How to Avoid Cognitive Decline & Dementia (starting in your 40s) | Dr. Tommy Wood

0:00Jonathan Fields: For decades, we have been told that a sharp, quick mind is a young person's game and everything after is kind of slow decline. Today's guest says that's mostly a story that we've internalized, not a biological fact. And there's one major life transition that most of us spend our whole lives looking forward to that may quietly be one of the most dangerous things you can do to your brain. If you want to know exactly what that is and why, and the numbers to check at your next doctor's visit that could really change the whole trajectory of your brain health, stick around. In this conversation, you'll discover why age-specific dementia rates have actually been falling for decades, even as headlines warn of a coming epidemic.

0:42Jonathan Fields: We'll talk about the real difference between forgetting a name and never truly encoding it in the first place, and why one of those only predicts decline and even dementia. Why retirement, especially early retirement, can quietly accelerate cognitive decline in even the sharpest, most accomplished people. We'll explore the three-part framework that ties together nearly everything we know about a resilient brain and the specific blood work to request and things to do this year that sets the stage for the next 50. Our guide is neuroscientist, performance consultant to Olympic athletes and Formula One drivers and author of The Stimulated Mind, Dr.

1:21Jonathan Fields: Tommy Wood. I'm Jonathan Fields, and this is Good Life Project. We'll jump right in after this short break.

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3:28Jonathan Fields: One of the things that I really want to start with is sort of on a meta level here is a question. And the question is whether cognitive decline, our ability to think deeply, to think clearly, to process complicated things, and even remember things, whether a decline in that is inevitable as we age. Because I think that's the story that so many of us have been told and maybe never really kick the tires. Absolutely. And it even could get more interesting than that because our cognitive function may purposefully change over time, and that may not even be a bad thing. So one example of that before we jump into the decline is that when we look at our different cognitive functions, and there are several that we can sort of measure, and we think we can maybe isolate as neuroscientists, There's one group of cognitive functions that we call crystallized intelligence, which is basically a fancy neuroscience word for wisdom.

4:35And this is our ability to remember facts about the world, integrate them together, have some bigger picture and make decisions. Maybe not decisions that require sort of very rapid decision making, but sort of, you know, these like bigger picture questions and things we might want to do. and that actually improves our bit our crystallized intelligence improves into our 60s and 70s and maybe even beyond even while on average we expect other functions to decline things like reaction time or working memory or how quickly we can process information so some of it actually is just a shift in how our brains work as we experience more of the world over time and that's not a bad thing.

5:20That's our brains working as expected. But when we think about this idea that our brains are destined to decline with age, this is something that has sort of been baked into society over the last hundred plus years. And I argue that maybe it started around the beginning of the 20th century when they were trying to formalize the idea of retirement. Before then people didn't really retire they couldn't afford to there weren't such thing as pensions where you had to work until you died um and there were people like uh sir william osler who was a canadian physician helped found johns hopkins hospital who helped to popularize the idea of retirement and one of the ways he did that was by telling people you know by the time you're 60 you're essentially useless and we should just put you out to pasture that's paraphrasing but it's essentially what he was known to have said publicly.

6:15And of course, back then, the average 50-year-old probably wasn't in as good health as they are today. But we've essentially internalized this idea that at some point in our 60s, perhaps, we expect this decline, and we expect to no longer be useful. And we have data, even that's like 50 or 60 years old, that disproves this. So one example is the Seattle longitudinal study that was run at the University of Washington, where I now work, by Warner Shai. And for the first time, they took the same people and they measured their cognitive function over multiple decades. They brought them back every seven years, and they measured the same person with the same tests, and they saw how their function changed over time.

7:02And for most people, their cognitive function did not change from their 50s to their 70s and beyond, which is, and this was starting in the 1950s, right? This is quite a long time ago now. And this is not what we expect. We expect those people to have declined. And those data are actually used to raise the retirement age in the US in the 1980s. And whether or not you're glad about that, you know, that's a more of a philosophical thing. But we've known for a long time that the average expectation should be that you maintain cognitive function from your 50s into your 80s. And yes, some people will potentially lose some function.

7:43And there are a number of modifiable factors that can alter that trajectory. But fundamentally, we have a lot of data that shows that actually, the expectation should be that we maintain function. And it's not unusual for that to happen. And now we understand a lot more about the things that we might be able to do in order to achieve that.

