“C’est triste d’oublier un ami. Tout le monde n’a pas eu un ami.”Antoine de Saint-Exupéry
“To forget a friend is sad. Not everyone has had a friend.”
Indeed.
Memory is both a gift and a burden. It shapes our identities, anchors our relationships, and colors our perceptions of the world.
The thought of losing it, of having our most cherished moments fade into oblivion, is profoundly unsettling—especially if it affects those we deeply care about.
Dementia and cognitive impairment, in their many forms, disrupt this delicate balance, stealing away the threads that weave our lives together.
Understanding this, we must seek ways to fortify our minds, not merely as a defense against loss but as an affirmation of life itself.
In this article, I highlight the often-overlooked yet crucial role of friendship in enhancing cognitive reserve. While much emphasis is placed on physical activity, nutrients, mental training, and even family bonds, the impact of friendship—particularly the close ones— on our brain health, including cognitive functioning, deserves special attention.
Additionally, I explore the concept of cognitive reserve in relation to system’s flexibility—focusing on neural dynamics and what it can teach us about it.
Une Vie Démente: Madly In Life
If you think this issue will never touch you, think again. First, age is not a barrier at all. Second, even if it doesn’t affect you directly, it can still impact someone important to you. It’s closer than you might imagine.
Much like the Belgian comedy-drama film Une vie démente, written and directed by Ann Sirot and Raphaël Balboni, which reminds us that the most profound changes often unfold in the quietest of moments.
In Une vie démente, we are not thrust into the chaos of a sudden accident or a tragedy. Instead, we are invited to witness the beauty and melancholy of ordinary days—the days we all share.
The camera lingers on mundane poetry: scenes of shopping, ordinary talks before bedtime, the soft exchange of glances among the characters, and the rhythm of life as it unfolds in small, seemingly inconsequential moments.
These scenes accumulate like drops of water, creating a flood that can wash away the most solid foundations. It is the butterfly effect in action—how the slightest shift, the subtle breath of change, can ripple through time, transforming everything in its wake.
The film captures the essence of memory’s fragility, illustrating how the threads connecting us can fray without warning.
The protagonist, Suzanne, has contracted ‘semantic dementia’ and grapples with the implications of her fading memories, transforming the lives of all around her. Each loss is a reminder of the impermanence of existence.
Her journey reflects a universal truth: the memory, with all its complexities, is not just a repository of facts and figures but a living, breathing entity that shapes our essence. It is in the quiet moments of intimacy and familiarity that we often find ourselves most vulnerable.
Cognitive Reserve
Cognitive reserve is one of the most frequently discussed concepts in scientific literature on cognitive decline.
It serves as a potential protective factor that can help mitigate cognitive decline. Specifically, it refers to the brain’s ability to withstand damage and maintain function despite challenges that come with aging or neurological conditions.
Although researchers may use different terminology and various methods to measure cognitive reserve, there is a general consensus across models. They agree that a combination of lifetime experiences—such as education, occupation, and social engagement—interacts with genetic factors to influence brain health.
When we talk about brain health, we are considering a broad definition that includes several aspects: the brain’s structure and function, its vasculature, metabolism, neurochemical transmission, and the onset and accumulation of pathological changes (Pettigrew, Soldan, 2019).
But some questions remain open: Why does a significant proportion of the elderly remain cognitively normal despite having Alzheimer’s disease pathologies? And why do some elderly individuals not show significant Alzheimer’s disease but still experience substantial cognitive decline?
Obviously, we need not only a better understanding of the condition: we also need scientific knowledge that equips us with tools to prevent its development.
How can we accumulate cognitive reserve?
It reminds us of a fundamental, natural phenomenon: the complex architecture of the human mind. Can we utilize the mind to protect the brain? It turns out that we can through understanding metastability.
The Elephant In The Room: Integrative Brain Configurations
Dr. Daniel Siegel, in the first chapter of his book The Developing Mind, explores how the brain balances two crucial processes: linkage, also known in neuroscience as connection or integration, and differentiation, which refers to specialization or segregation.
These processes are essential for understanding the connectome—the intricate network of connections throughout the brain. To identify this balance he introduces the term integration.
Integration allows different brain areas to communicate effectively, creating a state referred to as metastability. This state enables neural networks to adapt quickly, engaging and disengaging without becoming rigidly fixed in their interactions. This flexibility is vital for optimal brain function.
It’s worth noting that in complexity theory the term “criticality” refers to “the constantly shifting battle zone between stagnation and anarchy, the one place where a complex system can be spontaneous, adaptive, and alive” (Waldrop, 1992). Similarly, in mathematics—terms such as “complexity” and “coherence”—describe such linkage of differentiated parts. Thus, it reminds the neuroscience term “metastability.”
The research has shown that the functional interconnectivity of the connectome is a strong predictor of overall well-being (Smith et al., 2015). In other words, when different parts of the brain are well connected, it leads to better mental health and functioning.
