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Kognitive Reservekapazität und ihre Bedeutung für Auftreten und Verlauf der Demenz

Cognitive reserve and its relevance for the prevention and diagnosis of dementia

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Zusammenfassung

Die fortschreitende Hirnschädigung bei neurodegenerativen Erkrankungen wie der Alzheimer-Krankheit ist ohne Zweifel die Hauptursache der klinischen Demenzsymptome. Der Zusammenhang zwischen Hirnschädigung und Symptomatik ist jedoch nicht linear. Bestimmte interindividuelle Unterschiede wie eine gute Schulbildung oder ein großes Hirnvolumen bedingen eine höhere Widerstandsfähigkeit gegen die Hirnpathologie. Dieses Phänomen wird als kognitive Reservekapazität (KR) bezeichnet. Menschen mit hoher KR haben ein geringeres Demenzrisiko, wobei sowohl passive als auch aktive Reservekonzepte diskutiert werden. Bei der passiven KR geht man von hirnstrukturellen Besonderheiten wie einer höheren Neuronen- oder Synapsenzahl aus, die einen größeren Puffer gegen Verluste darstellen. Erst wenn eine bestimmte Verlustgrenze durch eine fortschreitende Hirnschädigung überschritten wird, treten Symptome auf. Neben dem passiven Konzept werden auch aktive Mechanismen diskutiert, die unabhängig von rein strukturellen Unterschieden zur längeren Aufrechterhaltung der kognitiven Leistungsfähigkeit beitragen. Bei kognitiv gesunden Menschen führen diese Mechanismen zur Adaption der Hirnaktivität bei Steigerung des Schwierigkeitsgrades einer Aufgabe; bei fortschreitender Neurodegeneration kompensieren diese Mechanismen die Schädigung. Menschen mit hoher KR zeigen dabei eine effizientere Aktivierung bei derselben Aufgabe und können dadurch das normale kognitive Leistungsniveau länger aufrecht erhalten.

Summary

Progressive brain damage is undoubtedly the main cause of clinical symptoms of dementia in neurodegenerative disorders such as Alzheimer’s disease. However, the association between brain damage and cognitive symptoms is not linear. Certain interindividual differences such as a good school education or a greater brain volume are associated with a higher resilience against brain damage that is usually referred to as cognitive reserve (CR). Individuals with high CR have a diminished risk for dementia and both active and passive concepts for this phenomenon are discussed. In the concept of passive CR, peculiarities of brain structure such as higher synapse or neuron counts are regarded as buffers against brain damage. Symptoms of dementia do not occur until a certain threshold of damage is passed. In addition to the passive concepts, active mechanisms are also discussed that are associated with the ability to maintain a certain level of cognitive performance in the face of progressive neurodegeneration for a longer period. In subjects with healthy cognitive function, these active mechanisms contribute to the adaptation of brain activity when task difficulty level is increased. Confronted with progressive neurodegeneration, these active mechanisms help to compensate for brain damage. Individuals with higher CR show more efficient activation for solving the same task, which helps them to preserve normal levels of cognitive performance for a longer period.

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Danksagung

Diese Arbeit stützt sich zum Teil auf Ergebnisse von Studien, die vom Bundesministerium für Bildung und Forschung (Förderkennzeichen: 01G|0420), dem National Institute on Aging (R01-AG09029, R01-HG/AG02213 und P30-AG13846), der medizinischen Fakultät der Technischen Universität München (KKF 8765), den Canadian Institutes of Health Research (MOP-108540) und dem National Institute of Child Health and Human Development (HD42385–01) gefördert wurden. Wir danken allen Patienten und Angehörigen, die an den Studien teilgenommen haben, und den Mitarbeitern des Zentrums für kognitive Störungen für ihre Unterstützung bei den Untersuchungen. Dorottya Ruisz danken wir für ihre wertvolle Hilfe beim Korrekturlesen. Alle zitierten eigenen Untersuchungen wurden unter Einhaltung der von der Deklaration von Helsinki vorgegebenen Richtlinien durchgeführt.

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  1. Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität, Ismaninger Straße 22, 81675, München, Deutschland

    R. Perneczky, P. Alexopoulos, G. Schmid, C. Sorg, H. Förstl, J. Diehl-Schmid & A. Kurz

  2. Psychosomatische Klinik, Windach, Deutschland

    G. Schmid

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  1. R. Perneczky
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  2. P. Alexopoulos
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  3. G. Schmid
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  4. C. Sorg
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  5. H. Förstl
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  6. J. Diehl-Schmid
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  7. A. Kurz
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Correspondence to R. Perneczky.

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Perneczky, R., Alexopoulos, P., Schmid, G. et al. Kognitive Reservekapazität und ihre Bedeutung für Auftreten und Verlauf der Demenz. Nervenarzt 82, 325–335 (2011). https://doi.org/10.1007/s00115-010-3165-7

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