8:04Jonathan Fields: I mean, it's fascinating also that that data started in the 1950s, because you look at that and you're like, well, you know, in the 75 year span since then, the life expectancy has certainly improved. Medicine has improved in so many different ways. But also what people tend to learn and know about how to live a, quote, healthier life has improved dramatically also. So, you know, the typical coercion lives very differently now than it did in the 50s. And you're saying that even with that, data started in the 50s still tracks to show that this is still true. Yeah, absolutely. And sort of alongside that, like you're saying, things have improved a lot in terms of what we know about treating, preventing chronic disease, what we know about what it means to live a healthier lifestyle.

8:54And with that, we are actually seeing changes in dementia diagnoses that don't get the headlines that they should. So what you'll hear most of the time is that dementia burden is increasing, that it's going to double or triple in the next two or three decades. It's going to be the disease that bankrupts Medicare, Medicaid. We've heard versions of these things. and that's potentially true if we sort of continue on the same trajectory but it's largely because we've gotten so good at preventing other diseases that we're you know living an increasingly long time and dementia is therefore sort of coming sort of rising up in terms of potential causes of death but when you look at the data another way something called age specific incidence of dementia is decreasing and age specific instance means that at a given age how likely are you to be diagnosed with dementia and that has been dropping for the past several decades so at 70 years old now you are less likely to be diagnosed with dementia than any other time previously in history and and nobody tells us that um and one of the reasons for that one of the reasons primary reasons that's thought to be the case is because we've gotten so good at treating and preventing heart disease, which is a major risk factor for dementia.

10:21But there are other things that have shifted too. So smoking has obviously decreased. That's been a big part of sort of cardiovascular risk reduction. But also access to education and the work environment, particularly for women, has improved a lot over the past 40, 50 years. It was only really in the 70s that that started um to to shift and become much more equitable in the u.s for example and we know that um education and the type of work that you do is also an important risk factor for dementia so multiple things have improved as as you've said over the last five six decades and that's actually being borne out in the data um unfortunately we just don't get told that we sort of get told the doom and gloom which makes us think that we're destined to experience this when And actually, a lot of things are suggesting that it might actually be getting better as we get better at sort of addressing our personal and population health.

11:17Jonathan Fields: That's so interesting. Knowing that that's a big part of the story that's really not being told kind of changes the way that you look at it. Yeah. I want to tease out a distinction that you're making here, though, because I opened the conversation asking you about sort of generically cognitive decline. You talked about this thing called crystallized intelligence. I've also heard the complement of that fluid intelligence. And then you're moving us into the domain of dementia. Talk to me about the span here. Like, what is this early? Like, how do we go from completely like high functioning? You know, our brain is firing on all cylinders to cognitive decline to dementia.

11:58I'll start at the end there. It's just sort of like dementia is the end state. And the reason why it's useful to talk about that is because this is what people really fear. Yeah, for sure. Dementia being a clinical diagnosis made by a doctor after a series of tests where somebody has lost enough cognitive function that they're no longer able to look after themselves on a day-to-day basis. That's essentially what might cause a diagnosis of dementia. and there are multiple types of dementia or causes of dementia the most common is alzheimer's disease which people almost certainly have heard of which makes up 60 to 80 percent of cases of dementia and you know one of the reasons i was making the case or is you're giving the details about you know education and workforce for women is is because um two-thirds of the burden of Alzheimer's disease affects women compared to men.

12:54The next most common cause of dementia is vascular dementia, which is essentially changes in blood vessels in the brain or changes in blood supply to the brain that then affects cognitive function. And actually, there's a huge amount of overlap between vascular dementia and Alzheimer's disease. And often, in most people, they actually occur together, that between them making up 70 to 90 % of the cases of dementia. And these are the cases of dementia in particular that we now think are potentially preventable if we do change some aspects about lifestyle and the environment that could support

13:28Jonathan Fields: the more vascular oriented yeah so vascular oriented or more directly linked to the environment and lifestyle whereas other cases of dementia maybe less so there's still a role to play there but it's more strongly linked in vascular dementia and Alzheimer's disease but You're absolutely right that there's some trajectory there. You don't suddenly experience dementia. It's thought to be the changes in brain function, brain health, cognitive function, and then essentially the sort of trajectory downwards in terms of cognitive function that might end up with dementia happens over decades. and it really seems like midlife is the period of time when risk becomes amplified so in our sort of 30s to 50s is where you're really sort of setting the scene for what's going to happen to your brain uh in in the future and this is changes in um physical health this is um how we sleep this is how you know how how we move physical activity smoking some of these other things we've touched upon a little bit already it essentially may take decades for these things to compound and start to affect uh the brain and then you know maybe within 10 20 years you you might start to experience some changes there's sort of the first stage of this progression is now something called subjective cognitive decline where you might notice some changes or somebody who knows you very well might notice some changes what would be examples of that it might be that people are noticing some changes in your personality um some things that uh it might be changed it might be changes in memory we often think about memory but it isn't always memory something that is frequently affected in alzheimer's disease for example and many uh many dementias is is executive functions so is being able to kind of make decisions and plan so there have been some recent studies that show that maybe uh a decade or at least several years before somebody you know gets a diagnosis of dementia, they've been gotten much worse at managing their personal finances.

