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Recommendations for Building and Maintaining Cognitive Reserve

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In my article about optimizing brain health throughout adulthood, I shared that many factors impacting brain health and dementia risk are modifiable. Multiple aspects of brain health are in our control, and that knowledge can bring optimism and empowerment for many.

Although we cannot have the certainty of perfect cognitive health in our older years, our brain can develop some resilience in the face of brain changes that may not be entirely in our control. Cognitive reserve helps our brain to cope with any declines it faces. We are all born with some amount of cognitive reserve, and we can build on the strength and amount of this cognitive reserve. Whether it's doing things that potentially help develop new brain connections, help with early dementia detection, or reduce brain risk, our cognitive reserve can be maintained and expanded.

Ultimately, we all want to keep our minds as strong as possible for as long as possible. Here are some recommendations to keep what we have and increase our brain's ability to cope with whatever may come its way.

7 Tips for Maintaining and Building Cognitive Reserve

1. Focus on Your Heart Health.

Focus on Your Heart Health

Whenever someone asks me about brain health and what might be important to maintain cognitive reserve, I often speak about the significance of heart health. Heart and brain health are very much related. Cardiovascular conditions like high blood pressure, high cholesterol, and diabetes narrow blood vessels and reduce blood flow. Since the brain can only store blood oxygen (the brain's fuel and energy) for several minutes, we need the blood flow to the brain to be strong and unobstructed.

Cardiovascular conditions like high blood pressure, high cholesterol, and diabetes are the highest risk factors for Alzheimer's disease and vascular dementia. Many of these risk factors can be associated, so if you have one, consider yourself at high risk for another and aim to be proactive. But even with a family or personal history of cardiovascular conditions, you can still make changes that may benefit you down the line!

Suppose you or your doctor is concerned about any aspects of your cardiovascular health. In that case, it is never a bad idea for your brain to consider medications (e.g., statins), treatment, or other lifestyle changes (e.g., exercise, diet). During visits and lab work, ask to monitor your blood pressure, blood sugars, and cholesterol. These actions can help keep your heart and, therefore, your brain healthy. Also, if cognitive impairment or dementia were to occur, good blood flow to the brain decreases brain load and stress. We want to do whatever we can to preserve brain function as long as possible, and good heart health is key.

2. Be Your Own Medical ‘Manager.'

Be Your Own Medical ‘Manager.'

Being an advocate for your health can help your brain! Although doctors are experts in medicine, you are the expert on yourself. It may feel difficult at times to speak up, but having informed conversations about your health is always your right. Here are a few recommendations to help you in your medical “manager” role and to keep that cognitive reserve:

  • Aim for annual doctor visits. Having a yearly physical exam and someone you can contact about your health questions is key to addressing many of the modifiable factors that I discussed in my other article on optimizing brain health throughout adulthood.

Bonus: Those who connect with their physician annually (at the least) have fewer hospital admissions! Since staying out of the hospital reduces your chance of delirium,1 this is a win-win for brain health.

  • Ask your primary care physician to help you review your medications a few times a year. Work with your doctor to identify and potentially reduce your use of drugs that may not support brain health. Certain medications, like anticholinergics,2 may deserve extra consideration to reduce or discontinue, given their negative impact on cognition in the short and long term.3 It's OK to ask questions like, “Why do I take this?” If you are taking more than four medications, see if any can be removed (although going below five may not be possible, it still may be helpful to ask). Also consider all the over-the-counter medications you take, even if you don't take them daily. In addition to considering if too many medications are prescribed, confirm the amount and frequency, since the overtaking of medications can occur. Overtaking may include occasionally forgetting and retaking a dose by accident. Also, ask about the benefit of pillboxes or reminders for medications, especially for those involving heart health.
  • Speak to your doctors and specialists to see if it's worth it for them to communicate or collaborate. Although electronic medical records may allow for shared notes, we cannot assume that doctors read each other's notes. Ask your doctors to speak to each other if it's important to you or if important information may need to be relayed between providers.
  • If they are not completed or ordered during your annual physical exam or other medical visits, consider asking for tests or labs to monitor your blood pressure, blood sugars, and cholesterol. As mentioned earlier, heart health is brain health, so extra advocacy and monitoring of these types of tests can only be to your brain's benefit.
  • Ask for a cognitive or memory screening if you are concerned about your memory.

