“The Wisdom Paradox” (Goldberg, 2005) is a fascinating book about the biology of cognitive wisdom, including its unique costs and benefits. This book provides a thorough explanation of how people in later stages of life successfully undertake major cognitive tasks, as well as how this aptitude can be maximized. With vigorous and life-long mental activity in novel tasks learning new information, an aging person can gain wisdom and minimize clinical brain injury.
Wisdom has intellectual, practical, moral, and spiritual facets. It can be defined as extensive pattern recognition of new information or situations as accurately being in some way similar to familiar information or situations, thus leading to successful problem-solving and reasoning abilities. There are many types of wisdom, including genetic, phylum wisdom, species or cultural wisdom, group wisdom, and individual wisdom. The wisdom of the phylum, which is contained in the amygdala, includes genetically-programmed, innate fears and survival mechanisms that have existed in all species for millions of years through evolution. This type of wisdom uses sensory and motor regions of the cortex, as well as subcortical regions of the brain.
Cultural wisdom is expressed as language and other symbolic systems passed down through the generations for thousands of years. Language is made up of a self-organizing, complex neural network widely spread throughout various regions of the cortex that are not pre-wired. Group wisdom includes certain remarkable talents or expertise shared by a group of people, which also come from self-organization of the association areas of the cortex. Lastly, individual wisdom is expressed by a person’s unique cognitive templates and pattern recognition devices that also are not hardwired in the brain. This type of wisdom is the main topic of this book.
There are three main stages of brain development. The first stage includes the learning of basic information and skills, as well as the forming of one’s identity. During this stage, many different neural processes are taking place, including the development, migration, and interconnections of neurons, as well as the myelination of axons. The second, more mature stage of brain development is distinguished by a more stable brain with developed templates from learning a great deal of new information that is now familiar. In this stage, individuals can contribute their knowledge and skills to the world with less current need for learning new information. People who are cognitively successful in this stage are likely talented or even genius in specific domains from gaining an abundance of knowledge regarding that domain.
The final stage of aging comes with at least some deterioration and reduction in brain tissue with less neuronal connectivity, myelination, and blood and oxygen supply. This is particularly the case in the right hemisphere, where damage occurs earlier on with greater atrophy. Subsequently, older individuals have decreased senses, processing speed, working memory, mental inhibition and flexibility. Selective and divided attention, as well as semantic and episodic memory, are also weakened with age. Neuroerosion and dementia develop gradually over these later years, and the brain regions that developed last are also the first to atrophy. Thus, the association areas of the cortex and prefrontal cortex are remarkably vulnerable to deterioration and dementia. The hippocampi are also susceptible to Alzheimer’s dementia with age. Despite all of these losses, for some people who have had a lifetime of learning new information, mental activity may continue to be successful in this stage. Aging comes with the privileged opportunity for competence and wisdom, which allow for incredibly successful cognition.
There are important cerebral hemispheric differences in the mammalian brain that have existed for millions of years. Although some left-handed people have an inverse hemispheric differentiation, the right hemisphere typically engages in more integrative functions making long-distance neural connections, while the left hemisphere consists of more local connections. While the right hemisphere is used for problem-solving in novel, unfamiliar situations, the left hemisphere is implicated in pattern recognition of familiar verbal and non-verbal information using preexisting cognitive templates. Thus, throughout the lifespan, information that was once dealt with in the right hemisphere transfers to the left hemisphere after it is learned and becomes familiar to the person.
Younger people rely on their problem-solving abilities to learn and understand new things, relying more on the right hemisphere. As individuals age and gain more experiences, they acquire more and more cognitive templates, or interconnected constellations of neurons, relying more and more on the left hemisphere. These templates have been shown to be the most valuable cognitive machinery, allowing people to continue to be cognitively proficient in new and familiar situations even in the face of brain corrosion or dementia, possibly for years. Thus, the more new information that a person learns and encodes, the more that cognitive templates are able to be at his/her disposal to recognize, understand, and solve or deal with familiar and new situations and problems. Expertise, competence, and most notably wisdom are all attained through a significantly large amount of cognitive templates and extensive pattern recognition devices. They are the rewards of aging.
The other main distinction between the two cerebral hemispheres, particularly the amygdala and prefrontal cortex, is emotion. The right hemisphere is more involved in negative emotions, and the left hemisphere is implicated in positive emotions. This difference has been supported through many different neuropsychological studies. Moreover, this hemispheric differentiation is strongly interrelated with the cognition hemispheric differences. That is, being familiar with something and recognizing it is useful and good to know is highly associated with positive emotions. On the other hand, being unfamiliar with something and not knowing how to deal with it is significantly correlated with negative emotions. As people age, the emotional balance shifts to favor more positive emotions and peacefulness, which is consistent with the fact that the left hemisphere is more active in older individuals.
