Cognitive Reserve and the Aging Brain
This week’s New York Magazine featured a story about David Milch, creator of the HBO series Deadwood, who was recently diagnosed with Alzheimer’s. “Milch started to worry that something was amiss five years ago,” wrote the reporter, “when he and his friends and relatives noticed more instances of ‘imperfect recall and tardy recall and short temper. I became more and more of an acquired taste,’ he says.”
Milch handed off the day-to-day responsibilities of nurturing his latest project, Deadwood: The Movie, to his collaborators, but he was also present on set for the filming as an observer and is forging full steam ahead with––get this––an autobiography.
For those of you who’ve never attempted to write an autobiography without a diagnosis of Alzheimer’s, let alone with one, I can tell you from personal experience, having published one and now working on another, that it is not for the faint of heart or faint of brain. Writing a book takes laser concentration for extended periods of time, which is why I particularly loved what Milch’s wife said about her husband’s latest endeavor: “Rita says the silver lining in all this,” writes the reporter, “is that her husband’s job requires him to routinely participate in memory-strengthening exercises that most other people encounter for the first time in Alzheimer’s therapy. ‘I compare it to a musician who can still play and has access to the memory of how to do that and is still able to exercise his talent,’ she says. ‘The brain is David’s most exercised muscle.’”
The same day I read this story about Milch’s diagnosis and improbable new book, I met with neurologist Dr. Lisa Mosconi, associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College. We were meeting to talk about a different topic, which I’ll cover next week in our blog, but as an aside, I asked her about this idea of staying active in one’s job past retirement. “There is an association between being good at your job––having a job that brings out the best in you in some ways, whether intellectually or in other forms––and a lower risk of dementia down the line,” she said. “There are some studies showing that postponing retirement has also been associated with a lower risk of dementia in later years. And I think it all comes down to cognitive reserve.”
“Your brain is built of neurons and connections between neurons,” she continued. “And these connections need to be strengthened, because otherwise they will die. There’s a process called pruning, where if you don’t use your dendrites, the connection between neurons will atrophy. They will actually withdraw. So it’s really kind of a use it or lose it situation in the brain.”
My grandmother, for example, worked as a lawyer––yes, she was one of the first female lawyers in the U.S.––all the way through her late 70’s, and her brain remained sharp as a tack until her death in 1991 at 82. In fact, when her husband (my grandfather) died, and she moved across the country to be closer to my parents, she had to take the bar exam––in her late 60’s; the oldest woman to ever take the bar in Maryland––in order to work in a new state. At the time, I wondered why she didn’t just relax into her widowhood and retirement. “I like to keep my brain active,” she told me. This was before research suggested that keeping cognitive decline at bay and working past the age of retirement might be causal.
The key, Mosconi told me, was actually liking your job and finding it engaging. I immediately thought of Ruth Bader Ginsberg, who’s now 86 and still sitting on the Supreme Court; Joe Biden, 76 and running for president; Warren Buffet, 88 and still investing. Perhaps, as we learn more about the link between enjoyable work and cognitive reserves, we will see fewer seniors leaving their jobs at 65.
I’m in awe of David Milch’s decision to embark on a new book project after an Alzheimer’s diagnosis, and yet at the same time I have now come to understand that he’s actually doing what his brain craves most at this crucial moment: keeping it active, by creating new pathways, Alzheimer’s be damned. We here at Neurotrack not only wish him all the best as he heads into this new project, we can’t wait to read the finished product.