Also, addressing and diagnosing sleep apnea, achieving optimal hearing, and staying out of the hospital (unless necessary, of course!) can be vital for brain health and maintaining cognitive reserve. In your medical “manager” role, consider speaking to your doctor about these other key aspects of health, given their link to brain health and intervention:

  • Speak about your sleep habits, bringing up any concerns about sleep apnea (e.g., loud snoring, feeling tired even after a full night's sleep). With CPAP therapy or other types of related medical intervention, many can reverse the adverse brain effects of sleep apnea, even if severe!
  • Speak to your doctor about your hearing and use of hearing aids if you have them. With social engagement as a critical aspect of brain health, diminished hearing can impact the ability to participate in valuable conversations, decrease mental stimulation, and heighten social isolation. Given this, the use of hearing aids, if needed or prescribed, helps with brain health. Using them consistently is also beneficial, since the brain likes consistency. Also, if you have hearing aids and they do not work correctly, ask what can help!
  • Speak to your doctor about any recent falls and fall prevention in general. Falls happen, and sometimes we cannot prevent them. However, we also know that falls often lead to hospitalizations. Hospitalizations increase unwanted environmental factors that increase the chance of infection, confusion, and delirium. It may be helpful to survey your home to move furniture and flooring or rugs that can be hazards. The last thing we want is a fall after all your hard work to support your brain health! Also, pay some extra attention to the use of medications or alcohol that cause imbalance or dizziness.

3. Get a Timely and Accurate Dementia Diagnosis.

Get a Timely and Accurate Dementia Diagnosis

Although no drugs or treatments can cure dementia, current Alzheimer's treatments may temporarily improve symptoms or slow down memory loss and difficulties with thinking and reasoning. Treatments may also manage the disease's behavioral symptoms. The earlier these medications are taken by someone who needs them, the better!

However, one cannot start an appropriate medication without an accurate diagnosis. Without a correct diagnosis, one may spend a lot of unnecessary time and energy on treatments that are not helpful, which may ultimately decrease rather than build on your cognitive reserve. The last thing we want is something to go wrong with doctors not knowing what is happening in your brain.

A neuropsychological evaluation is the best method and true gold standard for a timely and accurate mild cognitive impairment or dementia diagnosis. Neuropsychologists are the experts in looking at timelines and creating the blueprint for your brain health. In a neuropsychological evaluation, they systematically compare your current functioning to your abilities before being concerned about your cognitive functioning. Neuropsychological test results will offer a diagnosis and recommendations for the next steps to best support your brain health. You will also learn about your cognitive strengths and be given ideas for maintaining these strengths and your cognitive reserve.

4. Work Your Brain!

Work Your Brain

Challenging your brain is extremely helpful for brain health throughout your life and can be especially beneficial later in life. More specifically, keeping your brain active and engaged in complex mental activity is associated with a lower risk of dementia and greater cognitive reserve.4 Also, if you have been diagnosed with dementia, complex mental activity slows decline!

There's a recipe to get the most out of this brain work. The best activities are novel or new, challenging, enjoyable, and repeated. We want your brain to sweat a bit, but not too much. We want to learn new information to hit the sweet spot for facilitating neuroplasticity or synaptogenesis,5 which involves the continued formation of connections between neurons. This helps create a cognitive reserve that provides a buffer against cell loss due to dementia. In general, our brain networks grow more robust when the activities that keep our brain active involve some newness or novelty, we repeat them until they're familiar, and we complexify and enjoy them as much as possible.

Generally, my clients find the most benefit in choosing activities or hobbies that they once enjoyed or developing new activities that are both challenging and pleasurable. We don't want anyone to suffer in the name of brain health! These are some examples of what my patients have found worthwhile:

  • Reviewing a new language or returning to one they used to speak or study
  • Learning a new electronic device or app or organizing their email
  • Looking back at old textbooks from school
  • Trying out new recipes and possibly cooking more
  • Trying out a new craft or art
  • Learning a new card game
  • Building a piece of furniture
  • Exploring maps from countries they have visited or want to visit
  • Planning trips on a subway or train

It can be useful to make a list of topics or activities that you would like to do or learn about and keep trying and investigating.

5. Consider Regular Exercise or Movement.

Consider Regular Exercise or Movement

You've likely heard this many times already, but exercising is one of the best ways to keep the brain oxygenated and functioning well. While any amount of exercise more than you are already doing is a plus, participating in at least 20 minutes of physical activity that causes breathlessness and sweating at least twice a week lowers the odds of dementia (especially Alzheimer's disease) by 50 percent.

Quick tip: Any type of increased movement (more movement today than you did yesterday) is good for your brain and worth affirming!

Exercise has many direct and indirect benefits for brain health, cognitive reserve, and wellness.6 Exercise has these direct benefits:

  • Increases heart rate and pumps more oxygen to the brain
  • Reduces insulin resistance and helps keep blood sugars down
  • Lowers blood pressure
  • Improves cholesterol levels
  • Reduces inflammation
  • Enables the production of growth hormones, which help brain cells grow and survive
  • Stimulates the growth of new connections and blood vessels in the brain

So ultimately, exercising helps with brain neuroplasticity and cognitive reserve. Also, interestingly, engaging in a program of regular exercise of moderate intensity for six months is associated with an increase in volume in the parts of the brain that control thinking and memory, compared to those who did not exercise. Indirect benefits of exercise include improved mood and wellness, improved sleep, and decreased stress and anxiety.

