Critter Corner: Why Do Some Individuals Have the Capacity to Maintain Thinking and Cognitive Abilities in the Presence of More Advanced Dementia?

Dear Raider, 

I recently read about Diane Norelius in The New York Times Magazine. She was a woman with advancing dementia who was able to mask the severity of her condition pretty well by how coherent and well-spoken she was, despite her memory loss. How is this possible for some people with dementia?  

Thanks for your help! 

Rhee Ziliance 

Dear Rhee, 

Some individuals are able to maintain their thinking, cognitive abilities, and ability to speak coherently in the presence of measurable Alzheimer’s disease-related brain pathology. How can this be possible? 

Cognitive reserve is your brain’s ability to find alternate ways of getting a job done. It enables your brain to pull in skills and capacities to solve problems and cope with challenges, such as losing your memory from dementia. Cognitive reserve is something that is developed throughout your lifetime from education and curiosity.   

The concept of cognitive reserve originated in the late 1980s. Researchers would use it to describe individuals who died with no symptoms of dementia in their lifetime, but at autopsy it was discovered that they had brain changes consistent with advanced Alzheimer’s disease. It was said that these individuals did not show symptoms of the disease while they were alive because they had a large enough cognitive reserve to offset the damage and continue to function as usual.  

A lot of research has been conducted on cognitive reserve, which you can see from the NIH website Reserve and Resilience. Research has shown that people with greater cognitive reserve are better able to stave off symptoms of degenerative brain changes associated with dementia and also with other brain diseases, such as Parkinson’s disease, multiple sclerosis, or a stroke. A more robust cognitive reserve can also help you function better for longer if you’re exposed to unexpected life events, such as stress, surgery, or toxins in the environment.  

Lifestyle Changes Can Help with Cognitive Reserve 

We’ve heard many times that eating well and incorporating exercise in your schedule can help with lots of things. It’s no surprise that these are among the cornerstones of an effective brain health and cognitive fitness program.  

Simply eating more fiber or adding a morning walk to your routine isn’t enough to forestall mental decline, however. Instead, exercise, diet, sleep, stress management, social interaction, and mental stimulation work together to yield results. 

The FINGER Study for Cognitive Fitness 

The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) study looked at preventing decline with simultaneous focus on exercise, diet, cognitive stimulation, social activities, and cardiovascular values. 

“It’s like one hand and five fingers, very easy to remember. Physical activity, healthy diet, cognitive stimulation, social activities, and taking care of all vascular risk factors,” said Miia Kivipelto, physician and professor of clinical geriatric medicine in Sweden. “So, I would say that’s my recommendation. Activate all five fingers every day. Lift the positive and try to reduce the negative factors.” 

A two-year clinical trial of over 2,500 people was conducted on whether lifestyle interventions such as exercise, brain training, and diet could help improve cognitive fitness. Results showed that changing these health and lifestyle factors reduced the risk of cognitive decline by a staggering 30 percent. Read more about the FINGER study and recommendations for implementing some of the findings here. 

Hope this is helpful! 


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About Renee Eder

Renee Eder is the Director of Public Relations for the Farr Law Firm, and gives the voice to the Critters of Critter Corner. Renee’s poodle, Penny, is an official comfort dog who she and her children bring to visit with seniors who are in the early stages of dementia at a local senior home once a month.

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