According to current understanding, the brain seems to operate through global brain states. These states unfold in oscillating waves that link widely differentiated areas, often connecting entire networks.
Disordered Order
When we focus on improving either differentiation or linkage, we can intentionally create a more integrated brain state. This integration is foundational for self-organization, allowing the brain to adapt effectively to various challenges.
As the research highlights, dynamical systems—the brain—function best when they approach a state of criticality, where they can transition smoothly between order and chaos (Atasoy et al., 2017; Chialvo, 2010).
Criticality isn’t just about the brain’s functional flexibility and adaptability. These studies also highlight some important functional advantages of criticality (Beggs, Plenz, 2003).
For example, the greater diversity of brain states enabled by criticality allows for increased capacity to encode information and faster information processing. And this is thought to be linked as the neural mechanism behind the conscious wakefulness.
This understanding connects closely to the concept of cognitive reserve, which refers to the brain’s ability to improvise and find alternate ways of getting a job done. A greater cognitive reserve can help individuals cope better with brain aging and neurological damage.
When the brain is well connected and integrated, it is better equipped to build cognitive reserve. This is because the diverse neural pathways developed through strong interconnections provide the brain with multiple strategies to process information efficiently and solve problems.
Even conditions like autism, bipolar disorder, and schizophrenia demonstrate that impairments in neural integration can affect overall functioning.
Individuals with higher cognitive reserve often show resilience against cognitive decline, as they can draw upon their extensive network of connections to compensate for lost function.
Amicizia: The Brilliance of Friendship
The quality of our relationships is particularly significant in this context. Positive, integrative relationships that honor differences can stimulate healthy brain development, especially in young children.
“You see? In the fairy tales one does as one wants, and in reality one does what one can.”
Elena Ferrante
On the other hand, adverse childhood experiences—such as neglectful or abusive relationships—can inhibit healthy brain growth and negatively impact the brain’s capacity to manage stress later in life.
Fostering healthy connections and relationships enhances neural integration, thus supporting the development of cognitive reserve. By nurturing integrative relationships and promoting a balance between differentiation and linkage, we can bolster cognitive reserve. This, in turn, leads to improved mental health and adaptive functioning throughout life.
This holistic approach emphasizes the importance of both mental and emotional well-being, highlighting how interconnected our experiences and brain health truly are.
Great authors emphasise on the beauty of having a significant friendship. And it’s not a mere poetic chanting; intuitively, we all recognize the value of this connection.
Study on cognitive reserve published in the journal Neurobiology of Aging supports that social networks have a positive impact on its level. Larger network size, higher diversity, and lower density can bolster cognitive reserve by promoting access to cognitively stimulating social environments (Peng et al., 2022).
But here is a thing.
A Single Rose Can Be My Garden
According to socioemotional selectivity (SES) theory, developed by Laura Carstensen, as people age, they tend to limit their social worlds to a small group of close friends and family who are most important to them and provide emotional closeness (Carstensen, 1993; Carstensen et al., 1999; Lang and Carstensen, 2002). And that familiarity significantly influences relationships and leisure experiences, where companionship and social support become increasingly vital motivators for leisure participation at all (Burnett-Wolle, Godbey, 2007).
SES theory helps explain how older adults adapt to changing circumstances by focusing on their most meaningful relationships and prioritizing emotionally meaningful exchanges (Blieszner et al., 2019).
For instance, studies have shown that as cognitive decline progresses, individuals may find it easier to engage with friends rather than spouses, especially in social situations that require cognitive effort or high levels of interaction. The research indicates that after a dementia diagnosis, individuals are less likely to participate in leisure activities with their spouses (Di Lauro et al., 2017).
This shift can be linked to the distinct dynamics of emotional closeness and the nature of interactions that friendships offer, which can sometimes be less demanding and more comforting compared to relationships with a spouse. Friendships can add richness, a sense of connectedness, caring, and comfort to the lives of people with dementia (Harris, 2011).
WithIn and Between
Furthermore, studies highlight that friendships can significantly enhance the quality of life for older adults, including those with dementia. For instance, a study found that maintaining friendships can lead to better emotional well-being and a greater sense of belonging, which is crucial for individuals coping with cognitive decline (Baldwin et al., 2015).
Overall, it seems that the relationship between social isolation loneliness and cognitive decline can be bidirectional (Cardona, Andrés, 2023). Because unmet social needs earlier in life can lead to social isolation and loneliness later in life.
This is particularly true for older adults with illnesses like dementia, who are prone to being misunderstood and stigmatized (de Medeiros, Sabat, 2013).
Constantly we are reminded of how complex our ever changing lives are and there’s no one static universal formula.
Those Who Leave and Those Who Stay
“Maybe we should acknowledge that a bad friend, an unreliable friend, isn’t a friend” says Elena Ferrante—an Italian writer—who has beautifully remarked on the rarity of genuine friendships in her famous and my beloved Neapolitan Novels, likening them to true love.
