains utilize fully 75% of the body’s energy!

What type of brain-building diet might have been accessible 1.5 million years ago that didn’t require the cognitive demands inherent in hunting? One solution would be a ‘shore-based’ diet. This means foraging for life forms such as mollusks, crustaceans, eggs, spawning fish, frogs, and contiguous plant life readily available along lake shores or river banks. In a warm clime it would have provided a year-round, high quality diet abundant in calories, fat and protein. It also supplied long-chain omega 3 fatty acids (including DHA), the building blocks of electrically active membranes in neurons and photoreceptor cells.

Big brains must also synthesize abundant cholesterol and other components of nerve cell membranes. This requires a water-soluble source of appropriate building blocks. Ketone bodies (acetoacetate and β-hydroxybutyrate) generated naturally from partially burned fat were, and continue to be, an ideal energy source for the brain while simultaneously providing key precursors for synthesis of nerve cell membranes and synapses. These facilitated the anatomic expansion of the brain, which provided the additional neuronal circuitry that made the learning of hunting skills a possibility.

Hence, what was compulsory for explosive brain expansion of the species is as vital today for optimal brain function and plasticity. It is the ongoing ability to produce high levels of the most functional sites of nerve cells – the synaptic membranes. Appropriate assemblies of nerve cells, as determined by their connections (synapses), provide the basis for the functional attributes we enjoy today. Stress reduction, mental stimulation and proper sleep enhance their resistance to the aging process.

 

—This article was written by Larry McCleary, M.D, for SharpBrains.com’s Author Speaks Series. Dr. McCleary (blog) is a former acting Chief of Pediatric Neurosurgery at Denver Children’s Hospital. He is trained and has practiced as a pediatric neurosurgeon and has completed post-graduate training in theoretical physics. His scientific publications span the fields of metabolic medicine, tumor immunology, biotechnology and neurological disease. He is the author of The Brain Trust Program: A Scientifically Based Three-Part Plan to Improve Memory, Elevate Mood, Enhance Attention, Alleviate Migraine and Menopausal Symptoms, and Boost Mental Energy (Perigee Trade, 2007).

Key highlights and trends:

1- Global health problems require the attention of the scientific community. Richard Klausner encouraged the scientific community to focus on Global Problems: maternal mortality rates, HIV/ AIDS, nutrition, cancer, clean water.  Bill Frist, former Senate Majority Leader, added to that list the increasing epidemic risks of global zootic diseases (transmitted between humans and animals), supported by 2 interesting data points: at any one moment, there are 500,000 people flying worldwide; in a year, airlines transport the equivalent of 2 billion passengers.

2- “Let’s get real…Ideology kills”. Mary Robinson, former President of Ireland, on what it takes to stop HIV/ AIDS: “I am from Ireland, a Catholic country. And I am Catholic. But I can see how ideology kills..we need more empathy with reality, and to work with local women in those countries who need things like female condoms.” She was implicitly criticizing the large budget devoted to unrealistic abstinence programs. This session included a fascinating exchange where Bill Frist rose from the audience to defend the role of US aid, explaining how 60% of retroviral drugs in African countries have been funded by the American taxpayer, highlighting President Bush’s courage to make HIV/AIDS a top agenda item in many developing countries, and criticizing other countries for not doing enough. Which made Nobel Prize Laureate Peter Agre, also in the audience, stand up and encourage the US to really step up to the plate and devote 1% of the GDP to aid, as a number of European countries do, instead of 0.1%.

3- Where is the new “Sputnik”?: Basic science is crucial for innovation and for economic growth, but it is often underappreciated. Scientists are not “nerds”, as sometimes they are portrayed in popular culture, but people with a deep curiosity and drive to solve a Big problem. Many of the speakers had been inspired by the Sputnik and the Apollo missions to become scientists, at a time when the profession was considered cool. Two Nobel Prize Laureates (Peter Agre, Michael Bishop), talked about their lives and careers trying to demystify what it takes to be a scientist and to win a Nobel Prize. Both are grateful to the taxpayers dollars that funded their research, and insist we must do a better job at explaining the scientific process to society at large. Both are proud of having attended small liberal arts colleges, and having evolved from there, fueled by their great curiosity and unpredictable, serendipitous paths, into launching new scientific and medical fields.  Bishop listed a number of times where he made decisions that were considered “career suicide” by mentors and colleagues, and mentioned “I was confused” around 15 times in 15 minutes…down to earth and inspiring.

