Cognitive Reserve

November 6, 2013 by
Filed under: Spinewave Bulletin 

chiropractic cognitive reserveThe word “stress” is a misnomer. There are too many neurological mechanisms around how one processes information and how one feels about it.

Everybody is different. A stressful situation for one person may not be stressful for another. So the broad stroke term “stress” doesn’t work when assessing how a person is functioning (or whether they are well or not). People are so used to the smooth functioning of their brain and nervous system that rarely is attention paid to what is going on under the hood – until it starts failing.

3 key brain systems are critical to normal function:

  1. Working memory. The type of memory that allows us to both hold information in mind and work on it at the same time.
  2. Focused attention. Trying to divide attention between too many tasks results in performance errors.
  3. Emotional and cognitive self-regulation. Emotion tells us how important something is and cognition tells us what to do about it.

For the person who has experienced no obvious trauma, or perhaps just “wakes up one day” with a particular problem, the clinician has to be smart about how this might have come about besides the hand-wave diagnosis of “stress”, because invariably the person will report they are not under any overt stress; however they have problem.

Problems might include fatigue, exhaustion, insomnia, tremor, headache, backache, hyperventilation, anxiety, depression, constipation, diarrhoea, impotence, frigidity, vertigo or tinnitus just to name a few.

A potential breakdown has occurred between the 3 key brain functions and the person’s ability to process information has been exceeded. This is akin to random access memory (RAM) of a computer becoming maxed out.

In order for computers to work faster and handle more applications, they require more RAM. More RAM enables better processing between working memory, attention, and cognitive regulation. If these 3 systems don’t communicate properly, misdirected cortical energy expenditures start. This means the brain puts out the wrong messages at the right time – or the right messages at the wrong time.

“A true preventive intervention would be to intervene before any symptoms develop.” Dr Alvaro Pascual-Leone, Professor of Neurology at Harvard Medical School.

Instead of the word stress, the preferred idea is reduced “cognitive reserve”. Cognitive reserve refers to the ability of one’s nervous system to perform tasks well enough through the capabilities of its “software” (resilience). If cognitive reserve is diminished, the brain will falter, creating symptoms in the body.

The trick is this requires nothing obvious from the outside to occur in a moment to moment fashion. These processes (cognitive errors) accrue slowly over time and the system starts maxing out. Working memory is exceeded. Fatigue sets in. Physical symptoms start to appear. Cognitive errors can be as small as the way the body is held (posture); guarding the diaphragm, neck, jaw, throat; over-thinking, anticipating, or worrying.

As time passes – often a matter of years – the individual unknowingly becomes more proficient in making inappropriate responses. The responses tend to be made more frequently, until finally the person can be maintaining this type of “negative” energy expenditure continuously. This type of energy expenditure makes the individual more vulnerable to physical illness.

Generally people choose to remain oblivious to their state of being and wait until they run themselves into the ground or are incapacitated by a symptom.

The typical 3 stages of patient presentation are: 1. State of alarm, 2. State of resistance (denial), and 3. State of exhaustion.

Recognising insidious problems requires more lateral thinking from doctors these days. The human body is not a Lego set. Not everyone is stressed, but most people have reduced cognitive reserve or nervous systems running at maximum capacity that are due for an upgrade. This is why thorough functional neurological exams and correcting brain energy expenditures with specificity is so important: to stay healthy before one gets symptoms.

© Dr Neil Bossenger 2013

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