Features
Enhancing fall-back power of the brain
BY Dr B. J. C. Perera
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lon), FRCPCH(UK), FSLCPaed, FCCP, Hony FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
It is a well-known fact that many organs of the human body have some reserve quantum to fall back on during situations where a human being is taxed above its usual calm existence. An excellent example of this is the human heart. In the resting status of the body. the heart beats at around 70 to 80 beats per minute. During strenuous exercise this rate could automatically go up to about 150 or even 200, bringing the reserve power of it into play. The cardiovascular reserve can go up to several times its usual tranquil capacity whenever called upon to provide that extra power.
The notion that the human brain too has fall-back reserve power is a thing that that may surprise many people. As most of us know, we associate the brain with the higher functions of the mind where intelligence and many other cognitive features associated with it make the Homo sapiens to be quite different and differentiate humankind from all other species of the animal kingdom. Yet for all that, with advancing age, impairment of memory is a thing that most people worry about.
By age 60, more than half of adults have concerns about their memory. However, minor memory lapses that occur with age are not usually signs of a serious problem, such as Alzheimer’s disease, but rather the result of normal changes in the structure and function of the brain. However, major and progressive memory loss is a devastating problem for the elderly. Yet for all that, we differ from each other in the way our thinking skills age. One explanation is that some people have better resilience to the effects of ageing because they have developed a better capacity or ‘reserve’ to cope with the changes in the brain that occur with age.
The intellectual power that we can fall back on is referred to as cognitive reserve. Cognitive reserve is the mind’s and brain’s resistance to damage of the brain. One could also rather loosely equate this phenomenon to the ability of the brain to improvise and find alternate ways of getting a job done. It reflects how agile a brain is in pulling in skills and capacities to solve problems and cope with challenges. It is a phenomenon that has to be nurtured and strengthened by learning and experience right throughout a lifetime. Cognitive reserve is developed by an era of education and curiosity right throughout life.
The impression of such reserve power of the brain was first realised and then explored in the late 1980s. That concept which was labelled as cognitive reserve originated when researchers described individuals with no apparent symptoms of dementia or deterioration of the higher functions of the brain who were nonetheless found at autopsy to have brain changes consistent with advanced Alzheimer’s disease. Such observations suggest that there does not appear to be a direct relationship between the degree of brain changes in any given individual and the outward signs of those changes that manifest as loss of cognitive functions.
It was then postulated that these individuals somehow did not show symptoms of the disease while they were alive because they had a large enough cognitive reserve to offset the damage and enable them to continue functioning as usual. The concept of reserve accounts for individual differences in susceptibility to age-related brain changes or Alzheimer’s disease-related pathology. There is evidence that some people can tolerate more of these changes than others and still maintain function.
This curious phenomenon led to intensive research that has shown that people with greater inherent cognitive reserve are better able to stave off or even keep at bay, the symptoms of degenerative brain changes associated with dementia or even some other brain diseases, such as Parkinson disease, multiple sclerosis, or a stroke. A more robust cognitive reserve can also help one to function better and for longer even when one is exposed to unexpected life events, such as stress, surgery, or toxins in the environment. Such circumstances demand extra effort from the brain, somewhat similar to requiring a car to engage another gear.
Research suggests that our level of intelligence, which traces back to childhood as well as our set of lifetime experiences, helps to build cognitive reserve and may account for differences in cognitive reserve between different individuals. The lifetime experiences include education, having an engaging occupation and taking part in stimulating activities; the latter ideally combining leisure activities, learning and social interactions.
The evidence that lifetime experiences help to build cognitive reserve comes from studies of large groups of people over long periods. Such studies have repeatedly found that these life experiences are associated with a slower rate of cognitive decline in normal ageing and reduced risk of developing Alzheimer’s disease.
In other words, higher attainment and engagement appear to protect cognitive function in ageing. Indeed, some studies have suggested that these life experiences may reduce the risk of Alzheimer’s disease by 35-40%. The changes in the brain that are seen in the disease may still occur, but these people cope better and will not ever be diagnosed because they do not present with any symptoms.
