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In the MacArthur study, the characteristic that correlated most robustly with good cognitive functioning in aging was level of education. We think that education may help keep memory strong by inculcating the habits of being a lifelong learner—for example, reading a lot, becoming involved in intellectually challenging projects, and intensively exploring topics that you find fascinating.

Yaakov Stern and fellow researchers at Columbia University reported in 1994 that higher levels of educational and occupational attainment appeared to be related to a reduced risk of Alzheimer's disease. They speculated that higher education might be a proxy for cognitive reserve, a set of skills or repertoires that could serve to delay the onset of clinical symptoms. In this scenario, people with similar levels of underlying brain pathology would vary in terms of symptom severity, depending on their level of cognitive reserve. More recently, Stern hypothesized that cognitive reserve may be based on more efficient utilization of brain networks or the brain's ability to recruit alternate brain networks as needed, for example, in the context of injury or disease.

A separate series of brain imaging studies appears to support this hypothesis. Among Alzheimer's patients with similar levels of symptom severity, functional imaging with SPECT and PET scanning revealed that the brains of the people with the highest education levels showed weaker blood perfusion and metabolic activity than the brains of people with the lowest education levels. In other words, the brain of a more highly educated person had to exhibit a more profound degree of dysfunction than the brain of a less educated person in order to produce the same level of symptoms.

In a 2004 study, researchers at Rush University Medical Center in Chicago reported additional evidence in support of the connec- ,161

tion between educational background and Alzheimer's disease symptoms. They examined the relationships among underlying Alzheimer's brain pathology at autopsy, years of education, and symptom severity in a group of elderly Catholic clergy who had been participants in a longitudinal study. Consistent with the Columbia group, they found that among people with similar levels of Alzheimer's disease pathology, those with higher levels of education exhibited fewer symptoms and better overall functioning.

The Columbia group and others have also reported that, once Alzheimer's disease is diagnosed, high levels of education correlate with more rapid decline than low levels of education. In other words, when the amount of brain pathology becomes severe, cognitive reserve can no longer hold off the symptoms and the decline is steep and swift.

The Rush researchers also found support for the idea that the critical factor in cognitive reserve is not necessarily years of formal education per se but rather ongoing participation in cogni-tively stimulating activities. In a community-based sample, they found that people who more regularly engaged in cognitively stimulating activity were less likely to come to a diagnosis of dementia; importantly, frequency of engaging in cognitively stimulating activity was more important than years of education in reducing the risk of incident Alzheimer's disease. Cognitive reserve therefore appears to be malleable and dynamic, resulting from a combination of innate factors (the genetic component of intelligence) and ongoing life experience (regular engagement in cognitively stimulating activities).

Regardless of your education level, you, too, can be a lifelong learner. You don't have to go back to school (although that would probably do wonders for your memory!). Less ambitious efforts can also be beneficial. You might learn how to play a musical instrument or take up an intellectually engaging hobby. As with physical exercise, I find that it helps to schedule time on most days for mental exercise. Reading regularly, keeping up with current

Memory Myth: I Never Finished College— Now I'm Afraid I'm More Likely to Have Memory Problems than Someone with an Advanced Degree

It's true that people with an advanced education appear at lower risk of memory disorders and age-related memory loss than people with less education. But we think that what's most important is not whether you earned a Ph.D. or a B.A. thirty years ago but rather whether you continue challenging yourself intellectually throughout life. Continuous learning is both a use-it-or-lose-it strategy for enriching your life today and an investment in the future—helping you build up a "cognitive reserve" of neuronal connections. This reserve will help keep your memory and other cognitive functions sharp, even in the face of age-related changes in the brain.

affairs, and playing challenging games that require strategic thinking are all good ways to exercise your mind. Here are some other ideas:

• Go to theaters and museums.

• Plan day trips, as well as longer vacations, to interesting destinations.

• Plan, research, and execute a do-it-yourself home-improvement project that requires creative design work.

• Design and plant a new garden.

• At work, initiate or volunteer for a project that involves a skill that you don't normally use.

• Delve into research on something that you've always been curious about.

• Explore the Internet. You can gain access to a wealth of information on any conceivable topic.

• Take a course to learn a new skill that requires effort and practice, like playing a musical instrument, painting, or website design.

• Do puzzles and brainteasers. In addition to the crossword puzzle in your newspaper, consider using books, magazines, and the Internet to find math brainteasers and word problems. Jigsaw puzzles challenge the mind, too.

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