15:46For example, they're not able to plan, they're not able to budget, they're not keeping an eye of what's coming in and what's going out. Those kind of like complex day-to-day processes that we do, you might notice in a loved one or potentially in yourself that mistakes have been made or you've been able to keep track of things or, and that's kind of, that might be the first thing that could be noticed. In the very early stages, it's thought that those changes are potentially reversible. So if we can identify risk factors, if we can identify potential interventions, again, related to lifestyle, treating cardiovascular disease risk factors, treating things like diabetes or high blood pressure, we might be able to reverse a lot of those changes.

16:34That's probably going to get harder and harder as you go down that trajectory. um but it's really so it's really in that early period or period before you even notice something that you can kind of set the stage for what for what happens later i will say though that there are now lots of studies your big randomized controlled trials that show that people in their 60s or 70s if we change their diet and we give them some you know improve their physical activity and we address their cardiovascular risk factors you can see significant improvements in cognitive function even sort of in in older adults so even though i'm talking about midlife as this important period where it which it is you can still see significant benefit and changes you know even

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21:02Jonathan Fields: That's Kachava, K-A-C-H-A-V-A dot com code good life. One of the things that's coming up for me is I'm sure we have people joining us and they're kind of nodding along and maybe they're questioning this about the moment they're in their lives or maybe they have parents and they're questioning about them or they're like supporting parents. but you know they're also probably asking themselves okay so yeah that's the classic guy where did I put my keys or like what's the name of that person again or like those sort of like everyday things how do you start to tease out are these early signs of something that I should be really addressing to the extent that I can address it or am I just stressed out of my mind am I just overworked and overtired and eating terribly like how do you how do you start to make these distinctions or is it just a yes and thing at all like a little bit the answer is like well yes yes to both but uh there are some some important distinctions that that can be made so um when you're thinking about what happens in the brain in an individual with with Alzheimer's disease, for example, what changes, or one of the things that seems to change, is, particularly as we're talking about memory, is the encoding of memories.

22:26And so there are three main stages of memories. It could get a lot more complicated than that, but just for like our purposes, there's three main stages. One is encoding. You have experienced something, you've decided this is something you're going to remember the brain starts to make changes in order to remember this thing um then there's consolidation this is the process of actually building you know um kind of building that into the network such that this is something you remember in the future a lot of that happens during sleep and then there's retrieval you know actually accessing that memory when you want to access it when you're in that scenario you described uh i just can't who's this like i've met this guy like 10 times i just can't can't remember his name um that's a retrieval issue and for most people retrieval issues are generally related to what you described they're stressed they're sleep deprived that they were distracted when they met this guy last time and like they weren't really paying attention and so that tends to be reversible right if you can address some of those things um you can we know you're likely to be able to recover a lot of that and like some of it's just like situational you're also trying to remember it but you're also trying to think about this other thing that you were doing and you're worried about where you got to pick up the kids later and what am i going to have for dinner right so like most of this i think is relatively normal and a lot of these more episodic type memories we call them just like you only remember this guy because you see him in this place and if you see amount of context your brain doesn't really have the infrastructure to write it's like this is entirely normal um when people experience dementia more often it's an encoding issue right that memory never gets placed or tagged for or you know that um experience never gets tagged it to be saved as a memory so the individual never remembers that there's a thing that they're supposed to remember they right it's as if it never happened so there is a distinction there in terms of the experience that you have however if you are somebody who for several decades of your life is sleep deprived stressed distracted you know eating poorly and actually we know that um if you if you force people to eat um like a large amounts of a western style diet in a lab study like their memory gets worse you know within a week um and so if that's you for long periods of time we know those increase your risk of dementia so in the short term it's not necessarily something to worry about it could be it's a normal part of the the modern like life experience but if those uh things are never addressed and you know they happen for decades at a time we do know they they then increase your risk of later dementia yeah that makes sense to me as you're describing