The basic perception of cognitive reserve suggests that the brain actively attempts to cope with brain damage by using pre-existing cognitive processing approaches or by enlisting compensatory mechanisms. This would allow an individual with higher cognitive reserves to handle it better to enable the individual to better cope with the brain damage than another with lower cognitive reserves.
It has now been realised that cognitive reserve can be enhanced by a programme of cognitive fitness. Such an initiative would develop the ability of the brain to deal with and function normally when it is induced to call upon the reserve power, especially when disease states take their toll. The very heart and the central cog of a coordinated brain health and cognitive fitness programme involves rather simple but all too familiar lifestyle changes. The cognitive reserve hypothesis gives hope that exposure to various sorts of stimulating activities can help us age successfully. It also leads us to ask what people can do to help increase their cognitive reserve.
It is still unclear what the exact ‘recipe’ for this is. The evidence from studies of large populations suggests that it is exposure to the experiences and activities discussed above across the lifetime that contribute to the reserve, but we do not yet know what specific activities would slow the rate of cognitive decline or reduce the risk of dementia.
Researchers at Harvard Medical School have identified six cornerstones to any effective brain health and cognitive fitness programme. These are as follows:-
Task 1:
Eat a plant-based diet. This is beneficial in many ways and building up cognitive reserves is just one of them. The diet needs to be a good balanced one to supply all macro and micro nutrients.
Task 2:
Exercise regularly. Like the vegetarian diet, this too has a multiplicity of positive benefits. Building up cognitive reserves is just one of them. The nature and severity of the exercise needs to be individualised. Some medical advice would certainly help in that venture.
Task 3:
Get enough sleep. It is well-known that sleep facilitates tissue repair. It is perhaps the same with the neurones and their connecting meshworks as well. A minimum of 6 hours is essential and it is quite good to have 8 hours of quality sleep.
Task 4:
Manage your stress. It has been proven that stress has deleterious effects on many systems of the human body. It is perhaps the same with the brain and the neural tissues.
Task 5:
Nurture social contacts. Good social connections may provide mental stimulation through complex interactions with others and hence build cognitive reserve and maintain healthy cognitive function. This is a very important component of the cognitive fitness initiative.
Task 6:
Continue to challenge the brain everyday. Just as much as regular exercise improves the physical functions and the physical strength of the body, mental exercises are well-known to be beneficial for the proper functioning of the brain. Research studies suggest that doing cognitive tasks that feel difficult, like problem-solving, learning something new, reading a newspaper article and discussing it with a friend, etc.., truly challenge the brain.
This multi-pronged plan includes and integrates proven approaches to committed changes being made in everyday lifestyles. It is advocated that by incorporating simple, specific changes into a daily routine, one could add years of enduring mental stamina and vitality. It is extremely important to realise that these factors are equal parts of a cohesive plan and that they do not work very well in isolation or when they are taken up just as one or two separate efforts. For example, simply eating more fibre or adding a morning walk to your routine is not enough to forestall mental decline. Instead, diet, exercise, sleep, stress management, social interaction, and mental stimulation, all work in harmony, just like in a concert, to yield the desired results.
All that we have undertaken during a lifetime of this worldly experience certainly helps in building up a mental and neurological reserve to enable us to successfully navigate through the drastic effects of age on our mental faculties. There is emerging evidence that even in older ages, commitment to the cause of enhancing that cognitive reserve would certainly help. Old age then becomes a really great pick-up or fizz time.
So, let us go for it.., everybody !!!
The author is grateful to his friend, Professor Nalaka Mendis, for rekindling the writer’s interest in Cognitive Reserve.
by Dr Gotabhya Ranasinghe
Senior Consultant Cardiologist
National Hospital Sri Lanka
When we sought a meeting with Hon Dr. Ramesh Pathirana, Minister of Health, he graciously cleared his busy schedule to accommodate us. Renowned for his attentive listening and deep understanding, Minister Pathirana is dedicated to advancing the health sector. His openness and transparency exemplify the qualities of an exemplary politician and minister.
