Spaces for brain restoration: reserve and resilience

Why do some people who lived through war, abuse or terrible loss overcome these situations, becoming stronger? In physics, a material is resilient when deformed by a force, recovering after its original shape. In recent years, neuroscientists have realized that the brain behaves similarly. 

For different reasons, our brain can react and restructure itself in traumatic situations, although the 'restoration' capacity varies across the population. The scientific community has focused on this capacity in the last decade to understand it, delve into its mechanisms, and try to find out how to enhance it.

A new field of research

The capacity for restoration is commonly related to aging. It brings for example protective factors in Alzheimer's disease, and also in the evolution of other brain diseases. It seems that resilience is linked to a special brain property known as reserve, and these two to a third one: brain maintenance. These are abstract ideas, in the way that they are not related to something material —an area of the brain, a particular circuit— but rather work as an emergent property or construct of our psyche. They work quite much like a life preserver does. Another way to imagine it is the space left on the road in front of a braking big truck, to avoid an accident. Perhaps it may also be simply represented as a shock absorber.

In this emerging field, one of the problems researchers have is to find a common way to call these features. Over the past few years, evidence pointed to the same restoration and reinforcement phenomena, although scientists have sometimes called them in different ways. The Collaboratory on Research Definitions for Reserve and Resilience in Cognitive Aging and Dementia, funded by the National Institute on Aging and part of the U.S. National Institute of Health, includes renowned researchers such as Spanish neuroscientist Álvaro Pascual-Leone. They are trying to provide consensus, to move forward in the same direction. 

In an article published last year in Neurobiology of Aging, they define the ideas of resilience, reserve, and brain maintenance. It is worth commenting on them:

Resilience is the brain's ability to maintain cognition and functioning with aging and disease. It encompasses the following three ideas:

Cognitive reserve is a property of the brain that allows for better than expected cognitive performance, given the degree of brain changes related to life course and brain injury or disease.

Cognitive performance refers to intellectual abilities working correctly (what my grandmother would say 'having head').

Brain maintenance refers to the relative absence of changes in neural resources or neuropathological changes over time, as a determinant of preserved cognition in old age.

This means that there are almost no changes or diseases that reduce intellectual capacity upon reaching old age.

Brain reserve reflects the neurobiological state of the brain —number of neurons, synapses, etc.— at any point in life. Brain reserve does not imply active adaptation of functional cognitive processes in the presence of injury or disease, as does cognitive reserve.

Unlike cognitive reserve, brain reserve refers to the form, content, and function of the brain that is not 'intellectual', i.e., the brain's biology: what it is like, its cells, its connections…

All researchers agree that these properties are largely determined by our experiences and ability to cope with them, as well as to manage the stress that different situations produce. However, the way we cope with them is not always determined by our will or our way of doing, because multiple factors are out of our control.

It looks like some brains are prepared 'by default' with genetics that allow coping better with life's experiences. But there are other properties of the brain, such as neuroplasticity, neurogenesis and epigenetic mechanisms —those that modify genetics during life— that play an important role in reaching old age 'with a good head', as my grandmother used to say. These properties can modulate what is given to us at birth, up to modifying some genes’ function and brain wiring.

“We don't have to settle for what Nature has given to us.” Alvaro Pascual-Leone.

But there is one factor that strongly correlates with better preservation of brain capacities: education.

The role of education in resilience and reserve

Surprisingly, education, understood as the level of education a person can access in society, is linked to brain preservation in old age. Maybe that’s one way to enhance the buffer. Education provides people with critical cognitive and emotional skills to cope with stressful situations and adapt to changing circumstances. Among these are:

problem-solving skills

critical thinking 

informed decision-making 

ability to regulate emotions

Moreover, education fosters self-confidence and self-efficacy. When we acquire knowledge and skills we experience success in educational endeavors, developing greater confidence in our abilities. Confidence is a key component of resilience because it allows us to believe in ourselves and our ability to overcome difficulties. Self-efficacy is the belief in one's ability to carry on or get ahead in a situation, which leads to better self-awareness, and a more resilient brain.

Education also plays an important role in building support networks. Through interaction with peers and teachers, students can develop meaningful relationships that provide emotional and social support in tough times. These connections are fundamental to overcoming adverse situations. By creating an enriched human environment, chances of reaching older age with a good head —or brain— may rise.