What is the secret of “brain balance”?
Last Updated: Jan 12 2025
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Whether someone develops symptoms of Alzheimer’s disease depends on more than just whether they have changes in their brain.
People can have large amounts of Alzheimer’s disease (termed “neuropathology”) in the brain, and yet no symptoms of the disease. How can this be?
The secret is something called cognitive reserve, or what aldora calls your “brain balance”.
This article explains the science of cognitive reserve & balance, and a framework to get you started on your personal dementia prevention strategy.
Read on for the science of balance and how it can prevent dementia.
What is cognitive reserve?
Cognitive reserve is a medical term used to describe how strong your brain is. The higher your reserve - or strength - the more you can resist changes caused by disease.
If you can resist the disease, it means you won’t see symptoms for a long time, or possibly ever.
The most famous study describing this phenomenon is the Nun Study.
Researchers found that patients in their 90th decade of life could have large amounts of Alzheimer’s disease pathology in their brain, and yet not have any symptoms of memory loss.
On the other hand, people who had very little disease in their brains could have very severe symptoms.
The difference was in how much they had built up their brain’s strength over their lifetime and whether this outweighted the damage they had accumulated.
The key to a long life is therefore to match, or balance, your strength to the amount of disease that you accrue. That’s where “brain balance” comes in.
Two people can handle different amounts of disease in the brain depending on how much strength they’ve built up over the years.
What is “brain balance”?
To put the science of cognitive reserve into practical steps, think of strength and damage like a set of scales.
You have things that build strength on one side, and things that cause damage on the other.
Based on a combination of real-life clinical experience and leading research, here’s a list of ways to build strength and reduce damage.
Strength is built by:
Maintaining your hearing and vision
Getting formal education beyond high school
Pursuing challenging hobbies
Having an engaging social life
Exercising to improve blood flow to the brain
Eating foods that give your brain the nutrients it needs
Cultivating a growth mindset and ignoring ageism
Getting sleep for recharging and repairing your neurons
Building a sense of purpose for your life
Damage is caused by:
Excessive alcohol
Certain medications like amitriptyline and benzodiazepines
Falls or accidents that cause head injuries and concussions
Unmanaged depression or anxiety
High or low blood pressure
High or low blood sugar
High cholesterol
High or low weight
Smoking
Strokes (from high blood pressure, smoking, high cholesterol, lack of exercise, and/or high blood sugar)
Alzheimer’s proteins (read more here).
Our genetic risk can influence a small part of our ability to build strength or prevent damage, but the majority is in our control.
Your cognitive reserve is how much strength you build up - and therefore how much damage you can overcome.
How to find your balance
Download the handout to see where your personal brain balance sits right now.
The goal is to eliminate as many things as you can from the damage side, and add as many things as you can to the strength side over your lifetime.
The key is to work on these things over months and years - you don’t have to be perfect tomorrow. However, the older you are, the sooner you need to start - like investing for retirement.
The damage caused by Alzheimer’s often starts to develop 10-30 years before symptoms start - meaning you need to be working on your brain balance in your 40’s and 50’s.
However, there are several things you can do to re-balance your brain if you’re developing memory symptoms right now. Read this article for more.
Living a long life is about finding the right balance for your hopes, dreams, and health.
How much can you handle?
The magnitude of the causes of your strength and damage is important.
For example, if you drink 6 beers a day from your 20’s - 60’s, you will need to build up a lot of strength to overcome that damage over a lifetime. The more you drink, the more you’ll need to build strength, and you might not be able to overcome the damage, resulting in alcohol-related dementia in your 70’s.
On the flip side, if you have a glass of wine with dinner, wear hearing aids, go for a walk every day, and take medications to keep your blood pressure around 120-130, you’ll likely be in balance for most, if not all, of your life.
There are no guarantees, but there is a very simple road map for living a long life into your 90’s and 100’s. It’s all about balance.
If your balance is shifted heavily towards the side of damage, you’ll need to do a lot of things to build up your strength to overcome disease.
Start early
The best time to work on your balance is BEFORE your scales get tipped too far to the side of damage.
While it’s never too late, it is certainly easier to make small changes in your 30’s to 60’s to keep your scales in the right range.
If the damage has been there for many years or has progressed to moderate stages of dementia, it can be hard to reverse the symptoms (again, read this article for more on reversing your imbalance).
It never too early or too late to start thinking about dementia prevention.
In closing…
It is important that you know the extent to which you experience symptoms of dementia is in your control. If you choose, you can make a difference for your future.
Memory problems appear when your brain’s strength is outweighed by the damage that has occurred over a lifetime from common, preventable causes.
You can add more strength and prevent damage at any time in your life, but it’s best to start early.
You can find detailed guides for everything that builds strength and prevents damage with aldora’s brain strategies.
Related Posts
Key References:
Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission (Livingston et al, Lancet, 2024, found here).
Healthy aging and dementia: findings from the Nun Study. (Snowden D, Annals of Internal Medicine, 2003, found here).
Ellison J. Healthy aging and cognitive reserve. Alzheimer’s Disease Research, 2021. (Found here).
Havard Medical School. What is Cognitive Reserve? Harvard Health Publishing, 2024. (Found here).
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