Dr. Palitha Mahipala, the current Health Secretary, demonstrates both commendable enthusiasm and unwavering support. This combination of attributes makes him a highly compatible colleague for the esteemed Minister of Health.
Our discussion centered on a project that has been in the works for the past 30 years, one that no other minister had managed to advance.
Minister Pathirana, however, recognized the project’s significance and its potential to revolutionize care for heart patients.
The project involves the construction of a state-of-the-art facility at the premises of the National Hospital Colombo. The project’s location within the premises of the National Hospital underscores its importance and relevance to the healthcare infrastructure of the nation.
This facility will include a cardiology building and a tertiary care center, equipped with the latest technology to handle and treat all types of heart-related conditions and surgeries.
Securing funding was a major milestone for this initiative. Minister Pathirana successfully obtained approval for a $40 billion loan from the Asian Development Bank. With the funding in place, the foundation stone is scheduled to be laid in September this year, and construction will begin in January 2025.
This project guarantees a consistent and uninterrupted supply of stents and related medications for heart patients. As a result, patients will have timely access to essential medical supplies during their treatment and recovery. By securing these critical resources, the project aims to enhance patient outcomes, minimize treatment delays, and maintain the highest standards of cardiac care.
Upon its fruition, this monumental building will serve as a beacon of hope and healing, symbolizing the unwavering dedication to improving patient outcomes and fostering a healthier society.We anticipate a future marked by significant progress and positive outcomes in Sri Lanka’s cardiovascular treatment landscape within the foreseeable timeframe.
by Fr. Emmanuel Fernando, OMI
Jesuit Fr. Aloysius Pieris (affectionately called Fr. Aloy) celebrated his 90th birthday on April 9, 2024 and I, as the editor of our Oblate Journal, THE MISSIONARY OBLATE had gone to press by that time. Immediately I decided to publish an article, appreciating the untiring selfless services he continues to offer for inter-Faith dialogue, the renewal of the Catholic Church, his concern for the poor and the suffering Sri Lankan masses and to me, the present writer.
It was in 1988, when I was appointed Director of the Oblate Scholastics at Ampitiya by the then Oblate Provincial Fr. Anselm Silva, that I came to know Fr. Aloy more closely. Knowing well his expertise in matters spiritual, theological, Indological and pastoral, and with the collaborative spirit of my companion-formators, our Oblate Scholastics were sent to Tulana, the Research and Encounter Centre, Kelaniya, of which he is the Founder-Director, for ‘exposure-programmes’ on matters spiritual, biblical, theological and pastoral. Some of these dimensions according to my view and that of my companion-formators, were not available at the National Seminary, Ampitiya.
Ever since that time, our Oblate formators/ accompaniers at the Oblate Scholasticate, Ampitiya , have continued to send our Oblate Scholastics to Tulana Centre for deepening their insights and convictions regarding matters needed to serve the people in today’s context. Fr. Aloy also had tried very enthusiastically with the Oblate team headed by Frs. Oswald Firth and Clement Waidyasekara to begin a Theologate, directed by the Religious Congregations in Sri Lanka, for the contextual formation/ accompaniment of their members. It should very well be a desired goal of the Leaders / Provincials of the Religious Congregations.
Besides being a formator/accompanier at the Oblate Scholasticate, I was entrusted also with the task of editing and publishing our Oblate journal, ‘The Missionary Oblate’. To maintain the quality of the journal I continue to depend on Fr. Aloy for his thought-provoking and stimulating articles on Biblical Spirituality, Biblical Theology and Ecclesiology. I am very grateful to him for his generous assistance. Of late, his writings on renewal of the Church, initiated by Pope St. John XX111 and continued by Pope Francis through the Synodal path, published in our Oblate journal, enable our readers to focus their attention also on the needed renewal in the Catholic Church in Sri Lanka. Fr. Aloy appreciated very much the Synodal path adopted by the Jesuit Pope Francis for the renewal of the Church, rooted very much on prayerful discernment. In my Religious and presbyteral life, Fr.Aloy continues to be my spiritual animator / guide and ongoing formator / acccompanier.