4- We need a true Health Care Culture: Mark Ganz summarized it best by explaining how his health provider group improved care when they redefined themselves from “we are 7,000 employees” to “we are a 3 million strong community”, moving from being a cost controller with a paternalistic attitude to a health facilitator, looking underneath symptoms to identify and deal with underlying patterns. Mark also announced the launch of the Aspen Health Stewardship Project to 1) identify levers to change the culture of control, 2) frame the upcoming political health care debate, 3) create a reportcard to screen all political proposals. Will be interesting to check the progress of the initiative in next year’s conference.

Related to this, there were panels on how to improve Medical Education, including training doctors to be members of a team and improve patient-based problem solving and “soft skills” such as how to apologize to patients and their families. And on Electronic Medical Records, that have proven to reduce medical mistakes and overall healthcare system costs, yet many physicians resist their use due to the time required to fill out the online forms and workflow changes required. An interesting data point: in 65% of visits to the doctor these days, patients bring something printed from the internet.

5- You can’t manage what you can’t measure. We heard many times how defining and measuring outcomes, so common in the private sector, is critical to ensuring a good allocation of resources in the health and scientific fields, that use so much taxpayer money. For example. NIH funding grew from $9B in 1994 to $29B in 2007, yet the results are not clear. The same happened with health care as a whole, a sector that now consumes 16% of the US GDP with health outcomes (infant mortality, patient deaths in hospitals) worse than other countries that invest far less. There is an apparent consensus that science and healthcare need more resources but will only get them once they clean house. 

6- The rising role of public-private partnerships: There are multiple initiatives launched to bridge the increasing gap between academia and industry. The Foundation for the NIH has facilitated key conversation between the FDA and pharma companies. The Gates and Clinton Foundations have launched innovative partnership models to tackle global health problems. The Myelin Repair Foundation was launched to build bridges once its founder, who had “assumed someone had a plan”, discovered that little progress had happened in 20 years to help patients with multiple sclerosis. 

7- From Lifespan to Health-span. Population distribution in developed countries is shifting from a “population pyramid” to a “population rectangle” (see Japan population “pyramid”, right). There was a good deal of emphasis on the biology of aging and healthy aging, both on how the environment can regulate gene activation and on genetics. Cynthia Kenyon, a UCSF researcher showed her research on how disabling one specific gene in a worm can double that worm’s lifespan, and mentioned how that study has been replicated with fruit flies and mice, and could, conceptually, help humans live longer & healthier lives. The point of much ongoing research is not “how to spend more time on the nursing home” but how to slow down the process of aging, so we can live healthier longer.

8- Patient-advocacy groups are having an impact. We heard many examples on how small groups of motivated individuals have built large patient advocate movements that influence public policy. Michael Milken talked about the Cancer March, that helped increase NIH funding from $1.5B to 5$B. Hala Moddelmog, from the Susan G. Komen for the Cure, explained how they have 1 million people engaged in promoting cancer research and prevention. Robert Klein, key advocate of the California Proposition 71 (that will provide $6B for stem cell research through long-term bonds) explained how the proposition was passed, including engaging over 80 patient-advocacy groups.

9- There’s a new emphasis on understanding “how systems work” instead of ”how isolated genes make things happen on their own”: Genomics is starting to help predict susceptibility to disease and to therapies. Now, we must remember the difference between strong and weak genes (only specific combinations of which may create predispositions), and keep in mind the role of our experience and environment in turning some genes on or off. Regis Kelly provided a wonderful overview of neuroimaging, learning and neuroplasticity, and highlighted how many biologists are moving from thinking about ”how genes make things happen” to “how systems work”, given than in humans manipulating just one gene may trigger changes in 500 others.

10- The importance of our Lifestyle-Each of us owns our own health. 70% of heathcare costs derive from lifestyle-related diseases (such as smoking-induced cancer). We heard several calls to action for insurance companies to incentivize behavior modification to promote good lifestyle habits that improve quality of life and can delay disease symptoms, resulting in billions of dollars of cost savings. Yet, in my view, the discussion was too conceptual in this area, and not specific or action-oriented enough.

