(Editor’s Note: what fol­lows is an excerpt from Dr. Gary Small and Gigi Vorgan’s new book, The Naked Lady Who Stood on Her Head: A Psychiatrist’s Sto­ries of His Most Bizarre Cases)

CHAPTER TEN

Brain Fog

Sum­mer 1990

Gigi and I had moved to Stu­dio City, about a forty-minute com­mute to UCLA. On week­ends, we often went to the movies at Uni­ver­sal City­Walk, a repli­ca­tion of Los Ange­les within Los Ange­les. Why peo­ple couldn’t just walk down the real streets of Los Ange­les made no sense to me, yet there we were, on a Fri­day evening, eat­ing ice cream and strolling down a sim­u­lated street.

We had just seen Total Recall, Arnold Schwarzenegger’s new sci­encefic­tion film about a con­struc­tion worker who under­goes a false mem­ory trans­plant that takes him on an imag­i­nary trip to Mars. But things go wrong, and when he comes out of it, he can’t tell what’s real and what’s imagined.

“When he first got back from Mars, there were so many signs that he was from the future that I believed it,” I said.
“But honey, before he had that mem­ory implant done, he was per­fectly happy liv­ing in the present—on Earth. Then he got all para­noid.”
“Of course he did. How do you know what’s real­ity if you can’t trust your mem­ory?” I asked.
“I don’t know; you’re the mem­ory expert. I want to go into this shop for a minute.” Gigi dis­ap­peared into a record store.

As I ate my ice cream and watched the crowds, I kept think­ing about those ques­tions. If two real­i­ties seem equally true, how would you know which ver­sion to believe? Many of my patients strug­gled with sim­i­lar issues, whether they were psy­chotic, demented, or sim­ply hav­ing mem­ory problems.

Over the past few years, I had begun to con­cen­trate a large part of my prac­tice on mem­ory issues—not just in older patients with Alzheimer’s dis­ease but in middle-aged peo­ple who were wor­ried about their increas­ing for­get­ful­ness. My research was also focus­ing on early detec­tion of demen­tia and age-related mem­ory decline, and I was devel­op­ing brain imag­ing as a diag­nos­tic tool.

Gigi came back with a bag of CDs and said Read the rest of this entry »

Given the grow­ing media cov­er­age men­tion­ing the terms Cog­ni­tive Reserve and Brain Reserve, you may be ask­ing your­self, “What exactly is my Cog­ni­tive (or Brain) Reserve?”

The cog­ni­tive reserve hypoth­e­sis, tested in mul­ti­ple stud­ies, states that indi­vid­u­als with more cog­ni­tive reserve can expe­ri­ence more Alzheimer’s dis­ease pathol­ogy in the brain (more plaques and tan­gles) with­out devel­op­ing Alzheimer’s dis­ease symptoms.

How does that work? Sci­en­tists are not sure but two pos­si­bil­i­ties are con­sid­ered.
1. One is that more cog­ni­tive reserve means more brain reserve, that is more neu­rons and con­nec­tions (synapses) between neu­rons. Indi­vid­u­als with more synapses would then have more synapses to lose before the crit­i­cal thresh­old for Alzheimer’s Dis­ease is reached.
2. Another pos­si­bil­ity is that more cog­ni­tive reserve means more com­pen­satory processes. The brain of indi­vid­u­als with more cog­ni­tive reserve would use more alter­na­tive net­works to com­pen­sate for the dam­ages caused by the pathol­ogy in pre­vi­ously used networks.

In a newly pub­lished study, Roe and col­leagues from Wash­ing­ton Uni­ver­sity in St. Louis, used the num­ber of years of edu­ca­tion as a mea­sure of cog­ni­tive reserve. Why years of edu­ca­tion? Because pre­vi­ous stud­ies have shown that peo­ple who have more edu­ca­tion also exhibit a greater resis­tance to Alzheimer’s symp­toms, even while patho­log­i­cal changes are occur­ring in the brain (see Ben­nett el al., 2003 or Roe, Xiong, et al., 2008).

Roe and her col­leagues stud­ied 198 indi­vid­u­als whose mean age was 67. Out of these 198 indi­vid­u­als, 161 were non­de­mented and 37 were diag­nosed with Alzheimer’s Disease.

All the par­tic­i­pants in the study took a Read the rest of this entry »