Fr. Aloysius Pieris, BA Hons (Lond), LPh (SHC, India), STL (PFT, Naples), PhD (SLU/VC), ThD (Tilburg), D.Ltt (KU), has been one of the eminent Asian theologians well recognized internationally and one who has lectured and held visiting chairs in many universities both in the West and in the East. Many members of Religious Congregations from Asian countries have benefited from his lectures and guidance in the East Asian Pastoral Institute (EAPI) in Manila, Philippines. He had been a Theologian consulted by the Federation of Asian Bishops’ Conferences for many years. During his professorship at the Gregorian University in Rome, he was called to be a member of a special group of advisers on other religions consulted by Pope Paul VI.
Fr. Aloy is the author of more than 30 books and well over 500 Research Papers. Some of his books and articles have been translated and published in several countries. Among those books, one can find the following: 1) The Genesis of an Asian Theology of Liberation (An Autobiographical Excursus on the Art of Theologising in Asia, 2) An Asian Theology of Liberation, 3) Providential Timeliness of Vatican 11 (a long-overdue halt to a scandalous millennium, 4) Give Vatican 11 a chance, 5) Leadership in the Church, 6) Relishing our faith in working for justice (Themes for study and discussion), 7) A Message meant mainly, not exclusively for Jesuits (Background information necessary for helping Francis renew the Church), 8) Lent in Lanka (Reflections and Resolutions, 9) Love meets wisdom (A Christian Experience of Buddhism, 10) Fire and Water 11) God’s Reign for God’s poor, 12) Our Unhiddden Agenda (How we Jesuits work, pray and form our men). He is also the Editor of two journals, Vagdevi, Journal of Religious Reflection and Dialogue, New Series.
Fr. Aloy has a BA in Pali and Sanskrit from the University of London and a Ph.D in Buddhist Philosophy from the University of Sri Lankan, Vidyodaya Campus. On Nov. 23, 2019, he was awarded the prestigious honorary Doctorate of Literature (D.Litt) by the Chancellor of the University of Kelaniya, the Most Venerable Welamitiyawe Dharmakirthi Sri Kusala Dhamma Thera.
Fr. Aloy continues to be a promoter of Gospel values and virtues. Justice as a constitutive dimension of love and social concern for the downtrodden masses are very much noted in his life and work. He had very much appreciated the commitment of the late Fr. Joseph (Joe) Fernando, the National Director of the Social and Economic Centre (SEDEC) for the poor.
In Sri Lanka, a few religious Congregations – the Good Shepherd Sisters, the Christian Brothers, the Marist Brothers and the Oblates – have invited him to animate their members especially during their Provincial Congresses, Chapters and International Conferences. The mainline Christian Churches also have sought his advice and followed his seminars. I, for one, regret very much, that the Sri Lankan authorities of the Catholic Church –today’s Hierarchy—- have not sought Fr.
Aloy’s expertise for the renewal of the Catholic Church in Sri Lanka and thus have not benefited from the immense store of wisdom and insight that he can offer to our local Church while the Sri Lankan bishops who governed the Catholic church in the immediate aftermath of the Second Vatican Council (Edmund Fernando OMI, Anthony de Saram, Leo Nanayakkara OSB, Frank Marcus Fernando, Paul Perera,) visited him and consulted him on many matters. Among the Tamil Bishops, Bishop Rayappu Joseph was keeping close contact with him and Bishop J. Deogupillai hosted him and his team visiting him after the horrible Black July massacre of Tamils.
