Cognitive reserve & late-life dementia

Changing perspectives regarding late-life dementia
Majid Fotuhi, Vladimir Hachinski & Peter J. Whitehouse
Nature Reviews Neurology 5, 649-658 (December 2009)

Individuals over 80 years of age represent the most rapidly growing segment of the population, and late-life dementia has become a major public health concern worldwide.
Development of effective preventive and treatment strategies for late-life dementia relies on a deep understanding of all the processes involved. In the centuries since the Greek philosopher Pythagoras described the inevitable loss of higher cognitive functions with advanced age, various theories regarding the potential culprits have dominated the field, ranging from demonic possession, through ‘hardening of blood vessels’, to Alzheimer disease (AD).
Recent studies suggest that atrophy in the cortex and hippocampus—now considered to be the best determinant of cognitive decline with aging—results from a combination of AD pathology, inflammation, Lewy bodies, and vascular lesions.
A specific constellation of genetic and environmental factors (including apolipoprotein E genotype, obesity, diabetes, hypertension, head trauma, systemic illnesses, and obstructive sleep apnea) contributes to late-life brain atrophy and dementia in each individual.
Only a small percentage of people beyond the age of 80 years have ‘pure AD’ or ‘pure vascular dementia’.
These concepts, formulated as the dynamic polygon hypothesis, have major implications for clinical trials, as any given drug might not be ideal for all elderly people with dementia.


achievement/personal growth
family/dating relationship
integrity/doing what’s right
free time

I may hallucinate

On Being Sane in Insane Places
Rosenhan, D. L. Science 179, 250−258 (1973).

… the patients often recognized normality

… may be due to the fact that physicians operate with a strong bias toward what statisticians call the Type 2 error. This is to say that physicians are more inclined to call a healthy person sick (a false positive, Type 2) than a sick person healthy (a false negative, Type 1). The reasons for this are not hard to find: it is clearly more dangerous to misdiagnose illnesss than health.

…The tag profoundly colors others’ perceptions of him and his behavior.

There is an enormous overlap in the behaviors of the sane and the insane. The sane are not “sane” all of the time. We lose our tempers “for no good reason.” We are occasionally depressed or anxious, again for no good reason. And we may find it difficult to get along with one or another person–again for no reason that we can specify.

I may hallucinate because I am sleeping … These are termed sleep-induced hallucinations, or dreams

There is by now a host of evidence that attitudes toward the mentally ill are characterized by fear, hostility, suspicion and dread.

At times, depersonalization reached such proportions that pseudopatients had the sense that they were invisible, or at least unworthy of account.

A diagnosis of cancer that has been found to be in error is cause for celebration.
But psychiatric diagnoses are rarely found to be in error.

Wikipedia entry:
Rosenhan experiment

Dream Caused by the Flight of a Bee around a Pomegranate a Second Before Awakening (Salvador Dali).

Change blindness

Magic and the Brain
Scientific American 299, 72 – 79 (2008)
Susana Martinez-Conde & Stephen L. Macknik
•Magic tricks often work by covert misdirection, drawing the spectator’s attention away from the secret “method” that makes a trick work.
•Neuroscientists are scrutinizing magic tricks to learn how they can be put to work in experimental studies that probe aspects of consciousness not necessarily grounded in current sensory reality.
•Brain imaging shows that some regions are particularly active during certain kinds of magic tricks.

Scientific American 18, 16 – 17 (2008)
Vilayanur S. Ramachandran & Diane Rogers-Ramachandran
We have eyes, yet we do not see.
PRETEND YOU ARE a member of an audience watching several people dribbling and passing a basketball among themselves. Your job is to count the number of times each player makes a pass to another person during a 60-second period.

Change-blindness as a result of ‘mudsplashes’
Nature 398, 34 (4 March 1999)
J. Kevin O’Regan, Ronald A. Rensink & James J. Clark
Change-blindness occurs when large changes are missed under natural viewing conditions because they occur simultaneously with a brief visual disruption, perhaps caused by an eye movement, a flicker, a blink, or a camera cut in a film sequence.
We have found that this can occur even when the disruption does not cover or obscure the changes.
When a few small, high-contrast shapes are briefly spattered over a picture, like mudsplashes on a car windscreen, large changes can be made simultaneously in the scene without being noticed.
This phenomenon is potentially important in driving, surveillance or navigation, as dangerous events occurring in full view can go unnoticed if they coincide with even very small, apparently innocuous, disturbances. It is also important for understanding how the brain represents the world.

Big Fish Stories Getting Littler
by Robert Krulwich
February 05, 2014

Do we share the same reality?


Do we share the same reality?

– In daily life we typically assume so …

– …but perceptions are powerfully influenced by:

  • What we happen to be paying attention to
  • Contextual factors
  • Past experience
  • Expectations
  • Motivations (we often see what we want to see and don’t see what …)
  • And many other factors

I’d like to say to young people who are struggling in their own life is:
grown-ups are doing the best that they can but they don’t have any idea what your experience is really like and to the best of your ability you have to trust your instincts …

You will outlive your whole clan!

The lesson of framing research is told in the story of a sultan who dreamed he had lost all his teeth.
Summoned to interpret the dream, the first interpreter said, “Alas! The lost teeth mean you will see your family members die.”
Enraged, the sultan ordered 50 lashes for this bearer of bad news.
When a second dream interpreter heard the dream, he explained the sultan’s good fortune: “You will outlive your whole clan!
Reassured, the sultan ordered his treasurer to go and fetch 50 pieces of gold for this bearer of good news.
On the way, the bewildered treasurer observed to the second interpreter, “Your interpretation was no different from that of the first interpreter.”
“Ah yes,” the wise interpreter replied, “but remember: What matters is not only what you say, but how you say it.”

Chapter 1. Introducing Social Psychology
Myers, D. G. (2012). Social psychology (11th ed.). New York: McGraw-Hill.