25:21Jonathan Fields: those three different stages also um what popped into my mind was a conversation i had not too long ago with somebody who is one of these people who would walk into a room and he would you know like meet 100 people and at the end of it he could tell you the name of every single person in the room and i said what's going on there and he's like he's like what most people don't realize is with things like that it's not that you can't retrieve it as you were just describing you never encoded it yes absolutely and that's not necessarily a bad thing right there's if if it's really important to you to remember the hundred people in this room and you focus on each of them and you focus on some features of them and you like tag that to the name and you're having this conversation and you're like making eye contact and you're really kind of internalizing it you will encode that information but you need to tell your brain that it's important in the first place and it it may not be it may not be important to you to remember those hundred people and so unless you're really focusing on this and there are aspects of memory that are critical to encode that memory in the in the first place like importance and distinctiveness and like how do you tell the brain that this is something you actually want to remember by engaging with that information and giving it a reason um you know and other tags to kind of remember it right but if you're not doing that don't expect to remember it and that's normal like the this the the standard procedure is for your brain to forget actually the standard procedure is for you to never even experience it in the first place like most of your brain's computing power is filtering stuff out so that you only get what it thinks is important um so you can change that but it requires you to you know really engage um in the process of making that memory yeah and what you said is so important I want to repeat it again, make sure.

27:11Jonathan Fields: So most of what your brain is doing throughout the day is filtering out a massive number of stimuli or input so that you actually can focus on the few things that genuinely matter to you. So we have things coming at us all day, every day. But if our brain literally tried to make all of them important, encode all of them, put them into our, we probably couldn't function. Yeah. so there's a really nice paper um that there's there's relates to this it was called the unbearable slowness of being but basically i love the name yeah i know and it also just kind of um describes where we think of our brains as these amazing supercomputers which which they are but um it describes how slow human thought actually is like when you really boil it down humans do not think that quickly and so like they put a number on it 10 bits per second so like a bit is like a single one or a zero right so you can process 10 ones on zeros a second which actually when you're thinking about all the stuff that you're exposed to isn't very much um and so they liken the amount of information that you're that you're that comes into your brain versus the amount of information that you can actually physically be cognizant of and process is the same as the amount one human can drink relative to the amount of water coming through the through the hoover dam right so like what your brain is doing is figuring out which water you should drink while the rest of the water that comes to the hoover dam is being kind of let is let to to run past you um and so like that's kind that's the kind of scales that we're talking about yeah that makes so much sense and i would imagine now also with all of us tethered to our devices and billions or trillions of dollars being spent on algorithms that try and tell your brain oh this is important it's even harder these days yeah yeah yeah especially like and even beyond that right so it's like if we go to an app or something and we're focusing on one thing that that is what like one thing obviously your attention is being captured you're being told what is important but beyond but it's not just that probably more insidious um is the fact that while you're doing that somebody's texting you slack and teams are popping up and you know you're trying to watch netflix at the same time so like you can't even focus on this one thing that's trying to capture attention because like everything's trying to distract you and then that is the exact opposite of what is required in order to you know make make memories in the first place let alone remember them later yeah that makes so much sense you you argue also i I think this is really interesting that, you know, if we're looking at sort of like moments or windows or occasions in our life that many of us will experience better danger zones for cognitive decline or an acceleration towards potential dementia, retirement is one of the clearest danger zones.

30:13Jonathan Fields: Take me into this. Yeah. So I think I've previously said that retirement was the worst idea the brain ever experienced. And I'll preface this by saying that if you had a long career and you're ready for a break, I'm not saying you shouldn't enjoy your well-earned retirement. That's not what I mean. It's that when you look at lots of big population studies, the time when cognitive decline tends to accelerate is around the period of retirement. and particularly dangerous for those who retire early even after you you account for medical conditions or something else that that might cause you to retire early and the the reason this is thought to be the case is that the primary driver of your cognitive function is the way your brain engages with the world it's the skills you learn the people you meet the people the problems you solve and most of that occurs during work um and so if we retire and we don't replace those cognitive inputs with something else that stimulates our brains in a similar way we're removing this critical input that helps to maintain function it's it's very very similar to um you know a professional athlete retires and then just never works out again and you can very rapidly see a decline in their physical function right because they're no longer providing that that physical stimulus and the brain is essentially the same so the this is just something that we need to know about um and and interestingly uh it's difficult to to like really tease this out from the data all of it's observational but there's some suggestion that those who maybe had the highest levels of education and the most demanding jobs are at the greatest risk during this period because their brains are just used to all these inputs.

