Cognitive reserve and dementia

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Alzheimer's Caregivers Guide

Bruce Miller, director of the Memory and Aging Center at the University of California, San Francisco, and a leading memory loss researcher.

The work is based on research showing that people with dementia who participate in cognitively stimulating activities and are socially engaged have a better quality of life and suffer less depression.

At the same time, patients build up what is called "cognitive reserve," a resilience in the brain that seems to slow down or stop the disease's onset. said Joe Verghese, a leading neurology researcher at Yeshiva University's Albert Einstein School of Medicine in New York. So, for instance, people with large amounts of cognitive reserve might begin showing symptoms of Alzheimer's at 75, instead of at 70, he said.

The most common form of dementia, Alzheimer's is believed to be caused by abnormal deposits of proteins, called plaques and tangles, that may damage and destroy cells and nerves inside the brain. These deposits usually start in the part of the brain that plays an important role in memory and then affect the lobe responsible for planning, ordering and thinking. Eventually, they spread to the parts of the brain that regulate bodily functions, Verghese said.

Patients in the early and middle stages of the disease probably still have the brain plasticity to create new neurons and synaptic connections that might provide something of a bulwark against the disease or might shift functioning to areas of the brain that are unaffected or less affected, Verghese said.

Participants in Northwestern's eight-week project reported feeling more confident and able to cope with their diagnoses, as well as less isolated and depressed, according to Darby Morhardt, an associate professor and director of education at the medical school, who co-founded the project with Christine Mary Dunworth of Lookingglass.

"Alzheimer's disease doesn't completely eradicate the ability to think, create, form friendships and have fun," Morhardt said. "The images people have of Alzheimer's is devastating, but that's not how it starts."

This fall, Morhardt and Dunworth hope to write a curriculum manual so the improv program can be replicated across the country.

Therapies involving the creative arts might be especially effective because they infuse mentally challenging activities with meaning, emotion and a social connection, said Helga Noice, a psychology professor at Elmhurst College,

Noice and her husband, Tony Noice, an actor and adjunct faculty member at Elmhurst, recently received a $1.9 million grant from the National Institutes of Health to use functioning magnetic resonance imaging, or FMRI, to measure whether classes in the theater arts cause measurable changes to seniors' brains.

It is the first such study to look at the physical impact of the arts, and it builds on previous work they have done that shows acting classes improve cognitive functioning in the elderly, many of whom have memory loss.

"Theater is an especially powerful medium of expression for people with Alzheimer's, because it enables them to stand up in front of an audience and tell the people, both who care for them and who love them, how they feel," said Anne Basting, executive director of the Center for Aging and the Community at the University of Wisconsin at Milwaukee.

Basting, who has a doctoral degree in theater, looked into using the arts to help Alzheimer's sufferers as far back as 1996, when, she said, researchers were focusing on improving memory through reminiscence.

"I said forget memory and go to the imagination," Basting said. "It's about making it up in the moment, not about remembering the chronology of a life."

Basting created TimeSlips, a collaborative, improvisational storytelling process that emphasizes imagination over memory or logic. Even if a person in the advanced stages of Alzheimer's has just a syllable or a gesture left, that can be woven into the story, enabling him or her to contribute and bond with the group, she said.

"You can feel the connection, the sense of accomplishment and fun," Basting said. "For people with dementia living in nursing homes, that doesn't often happen."

At House of Welcome Adult Day Services in Northfield, where the staff is trained in the TimeSlips method, a book of stories recently was compiled and published with help from participants with memory loss.

"It validated them as people, their thoughts and feelings and their ability to be creative," said facility director Julie Lamberti.