The frontal lobes of the brain, particularly the prefrontal cortex, have important roles in individual wisdom. Like the right hemisphere, they are involved in novel situations and problem-solving. They are responsible for the complex executive functioning tasks of planning, decision-making, and carrying out the decisions. Thus, memories of the analysis and solving of problems are stored here. The prefrontal cortex is also indirectly involved in empathy, ethical and moral decision-making, and impulse control in terms of aiding the understanding of cause or effect of behaviors. Other frontal lobe functions include mental flexibility and gatekeeping of perceived information. With all of these roles, it makes sense that the frontal lobes are of utmost importance in novel problem-solving tasks. Wisdom comes with dedicated use of these prefrontal lobes, particularly the left pattern recognition lobe. Interestingly, the frontal lobes are last to develop in the brain and thus more vulnerable to wear and tear from aging. However, with increased use of these functions through many new experiences in novel problem-solving, more generic problem-solving memories will be lastingly stored. This significantly protects against clinical impairments of such brain damage.
Wisdom and its pattern recognition devices are strongly related to generic memories, or memories for patterns. These memories are processed and then stored in the various areas of the neocortex in which they also are perceived via intricate neural connectivity depending upon their relations to already-learned information. When new memories are formed, there are subsequent changes in the networks of neurons based on the incorporation of the new experience and mental activity.
Vying for limited space in permanent storage in the cortex, memories become long-term when similar experiences and perceptions are reactivated frequently enough. Memories also are more likely to endure when the amygdala becomes involved in their formation because genetics or previous experience has deemed such memories as emotionally meaningful. In such long-term storage, bioelectrical, biochemical, and structural changes in the neural network are lasting and resilient. Thus, these long-term, ingrained memories are highly protected from cognitive deterioration and dementia. This makes sense given that the most recent memories added to the neural network are the first to be lost and the last to return, as the longer-lasting memories are more permanent. Also, memories for facts, especially those that are more specific and personal, are more likely to be lost than generic memories and memories for skills. Generic, abstract patterns/memories are most likely to be reactivated and thus persist and are protected from brain damage. They contain general and essential information about many different experiences, such that even those not yet encountered can be identified.
Two primary generic memories are language and higher-level perception. It is important to note, however, that long-term memory traces take years to develop through a slow, gradual process. The more that a person learns and stores novel information in the cortex, the more likely that at least some of this information is going to overlap with and reinforce pre-existing memories, aiding the long-term storage of these memories. Although the hippocampi are crucial for the initial formation of long-term memories, a dementing process, which will likely damage the hippocampi, may not impact these ingrained long-term memory traces.
Throughout the lifespan, with increased novel experiences and mental exertion, undifferentiated stem cells will develop into new neurons that will travel to and connect with the relevant areas of the cortex. This will in turn protect these regions from clinical impairment of damage and demenia, possibly for many years if these neural networks are extensive enough. If these connections of neurons are strong enough, even activation of a small neural group will keep the entire network perpetually activated. In addition, these brain-exercising individuals are able to do more mentally challenging tasks more efficiently using less brain resources with a less needed blood and oxygen supply. This large cognitive reserve, which will be explained in more detail later on, is very helpful for older individuals because blood supply problems are likely to come with age.
The aging brain is more likely to be protected from deterioration and dementia when intense mental exercise has occurred from a young age, just as the body is more likely to be protected when vigorous physical exercise has occurred from a young age. This is because more numerous and generic pattern-recognizing devices have been able to be formed from the many life-time opportunities to learn new information. Thus, aging is the price paid for accruing wisdom patterns. An important note is that aging does not necessarily lead to wisdom. Wisdom is the priceless reward achieved through strong mental efforts and resulting significant neural connectivity and patterns.
Exercising one’s brain at a later age through rigorous cognitive augmentation exercises also can be remarkably protective. These demanding mental exercises can increase local and far-flung connections and can even supersede any potential damage from aging and dementia. In fact, in order to keep the mental acuity one has worked hard to achieve when younger, it is important to continue facing new mental challenges throughout life even when an older adult. Goldberg describes one such cognitive exercise program, which primarily focuses on an individual’s cognitive weaknesses to strengthen the neural connections in those brain regions, which likely are lacking in extensive neural networks. This program was found to have significant beneficial cognitive effects such as increased memory, focus, attention, and executive functions. These regular cognitive exercises also have therapeutic effects including a sense of empowerment and self-confidence, as well as less anxiety. Artistic activities are also very helpful in enhancing one’s mental power. All older individuals can benefit from such activities, from people living with dementia to gifted people with no current cognitive impairments who want to prevent cognitive decline.
