Can Resistance to Alzheimer’s disease be Built?

“Hopefully – through the ‘intelligent’ leisure activities we develop – we can help individuals to build the kind of cognitive reserve that we know is protective against Alzheimer’s disease.” – Dr. Sylvie Belleville

Sylvie Belleville
Dr. Sylvie Belleville is a professor in the Department of Psychology at the University of Montreal, and Director of Research at the Institut universitaire de gériatrie de Montréal.

Despite having no symptoms prior to death, some people end up dying with brains riddled with Alzheimer’s pathology. How do we explain this?

According to Dr. Sylvie Belleville, engaging in stimulating activities over the course of a lifetime is what seems to make the difference.

An indirect benefit of activities, she explains, is that they help to build up cognitive resilience over time, and that same resilience can be harnessed to manage the effects of age-related diseases, like Alzheimer’s disease (AD). Supporting this theory is the observation that individuals who have managed to delay the onset of symptoms – sometimes by several years – have had a high level of cognitive engagement throughout their lives.

Inspired by this knowledge, Belleville and her team are developing a program that aims to build cognitive reserve later in life. It will be tested for validation out of Toronto, ON and Montreal, QC between 2016 and 2018.

Interestingly, it’s not only highbrow academic activities that they have in mind for the program. While it’s true that academic activities – such as teaching actual strategies to store and retrieve information from memory or to better control attention and focus – do improve cognitive resistance in people at risk of developing AD, these interventions are not one-size-fits-all. They do not play to everyone’s strengths and interests equally, and so they can be exclusive and unappealing.

Knowing this, Belleville and her team have chosen to develop a training program that pairs aspects of academic cognitive training with leisure activities. In other words, cognitive strategies that are taught during academic sessions are applied and practiced in the context of engaging leisure activities. The idea behind this is that by applying these strategies outside of the formal lab setting, individuals will be more likely to use them in other everyday life situations.

Drum-strum

The leisure activities Belleville and her team have targeted are learning to play music, learning a second language (Spanish), watching educational documentaries and playing selected video games, because they are known to have a positive impact on cognition in both younger and older adults. Just like more formal, school-based learning activities, these activities engage and train cognition. However, they are also fun, motivating, and accessible, no matter a person’s previous life experiences.

Think of it as a kind of “living laboratory,” where people can experience, practice, and then have guided practice to go through strategies they have learned before, but with the goal of creating new pathways for navigating everyday life, and building up resilience against neurodegenerative diseases.

Thanks to the CCNA, Sylvie Belleville and her team will soon have the opportunity to test their hypothesis.

Once individuals are recruited for this program in early 2016, teams will begin looking at the effects these activities have on overall well-being and on cognitive outcomes, like memory and attention.  They will also measure how well these activities transfer into everyday life tasks, such as managing medications and planning grocery shopping. What’s more, the team will be examining brain imaging to see whether people develop new brain regions when they perform memory tasks, and whether there is a structural impact of the training program on the hippocampus (i.e. a region of the brain which is involved in memory and is also affected early in neurodegenerative disease processes).

Importantly, the same participants will be tested again 18 months to 2 years after the end of the program to evaluate its long-term effects on life and health outcomes, and to determine whether the benefits are maintained even after the activities have stopped.

Their early goal is to provide science-based evidence to support the theory that brain resilience to age-related diseases can be developed later in life. Soon after, if their program is successful, they will work on integrating it into community and care settings, so that it could be offered not by experts, but by individuals who have been trained to facilitate.

This has far-reaching benefit and uptake for the general public. By validating methods for “train the brain” programs, this team will help ensure that they have met the “real, everyday needs of people out of the laboratory and clinic.”