Calculate Your Cognitive Reserve!

How much alcohol do you normally consume when you drink?

• Zero or less than 1 or 2 drinks in a day

• Occasionally I go out and have more than 3 drinks in one day.

• I do go out and drink more than 3 or 4 drinks in one night multiple nights a week.

• I drink heavily daily.

Even though studies show that it may be beneficial to have 1 or 2 drinks per day, more than this has clear negative effects.  Drinking excessively can lead to severe liver damage, malnutrition and even death. Interestingly, brains of alcoholics resemble brains of elderly individuals in many ways.  Both show a marked reduction in brain volume and sever atrophy of the neurons.  Note that about half of alcoholics are free of brain damage. http://www.mycoloradocounseling.com/Alcohol_Education_A-2.html  Are you likely to change your drinking habits after learning this information?

• Yes

• No

What is the relative size of your brain/head?

• Very large

• Normal

• Small for my body.

Have you had any serious injuries to the head?

• No.

• A couple of not-serious injuries to the head.

• One or two injuries resulting in concussions.

• One or two head injuries resulting in loss of consciousness or loss of memory.

• Multiple, serious head injuries.

Permanent damage to the brain depends on the severity of head injury. The permanent effects of brain damage can affect your cognitive reserve by increasing your risk of Alzheimer's Disease later in life: -Mild head injures result in negligble changes to Alzheimer's prevalence -Moderate head injuries double the risk of Alzheimers -Severe head injuries increase the rate of Alzheimers by 4.5 times Breunig JJ1, Guillot-Sestier MV, Town T. (2013). Brain injury, neuroinflammation and Alzheimer's disease. Aging Neuroscience 5, 26. Even if you do experinced a major brain injury, the flexibilty of the brain is amazing.  The patient below lived despite having a railway spike through his brain.  Likely, alternate pathways allowed him to function despite this injury.     Ratiu P. & Talos I. F. (2004). The tale of Phineas Gage, digitally remastered. N. Engl. J. Med. 351: e21-e21. Even with protective gear, some sports can result in head trauma.  Currently, the adequacy of a football helmet is in question due to the high incidence of long-tem brain damage in athletes.   How often do you wear your seatbelt when in the car?

• All the time!

• Almost always

• Usually

• Not too often, I like to live on the Edge!

How many times a week do you exercise for thirty minutes or more?

• I never exercise. My couch is my best friend.

• I exercise once a week.

• I exercise 2-4 times a week.

• I exercise 5-7 times a week.

• I exercise more than once a day. You can find me at the gym.

As we discussed in class, exercise can affect how you age. Numerous functions of the body can be improved with regular exercise, as shown in the chart below.  Exercise also correlates to higher levelsof antioxidants which may reduce oxidaditve damage. In terms of cognitive aging, increased physical activity has been associated with a decreased risk of Alzheimer's Disease and thus an increased cognitive reserve (Scarmeas & Stern 2003). Reference: Scarmeas, N. & Stern, Y. (2003). Cognitive Reserve and Lifestyle. J Clin Ep Neuropsychol, 25(5), 625-633. Would you modify your exercise routine (or lack there of) in order to increase your health span?

• Yes

• Maybe

• No

How many hours a week do you spend volunteering?

• I never volunteer!!!

• 1-2 hours a week

• 3-5 hours a week

• 6-9 hours a week

• 10+ hours a week

When considered a leisurely activity, volunteering can have a major impact on your cognitive reserve! Elderly people who spent time volunteering were at a statistically significant lower risk of developing Alzheimer's or another cognitive disease compared to peers who didn't volunteer (Scarmeas & Stern 2003). Reference: Scarmeas, N. & Stern, Y. (2003). Cognitive Reserve and Lifestyle. J Clin Ep Neuropsychol, 25(5), 625-633. Would you be interested in finding volunteer work and activities this summer? It's helpful for everyone!

• Yes! I'll definitely volunteer this summer!

• Maybe.

• Probably not

How would you describe the level of stress you are typically under?

• No stress, I'm free as a bird!

• I have a fairly low amount of stress.

• I'm moderately stressed, but I handle it well.

• My stress level is becoming a problem.

• I'm not sure if I can handle any more stress!

Reference: Sonia J. Lupien , Bruce S. McEwen , Megan R. Gunnar & Christine Heim (2009). Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nature Reviews Neuroscience, 10, 434-445. I have a good way to manage my stress

• Yes

• No

Do you frequently engage in novel activities that make you think deeply or in creative ways?  Maybe you play chess, read modern literature, do crossword puzzles, play online role-playing games, or build models, for example.

• Yes, I engage in multiple creative and challenging activities very frequently

• Yes, but I don't get do do these activities as much as I would like

• Yes, but I only participate in these creative activities rarely. I'd do more if I didn't have so much work!

• Who has time for that stuff??

Did you know that the brain cells can actually be made throughout life?