Alzheimer’s dementia, as well as other dementias, has diverse symptom presentations, which can start with memory impairments due to injured hippocampi. It can also start with other impairments in language, spatial abilities, or executive functions from damaged frontal lobes. This variability in cognitive impairments is attributable to different people exercising different parts of their brain more than others. An increase in activity in these specific brain regions by learning new information will thus increase the development of neurons and connections in those areas. These areas that are stimulated more often, as well as their associated functions, are more protected from decay and impairment. This cognitive protection of impairment is especially significant in the prefrontal cortex and the hippocampi, where Alzheimer’s dementia first strikes. The diversity of dementia symptoms demonstrates a complex interaction between biology and behavior.
Another example of the important interaction between biology and behavior is that an even more diverse reaction to Alzheimer’s dementia is having no clinical impairment despite biological signs of the disease. This presentation occurs in those who take part in continual mental exercise of learning new things throughout their lifetime, developing an abundance of neurons and connections. Thus, those who are predisposed to developing a dementia or those in earlier stages of progressive dementia can actually limit or altogether avoid cognitive and behavioral symptoms of damage through what they choose to do with their brains (Goldberg, 2005).
This is the concept of cognitive reserve, in which biological disease of the brain is not related to the actual clinical symptoms of such pathology (Stern, 2002). Again, there is a strong interaction between genetics and the environment and behavior. A person’s cognitive reserve capacity allows for protection of the brain through the efficient usage of appropriate neural networks. This maximizes brain functioning or the compensating usage of other redundant neural networks for compensation of brain damage, optimizing resiliency and mental functioning. This can occur in those with and without brain pathology, such that a person with a high reserve capacity can perform despite brain damage or extreme task difficulty, respectively (Stern, 2002).
Each person has an individualized cognitive reserve capacity based on his/her unique neural processing (Stern et al., 2003). This capacity partly comes from prior mental activities in gaining new knowledge and experiences, including educational and occupational experiences and leisure activities (Le Carret et al., 2003). Cognitive reserve also is based on one’s genetic predisposition to such cognitive domains as intelligence, memory, and language (Lee, 2003), as individuals are pre-wired with a minimum and maximum aptitude for a skill, and their specific brain use and behaviors in that skill dictate their exact ability levels (Goldberg, 2005). Cognitive reserve also depends on one’s prior brain damage (Stern, 2002). Once the capacity of damage is filled, clinical neurological signs will develop. Likewise, with increased damage, there is increased severity of the clinical symptoms (Stern, 2002). Those with larger cognitive reserve capacities will therefore experience less brain impairments (Lee, 2003). With consistent learning of new information and taking on challenging, novel mental tasks, the brain likely will have enough cognitive reserve from abundant neural connections and pattern-recognition devices to excel and be cognitively efficient despite genetic brain deterioration (Goldberg, 2005).
Although there has been much research on the construct of cognitive reserve, additional research is still needed to better understand its functions and relations between the various underlying factors. It would be useful to design a study that sheds more light on cognitive reserve while also validating Goldberg’s (2005) cognitive enhancement program in helping older individuals build a greater cognitive reserve and protect against dementia symptoms. The proposed study would utilize a controlled experimental design. There will be 2,000 participants in the study who are 60 to 89 years of age. Participants in the study will be matched according to their educational level, occupational status, socio-economic-status, gender, and age. A wide range of educational levels from high school non-graduates to post-doctoral graduates, with individuals of all age ranges represented in each educational level will be included. Participants will be assessed for pre-existing organic dementia pathology. Those deemed demented will be excluded from the study. Additionally, those with cognitive symptoms from a history of brain trauma, as well as those who were deaf, blind, or chronically mentally ill, will be excluded from the study due to possible confounding neurological effects or erroneous outcomes from these conditions.
There will be a control and an experimental group in the proposed study. The experimental group will take part in the cognitive exercise program, which will last two years. The control group will not take part in the cognitive enhancement program during the course of the study. However, they will be on a wait-list, in which they are given the opportunity to participate in the program once the study is completed. This cognitive exercise program, which will be completed for one hour three times per week, will entail an individual completing a circuit of multiple validated computer exercises. This cognitive circuit training will strengthen multiple cognitive domains with the help of a personal trainer. The program is described in more detail by Goldberg (2005). The limitation of this program being used in the study is that there is an increased likelihood of participants dropping out (or passing away) when the time commitment is two years of intensive training. However, these older individuals also likely have a strong motivation to complete the training, as it could help protect them from brain impairment.