Sri Lanka-Singapore Free Trade Agreement
By Gomi Senadhira
senadhiragomi@gmail.com
“You might tell fairy tales, but the progress of a country cannot be achieved through such narratives. A country cannot be developed by making false promises. The country moved backward because of the electoral promises made by political parties throughout time. We have witnessed that the ultimate result of this is the country becoming bankrupt. Unfortunately, many segments of the population have not come to realize this yet.” – President Ranil Wickremesinghe, 2024 Budget speech
Any Sri Lankan would agree with the above words of President Wickremesinghe on the false promises our politicians and officials make and the fairy tales they narrate which bankrupted this country. So, to understand this, let’s look at one such fairy tale with lots of false promises; Ranil Wickremesinghe’s greatest achievement in the area of international trade and investment promotion during the Yahapalana period, Sri Lanka-Singapore Free Trade Agreement (SLSFTA).
It is appropriate and timely to do it now as Finance Minister Wickremesinghe has just presented to parliament a bill on the National Policy on Economic Transformation which includes the establishment of an Office for International Trade and the Sri Lanka Institute of Economics and International Trade.
Was SLSFTA a “Cleverly negotiated Free Trade Agreement” as stated by the (former) Minister of Development Strategies and International Trade Malik Samarawickrama during the Parliamentary Debate on the SLSFTA in July 2018, or a colossal blunder covered up with lies, false promises, and fairy tales? After SLSFTA was signed there were a number of fairy tales published on this agreement by the Ministry of Development Strategies and International, Institute of Policy Studies, and others.
However, for this article, I would like to limit my comments to the speech by Minister Samarawickrama during the Parliamentary Debate, and the two most important areas in the agreement which were covered up with lies, fairy tales, and false promises, namely: revenue loss for Sri Lanka and Investment from Singapore. On the other important area, “Waste products dumping” I do not want to comment here as I have written extensively on the issue.
1. The revenue loss
During the Parliamentary Debate in July 2018, Minister Samarawickrama stated “…. let me reiterate that this FTA with Singapore has been very cleverly negotiated by us…. The liberalisation programme under this FTA has been carefully designed to have the least impact on domestic industry and revenue collection. We have included all revenue sensitive items in the negative list of items which will not be subject to removal of tariff. Therefore, 97.8% revenue from Customs duty is protected. Our tariff liberalisation will take place over a period of 12-15 years! In fact, the revenue earned through tariffs on goods imported from Singapore last year was Rs. 35 billion.
The revenue loss for over the next 15 years due to the FTA is only Rs. 733 million– which when annualised, on average, is just Rs. 51 million. That is just 0.14% per year! So anyone who claims the Singapore FTA causes revenue loss to the Government cannot do basic arithmetic! Mr. Speaker, in conclusion, I call on my fellow members of this House – don’t mislead the public with baseless criticism that is not grounded in facts. Don’t look at petty politics and use these issues for your own political survival.”
I was surprised to read the minister’s speech because an article published in January 2018 in “The Straits Times“, based on information released by the Singaporean Negotiators stated, “…. With the FTA, tariff savings for Singapore exports are estimated to hit $10 million annually“.
As the annual tariff savings (that is the revenue loss for Sri Lanka) calculated by the Singaporean Negotiators, Singaporean $ 10 million (Sri Lankan rupees 1,200 million in 2018) was way above the rupees’ 733 million revenue loss for 15 years estimated by the Sri Lankan negotiators, it was clear to any observer that one of the parties to the agreement had not done the basic arithmetic!
Six years later, according to a report published by “The Morning” newspaper, speaking at the Committee on Public Finance (COPF) on 7th May 2024, Mr Samarawickrama’s chief trade negotiator K.J. Weerasinghehad had admitted “…. that forecasted revenue loss for the Government of Sri Lanka through the Singapore FTA is Rs. 450 million in 2023 and Rs. 1.3 billion in 2024.”