32:13They're used to solving all these problems, going to all these meetings, doing all this complex work that their brain is kind of dependent on it in order to maintain its function. So then you just have to make sure you're doing something else during this period of retirement. So are you learning new sports or new languages or a musical instrument? Are you volunteering? How are you continuing to show your brain that it's worth sticking around because that's essentially the signal that's going to keep it there.

32:42Jonathan Fields: Yeah. So it's not really, it's not the fact of retirement that triggers a slow decline. It's the fact that you've been doing hard things and struggling and problem solving and dealing with all sorts of things moving at you for decades as you work. And then all of a sudden there's the day where you receive the plaque and the pen and you walk out of the office and you know, you walk into this next season and all of a sudden all that isn't there just by default. And so all of the things that kept your brain in prime form aren't there. So it sounds like then what you're saying is, if that in fact is what retirement looks like for you, then it's on us to figure out how do we then invite new things into our experience of this season to continue to bring novelty and difficulty and challenge to the brain?

33:31Jonathan Fields: Because that's, why is that so important too that's absolutely right um and um i think some of this is related to what like arthur seabrooks has called the striver's curse which is that right when when you've been so successful you achieve so much and then right through your work and then you lose that all of a sudden there's this like well what's the point like there's like the the meaning is lost purpose is lost and so some of it is like regaining or finding a new um new ways to find meaning in what what you do which is like critically important for humans um but fundamentally the the majority of the tissues in the body and organs in the body their function is driven by the demands placed on them and the the like physical function in in people who exercise or don't exercise, but just in people who move their bodies, I think is the best example because those processes are essentially identical in the brain.

34:33So if you want to get stronger or you want to get fitter, the most important thing to do is exercise or movement that kind of drives that adaptation, right? You want to get bigger biceps, you need to do bicep curls. You want to be a better a marathon runner you have to go and run and this is what drives the adaptation it what maintains the function of the cells it drives a whole bunch of processes that we think of as anti-aging right there are some biochemical processes that we call aging and um exercise in in the muscle tissue is the main thing that prevents or reverses those changes um and it's really the building and maintenance of function that is driven by how we use our muscles or how we use our bodies and the brain is essentially the same and you can you can see some of these exact same processes so you stimulate a network in the brain um that's uh important for focus and attention because you're actually like truly focusing on something you activate all these same same pathways right you upregulate the performance of the mitochondria and like energy production and you you start to clean up the cells from like junky proteins that can accumulate over time because of the stimulus you're putting on those cells and those networks and it's the same for pretty much any tissue you can think of in the body it's like the same for your bones it's the same for your immune system right your immune system if it's challenged with a vaccine or an infection right it usually gets better at dealing with it next time and so that's that's really it is that the the function of our cells is primarily driven by the challenges they face or the stimuli they get and yes we can improve our ability to respond to those stimuli um just like if you're an athlete you want to make sure that you're getting plenty of nutrients and enough protein and enough sleep right because that's when you adapt and you recover to the training you did but the training is is is fundamentally a critical part of of building function and so this is just a fundamental aspect of our biology we want a tissue to function better we need to apply a stimulus to it yeah it's funny because i think you know it makes total sense when you think about the muscles

36:47Jonathan Fields: in your body i've got to work out if i want to stay strong if i want to be able to do all these different things we don't make that automatic leap to our brains though we're like oh the brain but the brain isn't a quote muscle right so yeah it's got to be different um and yet what you're saying is not so much yeah they're sort of but you know biochemically or physiologically very similar things are happening you can't see it which is why i i usually talk about that analogy to physical function or strength or muscles because that's something we can see we can we can we understand it but actually when you look at studies that um kind of track what happens after you apply a stimulus to your brain you see just the same things happening as you see in in the muscle in the muscle tissue um you can build more brain structure you can make it function better right so so like uh muscle structure is like muscle size and then muscle function is muscle strength right you can get parallel improvements in the brain um that we can actually sort of measure in various ways it's just harder for us to see because it's kind of in there right we're not all walking around with scams where people can just look at it and see what's happening inside of us.

