We are all afraid of dementia. Many of us witness an experience regarding a person during the process of his lack of memory, identification of electrical functions, gradual impoverishment of social events and finally tracking the ability to think and losing a form of independent existence. We may then have the impression that the personality that lived in a person close to us gradually disappears during his life; we irretrievably part with all his uniqueness and individuality and the resemblance to the person we knew and loved is limited only to external appearance. One of the most difficult aspects is the realization that, while suffering from dementia, one gradually completely loses control over one’s behavior and any influence over one’s life. Such a prospect inspires terror in everyone. At the same time, although the world is constantly researching a cure for Alzheimer’s disease, and every now and then information about some new breakthrough in the treatment of the disease reaches the public, there are still no drugs available that completely inhibit the symptoms of the disease. The information that we have contracted Alzheimer’s disease is therefore tantamount to slowly dying in our lifetime and parting with everything that is important to us and makes us conscious individuals with freedom of choice. Faced with this information and its consequences, we feel completely helpless.
This helplessness is exquisitely illustrated in scenes from the film Still Alice, in which the title character Alice, played immensely evocatively by Julianne Moore, after her memory problems have already been diagnosed as Alzheimer’s disease, first records a video for herself from a more advanced period of the disease, and at a later point in the film watches her own recording. Alice records a message to herself to influence her when she is no longer in control of her life. She instructs her exactly where to go to find the pills intended for euthanasia and what to do with them. Later in her illness, Alice accidentally comes across the recording and is able to understand its message. She attempts to carry out her own intentions, but before she reaches the place where the pills are hidden, interfering factors arise that make her have to stop her action for a while. The degree of impairment of executive functions at this stage of the disease, does not allow the heroine to return to the task at hand after once her attention has been distracted. In the end, Alice completely forgets what she was supposed to do moments earlier and fails to carry out the plan. At this point in her illness, she no longer has the ability to consciously influence her life, and is unable to carry out the assumptions she made earlier. She is doomed to gradually lose cognitive and social functions until she requires total care from others.
For the time being, once we become ill and the symptoms are present enough to be assessed and classified as characteristic of Alzheimer’s disease, other than slowing the disease process through nootropic drugs and using cognitive enhancement exercises, there is nothing we can do to stop the course of the disease. However, current knowledge of brain function leads us to believe that we can, to some extent, influence how quickly the symptoms of this form of dementia manifest themselves.
The concept of brain thresholds denotes the universal level of pathological brain changes, after which symptoms appear (in Alzheimer’s dementia when neurofibrillary tangles and senile plaques cover more than 60% of the hippocampal and parahippocampal curve area and pathology extends to the new cortex area). However, there are individual differences in the clinical picture of the disorder. Which means that despite similarly extensive brain lesions, individuals differ in terms of the depth of disease symptoms they present.
The so-called “brain reserve” hypothesis states that each of us has a certain spare brain reservoir, which is related to the density of the neuronal network, i.e. the scale of synaptic connections, which are found in excess in the brain. There is a concept indicating that in some people the brain reserve is depleted more quickly and symptoms of the disease appear much earlier than in those people whose reserve allows them to use it for longer. Mental deterioration over time will be milder in those who enjoy significant brain reserve compared to those with little. Cognitive resources have an important influence on how an individual will use brain reserve. These resources are a kind of “software” of the brain reserve, thanks to which the cognitive system can function effectively even in a state of cerebral pathology. They involve the ability to optimize and maximize behavior achieved by engaging different parts of the neural network, each of which is responsible for a different cognitive strategy. The amount of cognitive resources is influenced by the number of neuronal connections we manage to build during our lifetime. The more versatile, active and complex our functioning, the richer our neuronal network will be. The development of intellectual abilities is of course significant, but so is the overall variety of life activities. The mental as well as the social and physical spheres of our existence are important. A variety of experiences in relationships with people, engaging in physical activity, constantly developing intellectual skills and acquiring new ones, learning about diverse external environments — all of these have a huge impact on the development of our neuronal connections. Brain reserves and cognitive resources together can slow the development of the disease and mitigate its behavioral consequences. It happens that even extensive and irreversible brain damage sometimes has a sparse disease picture.
What does this mean in practice? The less we allow our brains to become lazy over the course of our lives, the later, even in an Alzheimer’s situation, the problems of our cognitive processes will become apparent, the longer we will retain the efficiency of our social functioning. The expansion of our cognitive resources is influenced by every book we read, yoga class, new person we meet, situation new to us that we have to deal with, every skill we acquire. This is not a matter of irrational optimism, of building false beliefs about the possibility of fully protecting ourselves from disease. We only have the influence to consciously spend a little more time with our loved ones, and to enjoy a little longer all that we have experienced and achieved during our lives. Worth it or not, I leave the decision to the reader.
Bibliography:
Krzysztof Jodzio, 2011 r., „Diagnostyka neuropsychologiczna w praktyce klinicznej”
Anna Herzyk , 2009 r., „Wprowadzenie do neuropsychologii klinicznej”,