• Yes

• No

Participants who reported a high level of cognitive leisurely activities had a 62% lower risk of Alzheimer’s or mild cognitive impairment at a 12 year follow-up. High was defined as “often” participates in these activities (Sattler et al. 2012). Also, in another study risk of dementia decreased by approximately 12% for each leisurely activity adopted in elderly adults (Stern 2002). References: Sattler, C., Toro, P., Schonknecht, P., & Schroder, J. (2012). Cognitive activity, education and socioeconomic status as preventative factors for mild cognitive impairment and alzheimer's disease. Psychiatry Research, 196, 90-95. Stern, Y. (2002). What is cognitive reserve? theory and research application of the reserve concept. Journal of the International Neuropsychological Society, 8, 448-460.

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Do you have a satisfying social life?

• Yes, I live in a home with other people that make me happy and I have a great social circle.

• Yes, I have a strong social support group, imperfect or not; I love them a lot. I have a lot of good times along with the struggles.

• It’s actually not that great, but I certainly have a social network and people are there if I really need someone.

• I get pretty lonely, sometimes my friends don’t feel so much like friends. I could really use a better support system.

• I am in desperate need of a more concrete and helpful support system.

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How much sleep do you get on an average night?

• Fewer than 5 hours

• 5 to 7 hours

• 8 to 9 hours

• More than 9 hours

In two recent studies, high CR (measured by education and literacy) resulted in better performance on attention and memory tasks in the face of sleep disorders (Zimmerman et al. 2012) (Alchanatis et al. 2005). Forming good sleep habits now will help prevent sleep disorders and problems later in life. Increasing your cognitive reserve is a good place to start! References: Alchanatis, M., Zias, N., Deligiorgis, N., Amfilochiou, A., Dionellis, G., & Orphandidou, D. (2005). Sleep apnea-related cognitive deficits and intelligence: An implication of cognitive reserve theory. Journal of Sleep Research, 14, 69-75. Zimmerman, M. E., Bigal, M. E., Katz, M. J., Brickman, A. M., & Lipton, R. B. (2012). Sleep Onset/Maintenance difficulties and cognitive function in nondemented older adults: The role of cognitive reserve. Journal of the International Neuropsychological Society, 18(3), 461-470.

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What is the highest level of education you hope to achieve?

• High school. I’m there man.

• Four-year Undergraduate

• Masters or other medium-term post graduate level like nursing or PA school

• PhD, MD, Dental, Vet

Years of education is currently the most used measure for cognitive reserve (Barulli et al. 2013). However, studies have indicated that education is not a good measure of cognitive reserve in younger people, perhaps because they haven't reached their full educational potential yet (Barulli et al. 2013). Reference: Barulli, D. J., Rakitin, B. C., Lemaire, P., & Stern, Y. (2013). The influence of cognitive reserve on strategy selection in normal aging. Journal of the International Neuropsychological Society, 19, 1-4.

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Brain size might affect your cognitive reserve simply by having more neurons and white matter (glia) to work with. Cognitive reserve is a theory that incorporates the idea of brain reserve: that increased cognitive functioning can be a direct result from increased potential pathways due to increased number of neurons (Barulli & Stern 2013). Thus, having a larger head could be a genetic factor influencing your cognitive reserve. Reference: Barulli, D., & Stern, Y. (2013). Efficiency, capacity, compensation, maintenance, plasticity: Emerging concepts in cognitive reserve. Trends in Cognitive Sciences, , 1-8.

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Imagine that you will experience significant decreases in memory for the last five years of your life.  For example, you would have difficulty remembering familiar names and places, you would have issues with short term memory, and you would be challenged by new tasks.  How many years of this five year life span  would you give up for one additional year of health span (perfect cognitive function).

• I'd give 4-5 years of LS to gain 1 year of HS

• I'd give 3-4 years of LS to gain 1 year of HS

• I'd give 2-3 years of LS to gain 1 year of HS

• I'd give 1-2 years of LS to gain 1 year of HS

• I'd give 0-1 years of LS to gain 1 year of HS

• I wouldn't give up any years of LS to gain 1 year of HS

  Boduroglu et al (2002) report that Chinese are less anxious about age related declines in memory than Americans.  Further, Chinese individuals are more cognizant of (or at least more willing to report) age related declines in memory.   Part of this decreased anxiety may result from cultural emphasis on respect and honor for elders.  Less of an emphasis on the negative aspect of aging implies that people in Chinese cultures will be less likely to sacrifice years of lifespan to increase healthspan.  Positive views towards aging may also affect individuals comfort and stress levels with the idea of memory decline during aging.  Following from this, one would expect that cultures with the most negative view towards aging might experience the most stress associated with aging. Chinese attitudes towards aging represent more of a type B personality type whereas Western culture represents more of a type A.  Would you classify yourself as Type A or Type B overall?  

• Type A (More organized, rigid etc)

• Type B (Less controlling, more laid back)