Can ‘cognitive reserve’ improve resilience to dementia?

00:07 Ben Moss 

Hello and welcome to the Aviva podcast and another of our data science specials. My name's Ben Moss and today we're going to be finding out more about cognitive reserve and how it links to dementia. Last year a three-month project was launched between Cambridge University and Aviva to look at factors that reduced the likelihood of dementia, one of which was cognitive reserve.  

Now following on from that, and together with a grant from the UK government, a three-year PhD project has now been funded to discuss this further. I'm delighted to say I'm joined by Professor Jon Simons, an expert in cognitive neuroscience from Cambridge University and Simon Warsop, life analytics director at Aviva and we'll start with that. Jon, thank you very much for joining us. Can you just explain, what is cognitive reserve and why it's so important in the prevention of diseases like dementia? 

00:56 Jon Simons 

Hi, good morning. So cognitive reserve really is a concept that we're trying to understand which people use to explain why some people, it seems, are able to maintain a really sort of healthy cognitive ability, despite some of the brain changes that seem to happen that are associated with getting older with aging and with diseases such as Alzheimer's Disease and other forms of dementia. So it seems that there are some people, for some reason or other that we don't really quite understand, are able to sort of stave off those cognitive changes, so the kinds of things like memory loss or disturbances in thinking or problem solving abilities, despite the fact that their brains are getting older. And sadly, as our brains get older, they do start to diminish in their function, they become a bit slower. You know, some of the signals don't work quite as well. The connections between brain cells don't really function quite as efficiently and effectively as they do when we're younger, and despite those brain changes, it seems there are some people for some reason, seemed to be able to maintain quite high levels of cognitive functioning, whereas other individuals certainly do start to feel those brain changes having an effect on their memory and having an effect on other forms of thinking. 

02:06 Ben Moss 

And Simon Warsop from Aviva, we know that this started as a three-month project on dementia, but what interested you as someone who works for an insurance company in taking this project further and focusing in on cognitive reserve. 

02:20 Simon Warsop 

Yeah, hi, Ben, thanks. We asked Cambridge to do a literature review to find out the things that were impacting dementia and the thing that piqued our interest the most was cognitive reserve.  

Now partly because it wasn't terribly well understood there wasn't a lot of consensus in the literature, but partly because this is something where we believe it's possible that people can increase their resilience in the face of dementia, and so could we find ways in which we could help people improve their later lives by staving off dementia.

I think the other idea that was fascinating to us was this idea you might be able to measure cognitive reserve and so you might get to understand early on in life, which people are most at risk of the terrible effects of dementia, and so those two... those two ideas of, you know, increasing people's resilience to dementia and also being able to measure how resilient people are in the face of dementia, meant that cognitive reserve for us was a fascinating area that we really wanted to explore more. 

03:33 Ben Moss 

And then Jon Simons from Cambridge University. I'll come back to you. How much research is being done on dementia? I mean, it's very well known, most people are aware of it and potentially how it can affect people, particularly older people. But how much do we actually know about it? 

03:49 Jon Simons 

We know an enormous amount. There's been an enormous amount of research that has been done over the last few decades on dementia, and we know for one thing dementia isn’t a single unitary thing, there are many different forms of dementia. So, Alzheimer's disease is the most well-known and by far the most prevalent. But there are many other forms of dementia as well that are associated with slightly different types of brain changes and slightly different things that cause those brain changes.

So, for Alzheimer's disease, for example, there's proteins that build up in the brain. Those proteins cause the brain's neurons - the cells in the brain - to function less well and for the connections to become damaged, for example, so that the brain can't talk to a different part of the brain quite as effectively as it can do when we're younger. And we know that there are many things that we can do, perhaps, to understand those brain changes. But at the moment there's not much we can really do to help with those brain changes.

So, there's no cure for these different forms of dementia yet. You know, it's difficult to find drugs that really have any sort of useful effect in reducing these brain changes and, as a result, the sorts of changes to our cognitive function that are associated with those. But what we are really interested in trying to find out is whether there are things we can do earlier on in life.

So as Simon was saying,  we're really starting to be interested in… there's a lot of work going on in the area of trying to understand in, you know, sort of midlife, middle age... are there changes that are very, very, perhaps, subtle changes that might be a kind of precursor. If you like, an early stage of what's going to happen later on in life, and maybe if we can identify what it is that’s going on in midlife that might predict something that happens later on in life. Perhaps at that stage we might be a bit more successful than being able to do something that can intervene, that can maybe either slow down those brain changes or to put in extra support, extra help, give people strategies, do some sort of thing at that early midlife stage that could perhaps slow down those changes.

Or maybe you know, perhaps even prevent those changes from turning into full blown dementia syndrome later on. So that's sort of where we're really at in terms of the cutting edge of the research in this area. 