While defining friendship is notoriously difficult, research has demonstrated a link between a supportive social network and the well-being of individuals who already developed the condition of dementia (Fortune et al., 2020).
“A single rose can be my garden… a single friend, my world.”
Leo Buscaglia
Patterns of friendship differ across time and cultures. Modern science is only beginning to uncover the neurobiological underpinnings of friendship. Yet, it has been centuries since novels about friends created a narrative structure resembling an experiment. In this structure, every friendship is unique. This allows us to explore the dynamics that promote intellectual and emotional growth in various environments.
However, since dementia often affects a person’s ability to interact and communicate, this type of condition can test a friendship (Spencer, Pahl, 2006). The reality is such that friends are not always supportive of continued interactions after a diagnosis (Vikstrom et al., 2008).
The Ties That Bind
Nonetheless, certain actions taken by individuals with dementia, as well as their friends, can make sustaining these friendships challenging.
Interestingly, Ferrante notes, “The Italian word for ‘friendship’ amicizia, has the same root as the verb ‘to love’, amare, and a relationship between friends has the richness, the complexity, the contradictions, the inconsistencies of love.” This etymological connection emphasizes the emotional depth and contradictions inherent in friendship.
In her interview, she highlights, “In life, as in novels, we are aware of the pain of others, we feel their suffering, only when we learn to love them.”
In this context, the maintenance of long-term friendships becomes instrumental for helping individuals with dementia continue to live well after their diagnosis (Harris, 2011).
Friends in a lasting, close-knit, and committed friendship are more likely to focus on what their loved one can still do, work around any challenges, and see them as a whole person rather than just their illness (Harris, 2011). This approach can be rewarding for both friends, allowing them to maintain a meaningful connection despite the difficulties.
For example, individuals with dementia may withdraw from social situations in order to avoid negative reactions from others or limit social interactions they find increasingly challenging (Vikstrom et al., 2008).
Friends also may withdraw from a person with dementia or ‘disappear’ because they are uncertain about how to act, they feel uncomfortable. They find it too difficult to see the changes, like loss of cognition or communication challenges, that are taking place within their friends (Harris, 2013; Sabat, Lee, 2012).
But when a bond is strong it is less likely to happen.
Walk Beside Me… Just Be My Friend
Ferrante reflects the truth that finding a friend who truly understands and supports you is a profound and valuable experience. As she states, “Just as great loves are rare, and lovers, on the other hand, numerous, so great friends are rare; meanwhile, acquaintances with whom we may, from time to time, end up in bed are numerous.”
In Neapolitan Novels, Ferrante portrays female friendship as both nurturing and filled with tension, yet cognitively stimulating. This complexity reflects the reality of life itself. She emphasizes that true friendship is not just about support and affection; it also involves navigating difficult emotions like envy, competition, and the struggle for identity.
A powerful example of this is the relationship between Lenù and Lila, who stand by each other through thick and thin. No matter the challenges they face, whether it’s societal pressures, personal crises, or the weight of their own insecurities, they remain each other’s unwavering support system.
Despite the moments of conflict and rivalry, their loyalty never fades: “You’re the only person I trust.” They know that they can rely on one another, creating a sense of security that allows them to thrive individually.
This dynamic is marked by a constant push and pull, where admiration can quickly turn into rage, closeness to distancing, yet their bond remains unbreakable.
Their relationship mirrors the complexities of friendships that are deeply intertwined with personal growth and societal pressures, showcasing how true friendship endures through trials and tribulations.
I also highly recommend taking a look at the TV series L’amica geniale based on the books. Made with such love and tenderness, it will provide you with great aesthetic satisfaction while also offering a touch of real emotional depth – qualities that make L’amica geniale a true ‘Empathy Machine’ of a TV series.
Where Attention Goes
I have always felt that friendship holds the utmost significance in my life. Amid all the noise about romantic ideals that surround us, we often forget how essential it is to cultivate deep, meaningful connections with friends.
“Where attention goes, neural firing flows, and neural connection grows”, Daniel Siegel highlights the importance of being intentional with where we direct our limited attention.
“You’re my brilliant friend, you have to be the best of all, boys and girls.”
Elena Ferrante
It’s important to remember that your attention is a finite resource. Attention can contribute to a state of mind, which can become a remembered brain activity configuration or neural net profile. This means that repeated activation of particular states, like shame or despair, makes them more likely to occur in the future due to the structural and functional linkages formed in the brain (Perry et al., 1995).
While it may be tempting to spread your attention across many acquaintances, investing quality time and focus on the meaningful friendships in your life is key for your overall health and well-being. The neural connections and sense of belonging that come from nurturing a few high-quality friendships are far more valuable than superficial connections spread too thin.
So pay attention to those who are truly worth it, and watch as the bonds between you and your closest friends deepen over time.
These companions stand by us, lighting our path. They encourage us to move forward, no matter how daunting the journey may seem. They also stay with us to support our well-being when everyone else leaves.