Novel Tool Assesses Dynamic Neurocognitive Adaptation Across a Lifetime

A new assessment tool developed at Cleveland Clinic aims to enhance the understanding of how lifestyle choices can promote neurocognitive adaptation and mitigate the risk of Alzheimer’s disease (AD). Development of the dynamic Neurocognitive Adaptation (dNA) scale, a questionnaire that takes about 15 minutes to complete and covers a variety of experiences across an individual’s lifetime, evaluates how certain activities may support neurobiological and neurocognitive health.

More than 6 million Americans currently live with Alzheimer’s disease, and that number is expected to increase to nearly 13 million by 2050. Studies of the association of lifestyle factors and lower risk is yielding promising news for the future of AD, says Filippo Cieri, PsyD, PhD, researcher at Cleveland Clinic’s Lou Ruvo Center for Brain Health in Las Vegas.

“People are living longer. With this increased life expectancy, we also have more people living with neurodegenerative diseases, such as Alzheimer's disease,” says Dr. Cieri. “The good news, however, is that the 2024 Lancet Commission on dementia prevention, intervention and care established that around 45% dementia cases are preventable. This means that the more we study, the more we're finding that at least some dementia cases seem to be preventable.”

In aggregate, particular lifestyle conditions are thought to build neurological reserve, resilience and resistance — assets that help individuals remain neurocognitively healthy as they age.

"Our findings suggest that engaging in diverse activities throughout one's life can significantly boost brain plasticity and resilience, which are essential in reducing the risk of Alzheimer's disease,” says Dr. Cieri.

Development and validation of the tool

The dNA scale was developed using exploratory and confirmatory factor analysis involving 815 participants aged 65 and older. The researchers started with a scale comprising 30 items across seven lifestyle domains or dimensions, then refined it to 20 questions across four dimensions: physical, cognitive, creative, and social.

“When you think about these kind of tools — a questionnaire specifically for older people — you cannot imagine anyone answering hundreds of questions. Even though you want to explore as much as possible, the more questions you have, the less reliability and consistency you will have,” says Dr. Cieri.

Among ways the new questionnaire improves upon previous assessment tools is that it considers the individual’s entire lifetime. Recent research indicates that engaging in some activities at certain stages of life, especially midlife, may provide stronger protections against dementia.

“Our term 'dynamic' points out the need to consider time in the adaptation process, to better understand sensitive windows of opportunity in adaptation, based on the complexity of the environment and adaptation to this complexity," says Dr. Cieri.

The scale also considers the influence of creativity, which he says has been under-considered in previous research.

Study participants answer questions regarding activities for their childhood years (0–10); adolescence (11–20); youth (21–30); adulthood (31–40); middle ages (41–50); senior ages (50– 64 years); and old age (65 and older). Questions instructed participants to identify the best answer for each period. Examples include “How often did you read, or do you currently read books/e-books/audiobooks?” and “Were you or are you currently engaged in physically demanding work activities?”

A 5-point Likert scale reflects frequency of activities, where 0 = never; 1 = once a year or less; 2 = several times a year; 3 = several times a month; and 4 = daily or almost daily. A total score was calculated by adding all items in each dimension.

Results and Findings

The final scale indicated that physical, cognitive, creative and social factors are associated with neuroprotection. The study also found significant positive correlations between these dimensions, suggesting that a combination of diverse activities supports better cognitive outcomes.

"It’s always a good idea to be physically involved, cognitively engaged, socially connected and creatively active in the environment as much as possible,” says Dr. Cieri. “These activities foster brain plasticity and adaptability, which are crucial for mitigating the risk of Alzheimer's disease."

With the dNA scale established as a reliable and comprehensive tool for assessing lifetime behaviors, the researchers are turning their attention toward the details.

“We are already working to explore the association of this scale to neuropsychological and neuroimaging data,” says Dr. Cieri. “We are no longer asking if people who are more involved in these activities are more protected compared to people who are not involved at all. We already know the answer is yes. Now we are trying to understand how — both through functional imaging and through the association with the neuropsychological memory, executive function, verbal fluency, neuroimaging structural data and volumetric cortical thickness. So if people are more involved, do they have, for example, a larger hippocampus or do they have greater thickness of the prefrontal region? Do they have different organization around their functional activity? The default network is a task-negative network in our brains. When we are not doing any specific task, this is the network that is activated in our brain. Does this network work better in a more adaptive brain compared to a less adapted or less plastic brain?”

Future Directions

The team is also working on validating the scale in different populations, including through collaborations with universities and research institutes in Italy, where they hope to gain insights regarding the effects of a variety of lifestyle factors, such as the Mediterranean diet, on neurocognitive health and resilience.

Among the most important implications of the research is that involvement in a complex environment can be very helpful against pathology.

“It's not trivial,” says Dr. Cieri. “The power of the environment should not be underestimated in its potential to protect against neurodegeneration. Our findings underscore that active engagement in physical, cognitive, social and creative activities throughout life can have a profound impact on brain health and resilience."