In short, a very stimulating inaugural 3-day conference. I hope the one next year is even better, and includes more in-depth conversations on the role of prevention and lifestyle in driving health outcomes, and builds more bridges with neuroscience and psychology. I would suspect the topics discussed in our Neuroscience Interview Series will have significant implications on the growing healthcare and prevention debate.

Update: you may enjoy the post The Alfred Nobel legacy: 2007 Nobel Prizes.

First, a prescient quote by Spanish neuroscientist Santiago Ramon y Cajal (1852-1934): ”Every man can, if he so desires, become the sculptor his own brain“.

Thanks to new neuroimaging techniques, regarded “as important for neuroscience as telescopes were for astronomy”, neuroscientists and cognitive psychologists have been finding that the brain has a number of “core capacities” and “mental muscles” that can be exercised through novelty, variety and practice, and that exercising our brain can influence the generation of new neurons and their connections. Brain exercise is being recognized, therefore, as a critical pillar of brain health, together with nutrition, physical exercise and stress management.

Previous beliefs about our brain and how it works have been proven false. Some beliefs that have been debunked include claims that adult brains can not create new neurons (shown to be false by Berkeley scientists Marian Diamond and Mark Rosenzweig, and Salk Institute’s Fred Gage), notions that working memory has a maximum limit of 6 or 7 items (debunked by Karolinska Institute’s Torkel Klingberg), and assumptions that the brain’s basic processes can not be reorganized by repeated practice (UCSF’s Drs. Paula Tallal and Michael Merzenich). The “mental muscles” we can train include attention, stress and emotional management, memory, visual/ spatial, auditory processes and language, motor coordination and executive functions like planning and problem-solving.

Mental stimulation is important if done in the right supportive and engaging environment. Stanford’s Robert Sapolsky has proven that chronic stress and cortical inhibition, which may be aggravated due to imposed mental stimulation, may prove counterproductive. Having the right motivation is essential.

A surprising and promising area of scientific inquiry is Mindfulness-Based Stress Reduction (MBSR). An increasing number of neuroscientists (such as University of Wisconsin-Madison’s Richard Davidson) are investigating the ability of trained meditators to develop and sustain attention and visualizations and to work positively with powerful emotional states and stress through the directed mental processes of meditation practices.

And now, some keywords:

Brain Fitness Program: structured set of brain exercises, usually computer-based, designed to train specific brain areas and processes in targeted ways.

Chronic Stress: ongoing, long-term stress, which blocks the formation of new neurons and negatively impacts the immune system’s defenses.

Cognitive training (or Brain Fitness Training): the field of brain exercises designed to help work out specific “mental muscles”. The principle underlying cognitive training is to help improve “core” abilities, such as attention, memory, processing spped, problem-solving.

Cognitive Reserve (or Brain Reserve): theory that addresses the fact that individuals vary considerably in the severity of cognitive aging and clinical dementia. Mental stimulation, education and occupational level are believed to be major active components of building a cognitive reserve that can help resist the attacks of mental disease.

fMRI: functional magnetic resonance imaging (fMRI) is a non-invasive neuroimaging technique that enables researchers see images of changing blood flow in the brain associated with neural activity. This allows images to be generated that reflect which structures are activated (and how) during performance of different tasks.

Heart Rate Variability (HRV): describes the frequency of the cardiac cycle, and is one of the best predictors of stress and anxiety. Our hear rate is not “flat” or constant: HRV measures the pattern of change.

Mindfulness-Based Stress Reduction (MBSR): yoga and meditation practices designed to enable effective responses to stress, pain, and illness.

Neurogenesis: the process by which neurons are created all throughout our lives.

Neuroimaging: techniques that either directly or indirectly image the structure, function, or pharmacology of the brain. Recent techniques (such as fMRI) have enabled researchers to understand better the living human brain.

Neuroplasticity: the brain’s ability to reorganize itself by forming new connections throughout life.

PubMed: very useful tool to search for published studies. “PubMed is a service of the U.S. National Library of Medicine that includes over 16 million citations from MEDLINE and other life science journals for biomedical articles back to the 1950s. PubMed includes links to full text articles and other related resources.”