If these numbers are correct, as tariff liberalisation under the SLSFTA has just started, we will pass Rs 2 billion very soon. Then, the question is how Sri Lanka’s trade negotiators made such a colossal blunder. Didn’t they do their basic arithmetic? If they didn’t know how to do basic arithmetic they should have at least done their basic readings. For example, the headline of the article published in The Straits Times in January 2018 was “Singapore, Sri Lanka sign FTA, annual savings of $10m expected”.
Anyway, as Sri Lanka’s chief negotiator reiterated at the COPF meeting that “…. since 99% of the tariffs in Singapore have zero rates of duty, Sri Lanka has agreed on 80% tariff liberalisation over a period of 15 years while expecting Singapore investments to address the imbalance in trade,” let’s turn towards investment.
Investment from Singapore
In July 2018, speaking during the Parliamentary Debate on the FTA this is what Minister Malik Samarawickrama stated on investment from Singapore, “Already, thanks to this FTA, in just the past two-and-a-half months since the agreement came into effect we have received a proposal from Singapore for investment amounting to $ 14.8 billion in an oil refinery for export of petroleum products. In addition, we have proposals for a steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million), sugar refinery ($ 200 million). This adds up to more than $ 16.05 billion in the pipeline on these projects alone.
And all of these projects will create thousands of more jobs for our people. In principle approval has already been granted by the BOI and the investors are awaiting the release of land the environmental approvals to commence the project.
I request the Opposition and those with vested interests to change their narrow-minded thinking and join us to develop our country. We must always look at what is best for the whole community, not just the few who may oppose. We owe it to our people to courageously take decisions that will change their lives for the better.”
According to the media report I quoted earlier, speaking at the Committee on Public Finance (COPF) Chief Negotiator Weerasinghe has admitted that Sri Lanka was not happy with overall Singapore investments that have come in the past few years in return for the trade liberalisation under the Singapore-Sri Lanka Free Trade Agreement. He has added that between 2021 and 2023 the total investment from Singapore had been around $162 million!
What happened to those projects worth $16 billion negotiated, thanks to the SLSFTA, in just the two-and-a-half months after the agreement came into effect and approved by the BOI? I do not know about the steel manufacturing plant for exports ($ 1 billion investment), flour milling plant ($ 50 million) and sugar refinery ($ 200 million).
However, story of the multibillion-dollar investment in the Petroleum Refinery unfolded in a manner that would qualify it as the best fairy tale with false promises presented by our politicians and the officials, prior to 2019 elections.
Though many Sri Lankans got to know, through the media which repeatedly highlighted a plethora of issues surrounding the project and the questionable credentials of the Singaporean investor, the construction work on the Mirrijiwela Oil Refinery along with the cement factory began on the24th of March 2019 with a bang and Minister Ranil Wickremesinghe and his ministers along with the foreign and local dignitaries laid the foundation stones.
That was few months before the 2019 Presidential elections. Inaugurating the construction work Prime Minister Ranil Wickremesinghe said the projects will create thousands of job opportunities in the area and surrounding districts.
The oil refinery, which was to be built over 200 acres of land, with the capacity to refine 200,000 barrels of crude oil per day, was to generate US$7 billion of exports and create 1,500 direct and 3,000 indirect jobs. The construction of the refinery was to be completed in 44 months. Four years later, in August 2023 the Cabinet of Ministers approved the proposal presented by President Ranil Wickremesinghe to cancel the agreement with the investors of the refinery as the project has not been implemented! Can they explain to the country how much money was wasted to produce that fairy tale?
It is obvious that the President, ministers, and officials had made huge blunders and had deliberately misled the public and the parliament on the revenue loss and potential investment from SLSFTA with fairy tales and false promises.
As the president himself said, a country cannot be developed by making false promises or with fairy tales and these false promises and fairy tales had bankrupted the country. “Unfortunately, many segments of the population have not come to realize this yet”.
(The writer, a specialist and an activist on trade and development issues . )
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