06:08 Ben Moss 

And Simon, Aviva is a very large insurance company. Do we know how much effect dementia and other cognitive diseases have on our customers? 

06:17 Simon Warsop

Yeah, so we can only really speculate that to some extent. But yeah, as you say Ben, Aviva’s a huge company. We have relationship with our customers throughout their lives and one of the things we've all noticed recently is that lives are getting longer. But for us, the fascinating point in this space is not just the length of life, but the quality of life and it is no surprise that dementia very badly affects quality of life.

Numbers suggest that there around about 850,000 people with dementia in 2014. That's increasing. That’s expected to be over a million people in 2021, affected by dementia, so from various points of view, anything we can do to help our customers increase the quality of their life for longer, so they're spending more of the longer life they're living, more of those years, well is clearly in our interest. 

07:18 Ben Moss 

And Jon, I mentioned in the introduction that there’s now a three-year PhD project, which is being funded partly by Aviva. What’s the objective for the project? 

07:29 Jon Simons

Well, really, we're interested to try and understand this notion of cognitive reserve a bit better and to try and understand “what are the contributors to this thing, cognitive reserve.” It really does exist as an identifiable sort of phenomenon. What is it? If we can determine what factors contribute to this, what factors lead somebody to be more likely to develop cognitive reserve as opposed to not, then you know that might perhaps be important for helping them to age a bit more successfully, maybe even prevent things like dementia from happening.

So really, what we're trying to do is to identify what are those factors and this PhD project is going to explore whether there's information that we can acquire from people, perhaps to do with their background so you know things like their demographics or age and sex and education and socioeconomic status, for example, whether there are a number of different health factors that might contribute to cognitive reserve.

So, for example, people's diets the kinds of exercise they might do, whether they're sleeping well and those sorts of things which all are thought perhaps to be related to some of these cognitive changes. There might be a whole lot of different lifestyle activities that people take part in, so whether they tend to travel, whether they have richer social lives and meet new people, whether they do new things, learning new things, learning a musical instrument or a second language or something like that, different past times people might do.

Generally people, you know, there's a thought that these people have sort of rich and varied sort of lifestyle in terms of new experiences and things that stimulate us cognitively, if you like, then that might also be something that can be helpful in these in terms of staving off these sorts of brain changes. 

So, the kind of things we're trying to do is to say, ‘can we identify all these different factors?’ Lots and lots of information on people, and then see whether that there's any of those factors that predict whether people are, in middle age, more or less likely to show some sort of subtle memory patterns of performance, performance on some of our memory tasks that might perhaps be predictive of something that's going to happen later on in life.  

So you know we might be able to say there's certain subtle changes in memory in middle age that we can relate to that background information, and then that can help us try to understand what it is that means that some people do better on memory tasks in middle age.

Some people do less work on memory tasks, and that might be later predictive of what could happen subsequently to those people in terms of perhaps, you know, leading to something like dementia. 

09:59 Ben Moss 

And I'll hold my hands up here and just be completely open and say that I am not a data scientist, so forgive me if I get this slightly wrong, but the proposal for the project mentioned you're going to be using this “novel approach of continuous episodic retrieval measures combined with computational model-based analysis to reveal the precision with which memories are recalled.” What exactly does that mean? 

10:24 Jon Simons

I apologise for the jargon in that proposal. Lots of technical terms that are very difficult to understand.

Basically, the standard memory tests that are used in most neuro psychological clinics, for example, tend to be memory tests that you give people a list of words to learn, and then you say you know, can you recall that list of words, or was this word on that list? Yes or no.

So, you're asking people to make a kind of binary decision: yes or no. Or something where there's one choice or another choice, and you can... Basically, that's very good for measuring “has somebody remembered that word, yes or no”? You know it gives you that kind of remembered versus forgotten contrast, which is great, but it's not particularly sort of sensitive. It's not particularly subtle, it's just a yes or a no. It's a one or a zero, and what we're realizing more and more is that memory is far more fine grained than that. It's far more rich and varied. There's a lot more going on in memory than that.  

Sometimes we remember things, but we remember them only vaguely. We’re still remembering them, it's just we can't remember so many of the details and it may be a bit fuzzy and a bit vague, whereas there are other times we remember something, and we remember the full-blown details. You know, we remember exactly what happened. We can kind of relive that experience again. We can feel it sort of unfolding in front of us in in our minds eye and we can remember the sights and the sounds and the smells, and who was there and who said what to whom. And all the different things. And it's a very vivid and rich sort of memory. So there's that kind of graduation, but isn't picked up at all in standard memory tests, and so those memory tests are typically not very good at measuring the sorts of subtle changes that we think might be important in middle age, because in middle age we're not talking about people completely forgetting having Amnesia. You know, where they can't remember anything. We're talking, perhaps, about some very, very subtle little changes that might be predictive of what might happen later on in life, so we need a very, very sensitive test to be able to pick those up.

