Author: Jeevitha Ramesh
A 48-year-old man began to withdraw from social activity and hobbies. The wife thought he was depressed and slow. He denied but admitted he no longer saw life as joyful. He faced difficulty in multitasking, so he stopped doing the accounts and stuck to procurement & sales at the family bakery. At times, he could not recall the names of the workers, also he started to have trouble with planning and execution of daily chores. His wife also thinks that he had unhealthy food habits and at times he couldn’t control his anger.
The above case study is an example of issues faced by a person as he ages and experiences a decline in his cognitive abilities.
The proportion of adults belonging to the age of 35+ are increasing steadily throughout the developed world. In India, the number of people belonging to 35+ is predicted to increase from approximately 45 million currently to 70 million by the year 2030. Advancing age is associated with an increased risk of declining cognitive ability. As humanity celebrates an increase in longevity, societies need to confront changing disease profiles. The number of people suffering from cognitive decline and other brain-related issues is expected to triple by the year 2040, and this will become a major challenge to healthcare systems in near future.
Effective prevention measures should target increasing brain capacity and cognitive reserve. Cognitive decline relates to a decline in several domains of cognitive abilities like problem-solving, executive functions such as planning and organizing. This limits an individual’s ability to complete basic tasks of independent living and also affects mood and personality. As age increases, such persons with declined cognitive functions need increasing levels of assistance with their personal care and safety. Care for such people is both labour-intense and long-lasting, and can be expensive.
Cognitive reserve is a hypothetical construct that moderates the effects of age-related decline and pathological damage of the brain. It refers to dynamic and structural capacities of the brain that buffer against reduction in the number or in the size of the brain cells, or both. It may also act as a buffer against a region in the brain which has suffered damage through injury or tumour.
It is an important concept that is crucial to understanding brain health. You can consider cognitive reserve as your brain's ability to improvise and find alternate ways of getting anything done. Research studies show that factors like level of education and occupational attainment impact positively on cognitive reserve. Also, activities such as meditation, physical exercise and nutrition intake reduce the incidence of cognitive decline in older adults. On contrary, negative lifestyle behaviours such as unhealthy diet, poor management of health conditions, lack of social interaction, lack of novelty or challenge, adversely impact the reserve.
Cognitive reserve can't be directly measured or observed, and other measures like education, intelligence (IQ), linguistic ability, and occupational complexity are often used to understand cognitive reserve.
Physical and cognitive activities are generally accessible options with health benefits. Widespread participation and family/peer involvement will increase the likelihood of long-term maintenance. While it might be optimal to start adopting healthy practices early in life, the available research evidence suggests that it's never too late to extend physical and cognitive activity in old age.
Research shows that cognitive training can improve executive functions through changes in prefrontal brain neuroplasticity. Cognitive activities protect the brain against its decline. Brain training programmes or playing video games directly impacts the brain regions especially prefrontal regions, occipital area and even the hippocampus which are responsible for memory, spatial orientation, attention and fine motor skills.
Physical activity, especially aerobic exercise, supports neuronal structural integrity and preserves the brain's functional capacity and cognitive activity strengthens the functioning and plasticity of neural circuits. Without healthy neuronal structures, one’s ability to participate in cognitive training is undermined. At the same time, the cognitive function appears to reinforce adherence to physical activity programs.
Research has shown that people with high levels of cognitive reserve can deal better with symptoms of degenerative brain changes related to dementia or other brain diseases, like Parkinson's disease, multiple sclerosis, or a stroke. A more robust cognitive reserve also can assist in functioning better if one is exposed to unexpected life events, like stress, surgery, or toxins within the environment where such circumstances demand extra effort from the brain.
In the absence of a vaccine or a disease-modifying agent against decline in brain functions, non -pharmacological interventions such as lifestyle modification seems like the most viable option today.
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