Working memory: the ability to keep information current for a short period while using this information. Working memory is used for controlling attention, and deficits in working memory capacity lead to attention problems. Recent research has proven that working memory training is possible and helpful for people with ADD/ ADHD.

Any other keyword you would like explained?

He is one of the leading proponents of the Cognitive reserve theory, which aims to explain why some individuals with full Alzheimer’s pathology (accumulation of plaques and tangles in their brains) can keep normal lives until they die, while others -with the same amount of plaques and tangles- display the severe symptoms we associate with Alzheimer’s Disease. He has published dozens of peer-reviewed scientific papers on the subject.

The concept of a Cognitive Reserve has been around since 1989, when a post mortem analysis of 137 people with Alzheimer’s Disease showed that some patients exhibited fewer clinical symptoms than their actual pathology suggested. These patients also showed higher brain weights and greater number of neurons when compared to age-matched controls. The investigators hypothesized that the patients had a larger “reserve” of neurons and abilities that enable them to offset the losses caused by Alzheimer’s. Since then, the concept of Cognitive Reserve has been defined as the ability of an individual to tolerate progressive brain pathology without demonstrating clinical cognitive symptoms. (You can check at the end of this interview a great clip on this).

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Key take-aways

- Lifetime experiences, like education, engaging occupation, and leisure activities, have been shown to have a major influence on how we age, specifically on whether we will develop Alzheimer’s symptoms or not.

- This is so because stimulating activities, ideally combining physical exercise, learning and social interaction, help us build a Cognitive Reserve to protect us.

- The earlier we start building our Reserve, the better; but it is never too late to start. And, the more activities, the better: the effect is cumulative.

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The Cognitive Reserve

Alvaro Fernandez (AF): Dear Dr. Stern, it is a pleasure to have you here. Let me first ask you this: the implications of your research are pretty astounding, presenting major implications across sectors and age groups. What has been the most unexpected reaction so far?

YS: well…I was pretty surprised when, years ago, a reporter from Seventeen magazine requested an interview. I was really curious to learn why she felt that her readers would be interested in studies about dementia. What she told me showed a deep understanding and insight: she wanted to motivate children to stay in school. She understood that early social interventions could be very powerful for building reserve and preventing dementia.

AF: That’s great…so let’s now fast forward, say, 60 years from our high-school years, and suppose that persons A and B both technically have Alzheimer’s (plaques and tangles appear in the brain), but only A is showing the disease symptoms. What may explain this discrepancy?

YS: Individuals who lead mentally stimulating lives, through education, occupation and leisure activities, have reduced risk of developing Alzheimer’s. Studies suggest that they have 35-40% less risk of manifesting the disease. The pathology will still occur, but they are able to cope with it better. Some won’t ever be diagnosed with Alzheimer’s because they don’t present any symptoms. In studies that follow healthy elders over time and then get autopsies, up to 20% of people who did not present any significant problem in the daily lives have full blown Alzheimer’s pathology in their brains.

AF: What exactly may be going on in the brain that provides that level of protection?

YS: There are two ideas that are complementary. One idea (called Brain Reserve by researchers) postulates that some individuals have a greater number of neurons and synapses, and that somehow those extra structures provide a level of protection. In a sense, we have more “hardware”, providing a passive protection against the attacks of Alzheimer’s. The other theory (called Cognitive Reserve) emphasizes the building of new capabilities, how people can perform tasks better through practice, and how these skills become so well learned that they are not too easy to unlearn. Like developing new and refined “software”.

AF: But, both seem to go hand in hand, correct? Neuroplasticity means that what you call “hardware” and “software” are two sides of the same coin and they influence each other, right?

YS: Correct. So these days we don’t make a sharp distinction, and are conducting more neuroimaging studies to better understand the relationship between both.

 

Building Your Cognitive Reserve

AF: OK, so our goal is to build that Reserve of neurons, synapses, and skills. How can we do that? What defines “mentally stimulating activities” or good “brain exercise”?