So, we've been developing over the last few years some tests that measure “not remembered versus forgotten” but how precisely people are able to remember their memories. This was called a continuous measure, and the technology where we show items on a screen and those items can be in a random location and they can be in a random orientation. These might be, you know, everyday objects like a glass or a candle or something. Every random orientation, random location and a random colour, and then we present the items on the screen in a memory test later and give people kind of a response wheel and they can move that wheel in a continuous sort of way and just change the location until it's just about precisely where they think they saw it in the first study phase. And then we can change the wheel again, and they can just make the orientation. Just was it that orientation, was it slightly further round to the right, and it's slightly further and they can just keep, you know, adjusting it until they think they're remembering it as precisely as they possibly can. And then we were able to measure with our computer models, we can measure not just have they remembered that item we studied or not, but we can measure how precisely they're remembering all the different factors, all the different features of that item. And that then gives us a much more fine grained and detailed measure of the memory abilities, not just yes versus no, but actually the precision of that memory.  

So, it gives us a lot more detail and hopefully a much more sort of sensitive measure of memory. 

13:43 Ben Moss 

Thank you very much for explaining that, that was much simpler than the language I used in in the question. So, thank you. And Simon, how do you see this research being applied in the real world, particularly in terms of the work that Aviva does? 

13:55 Simon Warsop

Yeah, it's a brilliant question, the Nirvana here would be if we could come up with a way of measuring cognitive reserve that was highly predictive of people's dementia outcomes, then that would be fantastic. But from there being then able to say to people “this is your current measure of cognitive reserve. What is likely to happen in terms of dementia in later life for you is this, but if you do these next actions then you can actually improve your cognitive reserve, and by improving your cognitive reserve you can make sure that dementia is either pushed out a little bit further, doesn't last as long, or maybe doesn't even get you at all”, and so that concept... that idea is incredibly attractive to us. You know, from a societal point of view but also for making sure that our customers, our pensioners, have a better quality of life and that we can help them, you know, much earlier in their life.

So, for us is there's a lot of attraction here in finding this Nirvana, this ability to measure. What Jon describes in terms of testing people's subtlety of memory is really interesting, and of course what we'd be looking to do is take that from there down into a much more simple set of questions that we’ll be able to apply. But you know, I'm thinking a long way down, further down the line here, I think finding great measures, and as Jon described in which isn't binary, was a single fact remembered or not remembered? That is the first step in terms of a long process I suspect here to get into, you know that that Nirvana that we describe about be able to measure it and then be able to tell people how to improve their cognitive reserve. But that would be great if we could do that. 

15:41 Ben Moss

And Jon just a final one for you. It's not every day I get to speak to an expert in your area, so I might be putting you on the spot slightly, but I'll give it a go. Is there anything from your research or from you know, the work you've done that people can take into their everyday lives to maybe help their cognitive reserve? Or, you know, give them a boost, their brainpower, or help them with their memory?

Is there anything in particular that you've pinpointed in your research that says if people do this on a regular basis, that can help. 

16:11 Jon Simons

Well, I think there's lots of research out there suggesting there might be these wonder cures. You know if you just start doing Sudoku's or something, that's going to stave off Alzheimers. There's all these sort of claims that you can see out there, and I think there's some suggestions that if you start doing Sudoku's you can receive a boost from that sort of thing, so that can be a good thing, but it tends to be very short term. 

And I think perhaps what the research is actually telling us, and you know, there's other research that says that something else is also going to be a bit of a benefit, and I think really, what the research is telling us it's novelty. It's doing new things, stimulating your brain by taking on new things that you haven't done before, and varying those things.

So, it might be Sudoku's one week, it might be learning another language another week, it might be doing a bit of painting or something a week after that, lots of social stimulation. Meeting new people. Think putting yourself in slightly, you know, not exactly uncomfortable, but new situations where you don't just act automatically. You’ve got to think how am I going to react in this sort of situation? Or how am I going to learn this new game, or this new task I'm going to set myself?

That constant sort of… slightly stretching yourself, slightly sort of stimulating yourself, does perhaps seem to be something that can help to stave off these sorts of changes. It's been like an exercise thing, you know. If you do the same exercise every day, you rapidly find it doesn't help you very much anymore. You have to move to different exercises, and exercise in different muscle groups and that kind of thing. So, it might be analogous to that. You know, varying things, stimulating yourself, doing new things all the time could well be a very useful thing to do. 

17:42 Ben Moss 

Fantastic thank you very much. Well that was Professor Jon Simons from Cambridge University and Simon Warsop from Aviva. Thank you so much for joining me on the Aviva podcast today. If you want to find out any more about some of the topics discussed in the podcast or get information on Quantum, Aviva's data science practice, please just visit the show notes.