Examples of behaviors that may create reserve include education, high literacy, engaging work, and maintenance of an active, engaged lifestyle in late adulthood.24,25 All of these experiences appear to delay progression towards Alzheimer’s disease, although, without experimental studies, the causal component is unclear (eg, do people high in reserve stay in the workforce or does workforce participation create reserve?). Stern26 distinguishes between neural reserve and neural compensation. Reserve is essentially an increased supply of neural resources created as a result of experiences, whereas

neural Inhibitors,research,lifescience,medical compensation is the ability to draw more effectively and efficiently on networks. Can the brain actually improve as a result of experience? Although the findings in the literature are sparse, there is a range of evidence suggesting that the older brain has considerable plasticity. LY450139 ic50 Probably the most compelling data comes from stroke patients who have sustained permanent damage to their brain in specific areas Inhibitors,research,lifescience,medical as a result of neural bleed or blood clot. Despite very significant damage that has led to loss of behavioral function, stroke patients show dramatic recovery with sustained therapy.27 This change in function can only be due to plastic changes Inhibitors,research,lifescience,medical in brain function, where new parts of the

brain take over functions performed by areas that have been damaged. The plasticity evidenced in Inhibitors,research,lifescience,medical stroke patients is quite amazing, and indicates that the aging brain is very capable of neural reorganization. One important thing to note about stroke patients are that they undergo many hours of intense therapy to regain function, and that this training is in domains that greatly facilitate function in everyday life. Thus, the environment maintains and supports gains in improvement after stroke, as patients must have communication and mobility skills if they are to maintain independence in everyday life. It is also important Inhibitors,research,lifescience,medical to recognize that a part of the stroke patient’s brain has literally

shut down, and this extreme condition forces the brain to manifest any plasticity that is available Fossariinae to restore function, when it may not do so under normal conditions. Healthy adults, on the other hand, may not have the ability to consciously draw upon unused parts of the brain to enhance cognitive function. Much remains to be understood as to how much cognitive training or other cognitive interventions can enhance function, but it does seem clear, based on stroke patients, as well as data from animal studies,28 that the potential of brain reorganization does occur even in late adulthood. Nevertheless, the conditions under which healthy older brains reorganize in an adaptive matter to enhance cognitive function are poorly understood.