Michael Valenzuela is a psychologist (B.Sc Hons, University of New South Wales), medical doctor (M.B.B.S Hons, University of Sydney, 2004) and clinical neuroscience researcher (PhD, University of New South Wales, 2005). His early career research was recognised by the prestigious Australian Museum Eureka Prize for Medical Research in 2006. He was also named co-winner of the inaugural NSW Young Tall Poppy of the Year in 2011 and received the Organon Medal for outstanding contribution to psychiatric research by an early career researcher from the Australasian Society for Psychiatric Research. In 2011 he received a National Health and Medical Research Council of Australia (NHMRC – Australia’s peak medical research body) Excellence Award, given to the highest ranked early career researcher. In 2012 he began his first independent research-intensive faculty appointment at Sydney Medical School, University of Sydney, establishing the Regenerative Neuroscience Group within the Brain and Mind Centre. In 2015, he received a NHMRC Career Development Fellowship Level 2 (Clinical category), one of only 6 awarded nationally. In 2017 he received the title Professor of Regenerative Neuroscience at the Sydney Medical School.
Cognitive Reserve: A Powerful Tool for Promoting Healthy Cognitive Ageing
Cognitive Reserve (CR) refers to malleable psychological and neurobiological processes that together can help protect and support cognitive health throughout the lifespan. Some of the main drivers of CR are education, occupational complexity and diverse engagement in cognitively-challenging activities in later life. These psychosocial determinants of CR are potentially powerful: meta-analysis has shown that high level engagement in these factors is linked to a 45% lower incidence of dementia over 7 years.
This Symposium will therefore present the latest evidence and concepts about CR and how individuals, community and policy-makers can take advantage of this powerful tool in order to promote cognitive health.
We will begin by outlining the history of CR, as well as identify competing conceptualisations and common misconceptions. This will be followed by a review of some of the biological foundations that underlie CR. Two speakers will then address what can be done to stimulate and promote CR. This includes computerised cognitive training to promote and protect cognition during healthy ageing as well as during the at-risk period of Mild Cognitive Impairment, and complex psychosocial interventions that focus on exposing older adults to new environments that challenge their social, cognitive and physical function.
This Symposium will conclude with a discussion around policy implications for developing and developed nations. Audience participation and contribution will be encouraged and facilitated.
Yaakov Stern: What is Reserve?
Epidemiologic evidence indicates that lifestyle factors including educational and occupational attainment, engaging in leisure and social activities, as well as IQ are all associated with reduced risk of developing dementia. Many of these lifestyle factors have also been associated with reduced rate of cognitive decline in normal aging, and have a similar moderating influence on the expression and progression in many other brain diseases. The cognitive reserve hypothesis posits that individual differences in the flexibility and adaptability of brain networks underlying cognitive function may allow some people to cope better with age- or dementia-related brain changes than others. This is in contrast to the complementary concept of brain reserve, where the variability in the anatomic features of the brain itself provides reserve against pathology. Recent evidence also supports the idea that specific genetic and lifestyle factors may help preserve a healthy brain or enhance brain reserve, a process that has been called brain maintenance. This talk will review the development of and research support for these theoretical concepts. It will also discuss the clinical implications of cognitive reserve for facilitating successful aging
Michael Valenzuela: Neurobiological Mechanisms Underpinning Cognitive Reserve
A multiplicity of brain mechanisms are likely to combine to underpin Cognitive Reserve. ‘Environmental enrichment’ in rodents examines the impact of moving from standard housing to a more complex home cage with opportunities to explore new objects, interact with more cage-mates and exercise with running wheels. It is therefore a useful model of cognitive reserve and has found that pro-neuroplastic changes in gene expression can occur within a matter of hours. Over days there are strong increases in neurotrophic factors, followed by increases in synaptic contacts, neurogenesis, blood flow and vascularisation. Over months, whole brain volume expands. Some of these structural changes have also been found in humans using brain imaging. Functional neuroimaging studies further suggest that reorganisation of brain networks may be an important compensatory mechanism by which older persons with Alzheimer’s disease can remain cognitively healthy. Finally, post mortem human brain studies further confirm the importance of synaptic and neurotrophic changes for understanding cognitive resilience in the face of degenerative neuropathology.
Amit Lampit: Cognitive Training for Building Up Cognitive Reserve
Computerised cognitive training (CCT) is a safe and scalable intervention aiming to enhance and maintain cognitive function using adaptive and controlled practice on cognitively challenging tasks. Large systematic reviews encompassing dozens of trials have established the short-term efficacy and safety of CCT in older adults, and suggested several key principles for designing effective training programs. Yet translation of CCT research into clinical practice and community implementation is still slow, and questions regarding the prevention potential of CCT remain unresolved. Arguably one of key reasons for this translation gap is lack of standardisation in the field, bringing about significant variations in methods and results across studies. In order to close this gap, we are developing new generation CCT technologies for mass delivery of clinical-grade training, remote clinical supervision, monitoring and maintenance of gains. This talk will review the current evidence for CCT across the spectrum of age-related cognitive decline and other brain disorders, novel technologies for delivering effective CCT and current challenges for research and practice.
Michelle Carlson: Complex Community Interventions for Promoting Cognitive Reserve
Volunteering in later life has many benefits, not least for the promotion of the volunteer’s own brain health. For more than 10 years our group has led research looking at the impact of volunteer service programs in which older persons actively participate as agents of learning within public school classrooms, aiding and assisting students in grades K-3.
The Baltimore Experience Corps Trial, a collaboration between Experience Corps, Johns Hopkins, the Greater Homewood Community Corp., was aimed at determining if a new model of senior service improves the educational outcomes of children in elementary schools in Baltimore, as well as the health and functional status of older adults.
The Brain Health Substudy is a nested trial within the larger Baltimore Experience Corps Trial, and seeks to determine whether this complex community-based intervention can directly result in neurocognitive changes in executive function as measured by functional magnetic resonance imaging.
Early results found that Experience Corps can indeed lead to three-way gains: volunteers’ cognition is supported, functional brain activity is modified towards a younger brain pattern, and educational outcomes in the school children is improved.
In this Symposium, the latest findings from both these long running studies will be presented and discussed in relation to a Cognitive Reserve framework.