People with more years of schooling appear to suffer the symptoms of dementia later than others who have it — but once it does come, it proceeds more quickly, researchers say.
The hypothesis is one of a cognitive reserve, which as I understand it, prevents decline kind of the way that aerobic exercise builds muscle mass and prevents muscular atrophy or dystrophy. That is to say, if a person “strengthens” the mind with increased intellectual challenges and education, they can delay degeneration into dementia, as typified in Alzheimer’s. Or seem to.
Though I can’t think of a specific study to support it, I remember reading all over the place that habits of lifelong learning and continued mental stimulation (i.e. reading, doing crosswords, taking up new hobbies, having challenging conversation and a dynamic living environment) can significantly improve one’s alertness and sharpness into old age, as well as stave off the effects of dementia. It makes perfect common sense, with the idea that if you want to keep your mind, you must use it, but it also makes a degree of metabolic sense.
The last I studied Alzheimer’s (which is already an embarrassingly long time ago), the working model was one of beta amyloid plaques and tangles which cause neurodegeneration. In lay terms, there’s gunk clogging the cells, so they get messy and the brain doesn’t function as efficiently.
There was some suggestion that nutrition played a role, but ultimately the causes were thought to be either unknown or genetic. Because it is an irreversible pathology, this is an important disease to study, and in cases like my family, where there is a strong history of dementia and mental decline, it’s worrying to believe it may simply be inevitable (hence my father’s current “If I get that way, please shoot me in the head” attitude). Therefore, I am always interested in studies like these and what they reveal.
An interesting aspect of this study is that because more highly educated people do have a greater cognitive reserve, it can be more difficult to detect symptoms of degeneration as quickly (this makes me worry that this is the only real delay in the effects of dementia – one of detection and not pathology). That is to say, someone with a PhD could probably speak at length on a given topic and sound very intelligent, maybe forgetting a word here or there, but we wouldn’t be as quick to say they’re losing their mind because they stillseem so sharp and on the case. Unfortunately, it is very possible that you could ask that same person if they’ve had breakfast that day and they won’t have any idea what on earth you’re talking about. I worry that this may be happening with my grandmother.
To quote my mother’s eloquent summary,
So I’m getting that the cognitive reserve actually could mask the fact that you have dementia for a good long time but once that reserve falls apart, the walls come tumbling down worse than the slow slip into dementia.
She then suggested that the studies which support the preventative power of lifelong learning that I brought up may simply be enhancing the cognitive reserve, in a way protracting or prolonging the inevitable decline, with a buffer. She asked, “How long could you keep that up, like maybe your whole life?” I certainly hope so, but I think there is more to it than just keeping a knowledge base close at hand.
A big facet of dementia, as I see it, is behavioral. I know, this is weird, but hear me out. Both of my father’s paternal grandparents spiraled into dementia and complete senility as they aged, so he fears it is genetic. I believe it is more likely that their life habits contributed, and because I didn’t know them personally, this is all speculative, but things like not reading in adulthood, social or personal isolation, an arrogant refusal to have one’s beliefs challenged, believing that senility is just a part of getting old, and so on could cause a person to get set in their ways and halt intellectual activity. If they aren’t forcing themselves to be specific, to keep their memory and alertness sharp, then it would be easy to forget more and more and “slip” much more frequently. (Counter example, I think the reason I have a strong vocabulary is because I force myself to learn and remember the specific words I want, and I look up the ones with which I’m vaguely familiar but can’t pinpoint exact meanings).
It’s like intellectual rigor in a way, but applied interiorly. The kind of mental stagnation of an older person set in their ways would have to have metabolic ramifications, and if it is eventually determined that Alzheimer’s and dementia have metabolic roots (which I really believe they do), then it would all fit perfectly.
To put it a little more crudely, I’ll use the words of a family friend who died of ovarian cancer, describing her “pipes”: “If you don’t use em, they turn on you.”
I must reiterate, I don’t think degeneration is inevitable, even if there is a genetic link. After all, some families also have histories of alcoholism, schizo-affective disorders, and reclusion, but we don’t necessarily have to follow those paths either. Being aware of the history gives a person the means to take preventive measures (education, good nutrition, developing lifelong learning habits etc), which could stave it off longer.
I’m imagining the brain like a subway line in the city that is mental health. If certain lines go unused or neglected, they’ll eventually get cluttered with trash, vagrants, dead rats, and the like. When you then try to send a train down a long-neglected line, it’s possible it will run over some of this clutter or get derailed by some home-made extension r
oute a wino built. These would be the hiccups and lapses caused by plaques and tangles which characterize the early stages of dementia.
I think the ego can exacerbate this. As long as a person is aware of the slips, they will take pains to conceal them, deny lapses, or avoid topics or scenarios which could trigger embarrassing situations. If someone can’t remember if they’ve eaten, they’ll say they have, so as not to be a bother. It’s a lousy example, but I’ve noticed a lot of older people stop calling children by name, instead dolling out generic terms of endearment, in part because it keeps them from calling a child by the wrong name. I’ve also noticed that they regard their own grandchildren and complete strangers’ children with the same level of warmth and familiarity, which may be general benevolence, but could mask a lack of recognition (always better to err on the side of being overly friendly than to sleight one’s grandson). Where it gets nefarious is in the ways a person tries to hide degeneration from himself, and there it is possible that the habits of non-specificity or actions which do not depend on memory become self-fulfilling: they simply wander through the world without names, details, or memory relating them to the present moment.
If in contrast, a person were to maintain the lines, sending trains down regularly even if it’s not necessary (i.e. reading books on a variety of topics, staying abreast of current events, hearing and considering all sides of issues, learning new skill sets, challenging the memory, reconsidering old beliefs etc), the lines stay clear, or at least we learn of problems sooner, perhaps early enough to begin repairs (treatment) before full-on service gaps set in.
Definitely a solid argument in favor of an intellectual life of continued learning and mental flexibility. Even if they have no bearing in preventing Alzheimer’s, and dementia really is as inevitable as my father fears, at the very least the quality of life leading up to it would be greatly enhanced by constant mental stimulation.
My mother put it most succinctly at the conclusion of our email exchange – “You stop learning, you stop living.”
(Images linked to their respective sources.)
Edited to Add – from today’s Times, an article on the benefits of exercise for the brain.