YS: In summary, we could say that “stimulation” consists of engaging in activities. In our research almost all activities are seen to contribute to reserve. Some have challenging levels of cognitive complexity, and some have interpersonal or physical demands. In animal studies, exposure to an enriched environment or increased physical activity result in increased neurogenesis (the creation of new neurons). You can get that stimulation through education and/ or your occupation. There is clear research showing how those two elements reduce the risk. Now, what is very exciting is that, no matter one’s age, education and occupation, our level of participation in leisure activities has a significant and cumulative effect. A key message here is that different activities have independent, synergistic, contributions, which means the more things you do and the earlier you start, the better. But you are never stuck: better late than never.

AF: Can you give us some examples of those leisure activities that seem to have the most positive effects?

YS: For our 2001 study we evaluated the effect of 13 activities, combining intellectual, physical, and social elements. Some of the activities with the most effect were reading, visiting friends or relatives, going to movies or restaurants, and walking for pleasure or going on an excursion. As you can see, a variety. We saw that the group with high level of leisure activities presented 38% less risk (controlling for other factors) of developing Alzheimer’s symptoms. And that, for each additional type of activity, the risk got reduced by 8%. There is an additional element that we are starting to see more clearly. Physical exercise, by itself, also has a very beneficial impact on cognition. Only a few months ago researchers were able to show for the first time how physical activity promotes neurogenesis in the human brain. So, we need both mental and physical exercise. The not-so-good news is that, as of today, there no clear recipe for success. More research is needed before we prepare a systematic set of interventions that can help maximize our protection.

AF: We typically emphasize the importance of a good nutrition, physical exercise, stress management and mental exercise that presents novelty, variety and challenge. What do you think of the relatively recent appearance of so many computer-based cognitive training programs, some more science-based than others?

YS: Those elements you mention make sense. The problem is that, at least from the point of view of Alzheimer’s, we cannot be much more specific. We don’t know if learning a new language is more beneficial than learning a new musical instrument or using a computer-based program. A few of the cognitive training computer programs we have seen, like the one you discussed with Prof. Daniel Gopher to train the mental abilities of pilots, seem to have clear effects on cognition, generalizing beyond the training itself. But, for the most part, it is too early to tell the long-term effects. We need better designed clinical trials with clear controls. Right now, the most we can say is that those who lead mentally stimulating lives, through education, occupation and leisure activities seem to have the least risk of developing Alzheimer’s Disease.

 

Research interests

AF: Tell us know a bit more about your current research

YS: We are studying a number of related areas, applying neuroimaging techniques to understand how exactly all these Cognitive Reserve concepts are implemented in the brain.

One, we want to understand individual differences in how people approach tasks. We want to measure their efficiency and capacity the brain networks that mediate tasks performance with the idea that those with greater efficiency and capacity might cope better with age-related problems. For example, we can all understand that a competitive swimmer is going to swim better than I would even if he has some weights in his legs, but we haven’t yet identified what exactly is the equivalent in the brain.

Second, we want to understand how old people compensate for the areas of decline. For example, do they begin to use new brain areas when the ones that are typically used start to fail.

Third, whether the Cognitive Reserve presents benefits beyond the prevention of Alzheimer’s symptoms. Does having a higher reserve result in better attention, better executive functions, more successful aging overall?

AF: All very important topics. And I am sure everyone reading this interview will devour any new details on how to build our Cognitive Reserves. Thank you for your time, and please keep us informed.

YS: My pleasure. Thank you for your great educational initiative.

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Great related video on the Nun Study:

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Further scientific reading

Stern Y. Cognitive reserve and Alzheimer disease. Alzheimer Dis Assoc Disord. 2006, 20:112-117.

Scarmeas N, Albert SM, Manly J, Stern Y. Education and rates of cognitive decline in incident Alzheimer’s disease. Journal of Neurology, Neurosurgery, and Psychiatry, 2006;77:308-316.

Scarmeas N, Stern Y. Cognitive reserve and lifestyle. J Clin Exp Neuropsychol 2003;5:625-633.

Stern Y, Zarahn E, Hilton HJ, Flynn J, DeLa Paz R, Rakitin B. Exploring the neural basis of cognitive reserve. J Clin Exp Neuropsychol 2003;5:691-701.

A few related links

• Check our previous interviews in our Neuroscience Interview Series
• Nintendo BrainAge, Happy Neuron, Lumosity, MyBrainTrainer…
• MindFit and Posit Science in the Wall Street Journal’s “Putting Brain Exercises to the Test”