A neuropsychological battery administered and interpreted by a licensed psychologist, who is blind to the experimental conditions, will be used to measure the continuous dependent variables of cognitive functioning. Memory will be tested with the Wechsler Memory Scale, Third Edition (Wechsler, 1997b). Other cognitive functions, including verbal comprehension and expression, processing speed, perceptual-organizational abilities, and working memory and attention abilities will be assessed using the co-normed Wechsler Adult Intelligence Scale, Third Edition (Wechsler, 1997a). These variables were shown to be significantly related to cognitive reserve (Lee, 2003). Interference with social and daily life also will be evaluated based on the Bristol Activities of Daily Living Scale, a reliable, validated measure of activities of daily living intended to assess for dementia (Bucks, Ashworth, Wilcock, & Siegfried, 1996). The limitation of the pre- and post-use of these cognitive tests is the strong possibility of practice effects of these tests. This could limit the sensitivity of noticing the differences in cognitive abilities after potentially greater cognitive reserve or potential clinical manifestations of dementia.
The other main dependent variable will be the neuro-imaging results from a magnetic resonance imaging (MRI) procedure to determine the amount of white matter in the brain. White matter decline will be an indicator of brain neurodegeneration and progressive dementia. The dependent cognitive and neuro-imaging measures will be given right before the program begins, as well as two years after the installation of the program. Each individual’s pre-test score will be compared with the post-test score, and the individual’s cognitive test score will be compared to the MRI white matter quantity. Statistical procedures will show whether significant differences exist between the experimental group and the control group in their differential clinical manifestations of dementia. Clinical symptoms of progressing dementia will be defined in this study as memory loss and loss of the other aforementioned cognitive functions from pre- to post-test. Those individuals in the experimental group who had a loss of white matter from pre- to post-test will still have higher scores in the measures of cognitive functions compared to those in the control group with similar white matter loss.
Although many studies have investigated the protective value of earlier life experiences (e.g., see Stern, 2002 for a review; Le Carret et al., 2003), this study would investigate the protective effects of increased cognitive exercises and abilities, which are developed later in life, on the onset of Alzheimer’s dementia symptoms. The primary hypothesis is that those aged individuals with more cognitive training and ability will develop fewer and less severe symptoms of Alzheimer’s dementia. These results will be observed regardless of their actual neurodegerative loss of white matter. This hypothesis infers that those with such experiences of continual brain activation will have more cognitive reserve to protect against the clinical expression of dementia, even if they begin the rigorous mental exertion later in life, as described by Goldberg (2005). If the hypothesis is supported, then the concept of cognitive reserve could be expanded to include influences by later-life experiences. Older individuals could actually seek out novel and challenging cognitive experiences that could increase their reserve capacity. They could find solace in knowing that it is not too late to exercise their brains and be protected from symptoms of dementia. References
Bucks, R. S., Ashworth, D. L., Wilcock, G. K., Siegfried, K. (1996). Assessment of activities of daily living of dementia: Development of the Bristol Activities of Daily Living Scale. Age Ageing, 25, 113-120.
Goldberg, E. (2005). The Wisdom Paradox. Penguin Group: New York.
Le Carret, N., Lafont, S., Letenneur, L., Dartigues, J., Mayo, W., & Fabrigoule, C.
(2003). The effect of education on cognitive performances and its implication for the constitution of the cognitive reserve. Developmental Neuropsychology, 23, 317-337.
Lee, J. H. (2003). Genetic evidence for cognitive reserve: Variations in memory and related cognitive functions. Journal of Clinical and Experimental Neuropsychology, 25, 594-613.
Stern, Y. (2002). What is cognitive reserve? Theory and research application of the reserve concept. Journal of the International Neuropsychological Society, 8, 448-460.
Stern, Y., Zarahn, E., Hilton, H. J., Flynn, J., DeLaPaz, R., & Rakitin, B.
(2003). Exploring the neural basis of cognitive reserve. Journal of Clinical and Experimental Neuropsychology, 25, 691-701.
Wechsler, D. (1997). WAIS-III: Administration and scoring manual. San Antonio, TX:
The Psychological Corporation.
Wechsler, D. (1997). Wechsler memory scale (3rd ed.). San Antonio, TX: The
Psychological Corporation.