6. Watch Your Diet and Alcohol Intake.

Watch Your Diet and Alcohol Intake

Considering what you consume can help your mind and your body. It may also buffer your brain against potential disease, risk, and cognitive declines. Over the past few decades, there has been a growing understanding of the long-term effects of a health-promoting diet in contrast to a less healthy diet. Certain foods we eat can impact cardiovascular conditions and, therefore, the brain. For instance, high amounts of saturated fat increase cholesterol, high amounts of salt increase stroke risk and high blood pressure, and high amounts of sugar heighten the likelihood of Type 2 diabetes.

Those who eat a Mediterranean-style diet (which emphasizes fruits, vegetables, fish, nuts, unsaturated oils, and plant sources of protein) have a reduced risk for developing cognitive impairment and dementia.7 Also, the Physicians Committee for Responsible Medicine recommends:

  • Eating plant-based foods and berries
  • Eating foods rich in vitamin E, like leafy greens and seeds
  • Increasing your intake of vitamin B12 (to preserve nerve function)
  • Taking a multivitamin without iron or copper (as these metals can harm brain health)
  • Minimizing the consumption of saturated and trans fats

In general, a well-balanced diet will decrease the need for supplements. However, aim to get your blood levels tested for B12, vitamin D, and iron, and consider supplements if you are deficient.

Also, dietary guidelines8 suggest keeping alcohol use in moderation to best support brain health and maintain cognitive reserve. One thing to consider in this recommendation is that aging can decrease the body's tolerance for alcohol. Furthermore, the older we get, the more quickly we may experience the effects of alcohol, including impairments to balance and coordination, memory, attention, and the skills necessary for driving. This impact puts older adults at higher risks for car accidents, falls, and other unintentional injuries resulting from alcohol use.

Given the importance of staying out of the hospital (if possible), these may be helpful factors to consider when thinking about your alcohol use. Recommendations are up to one drink per day for women and up to two drinks per day for men.9 It may be useful to keep track or tally up how much alcohol you drink a day or week to consider whether a reduction makes sense.

7. Socialize!

Socialize

We are social creatures by nature. Interestingly, there are parts of our brains that exist only for social stimulation. These brain regions “light up” only when encountering a familiar face or in an interpersonal context. The fact that unique brain regions are activated makes social connectedness extra helpful in maintaining and building cognitive reserve. Furthermore, communities with the highest life expectancy and highest per capita centenarians (those who live to 100) have a sense of belonging to a larger community and regular interaction with social groups that promote healthy behaviors.

The neat thing about social connectedness and related reduction of dementia risk is that it matters less what it is or how many people are involved (so being engaged with only one other person counts!), and more that the interaction satisfies you. For the most benefit, you'd want the experience to be meaningful to you in some way. Consider finding ways to be part of your local community, such as volunteering, joining a club, attending a spiritual or religious community event, or attending learning-based events. You may also want to engage in activities with friends and family.

Written By

Abby Altman

Geropsychologist/Senior Mental Health Expert

Dr. Abby Altman is a geropsychologist and a consultant for SeniorLiving.org on the subjects of senior mental health and healthy aging. As a daughter of an occupational therapist working in nursing homes, Abby Altman, Ph.D., learned from a young age to appreciate… Learn More About Abby Altman

Citations
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  2. Drugs.com. (2021). Anticholinergic Drugs to Avoid in the Elderly.

  3. Weigand, A. J., Bondi, M. W., Thomas, K. R., Campbell, N. L., Galasko, D. R., Salmon, D. P., Sewell, D., Brewer, J. B., Feldman, H. H., Delano-Wood, L., & Alzheimer’s Disease Neuroimaging Initiative (2020). Association of anticholinergic medications and AD biomarkers with incidence of MCI among cognitively normal older adults. Neurology, 95(16), e2295–e2304. https://doi.org/10.1212/WNL.0000000000010643

  4. Landau, S. M., Marks, S. M., Mormino, E. C., Rabinovici, G. D., Oh, H., O’Neil, J. P., Wilson, R. S., & Jagust, W. J. (2012). Association of lifetime cognitive engagement and low β-amyloid deposition. Archives of neurology, 69(5), 623–629. https://doi.org/10.1001/archneurol.2011.2748

  5. Lumen. (2021). Brain Development.

  6. Harvard. (2014). Boost your thinking skills with exercise.

  7. Lourida, I., Soni, M., Thompson-Coon, J., Purandare, N., Lang, I. A., Ukoumunne, O. C., & Llewellyn, D. J. (2013). Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology (Cambridge, Mass.), 24(4), 479–489. https://doi.org/10.1097/EDE.0b013e3182944410

  8. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020.

  9. National Institute on Aging. (2021). Facts About Aging and Alcohol.