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40:11Jonathan Fields: one of the things that became popular i feel like i i don't hear as much of it now you know is this notion of brain games um and it started out you know in more analog way of well let's do crossword puzzles and sudoku and things like that and then it became digitalized and apps and all these different things um are things like that enough to make a meaningful difference so So the quick answer is no. It doesn't mean that they're bad. And when you look at the things that people do with their brains as they get older and their later risk of dementia, often there will be a case of, well, how many different skills, activities, hobbies, things do you engage in?

40:58um and it seems that those who you know regularly do three or four things that kind of challenge their brains tend to and that can be come you know from physical movement um dancing languages volunteering like that kind of stuff but then there's also reading crosswords um going to lectures things like that so crosswords kind of and sudoku and wordle or whatever they kind of fit into there as yes it could be part of the picture and some of the studies have kind of shown that but it's it's never enough on its own and and the reason for that is if you think about how you're using your brain um gloria mark is a um she's an occupational psychologist everybody haven't read her book read her book attention span it's fantastic um and she has this quadrant in terms of focus and challenge right so um and and so like there's two two levels of focus and two levels of challenge and so things like sudoku and crosswords you're focused but you're not challenged right so it feels good you're kind of doing something you're good at you get you get a little bump of oh yeah i achieved something but the type of activity that really shapes the brain is where you're both focused and challenged um and that's some and that's what happens during complex skill learning uh complex problem solving um and that's it it can be hard to do for extended periods of time maybe you can only do it for 30 or 60 minutes a time right you can't go it is it's it's kind of like you know you can't go and lift your heaviest squats in the gym all day every day right you need focused periods of training and then and then you need to rest and recover and adapt afterwards so it can be part of so like crossbow and sudoku can be part of the picture but you also want something that's really kind of stretching complex complex skills yeah um

42:45Jonathan Fields: So challenge is a really big part of it. It's not just focus, challenge. Exactly. So challenge is really important. And so one like small part, like sort of part of this picture, because you mentioned brain games, is there is one type of brain training that does have some good evidence for it. um it's uh training of processing speed uh so like how rapidly your brain processes information which tends to drop off sometime around 60 on average if you look at like a big population of more than a million people there was one study that looked at this and there was a a study going back to the 90s called the active study which is still the biggest ever study of brain training in older adults um and one group in the active study so they're three different training groups in a control group and one group did processing speed training and so what happens is information flashes up on a screen and you have to remember what you saw and where you saw it um even if it only flashed up for like 200 milliseconds and then if you're good at it it will get harder like that time will get shorter and shorter um and it adapts it adapts to you to kind of push the the edges of your current processing speed and make it a little bit better and adults who did that training it was a 10 training sessions over six weeks and then booster sessions at one year and three years they just published a 20-year follow-up of the active study and that group had a significantly decreased risk of later dementia by like really challenging this processing speed aspect of the brain other forms of brain training don't have as good evidence as this specific type um it's it's been built into a platform called brain hq um which has been used in lots of studies now so there is some evidence for for brain training but if you ever do uh so like the double decision in brain hq which is this the modern version of this task that did an active it's actually very hard and it requires where you are really challenged to kind of process information rapidly so um equally i think you get the same thing by going and playing pickleball because it requires all those same kind of fundamental processing speed aspects plus you get physical activity and social connection and all this other kind of stuff so probably a lot more you don't yeah yeah so i would advocate for doing it that way but if you want to do some kind of formal brain training that does have some evidence for it that would be the way to do it So then it sounds like this particular type of thing.

45:25Jonathan Fields: So we need focus and we need challenge. And there are lifestyle things that you're talking about here that can give us what we need. I mean, because I'm also thinking, what about learning a language? What about learning an art form or a craft that we're an absolute newbie at? Like we have no skill at, you know, do things like that make a meaningful difference? so i would argue yes um there are a few different lines of evidence on on the things that you've mentioned so um for language learning some of the best evidence we have as it relates to later cognitive function and cognitive decline is actually people who who grow up bilingual if you grow up bilingual you have a lower risk of later dementia and it's and i have some some uh friends and colleagues who study this and it's thought to be because your brain is constantly juggling between two different language systems like suppressing one while using the other and switching back and forth you get better at like processing complex decisions because your brain is sort of like used to having to do that um however there are also studies in older adults where you you have them join a language class or even use a duolingo app and you see some significant improvements in related cognitive functions executive functions so like being able to rapidly make make decisions and maybe even some changes in the brain that kind of map onto that um there are also um studies like for the other things that you mentioned so you see something similar with music learning even even in old even in older adults um and that works throughout the entire lifespan if you get kids and you teach them how to play musical instruments that your their broader cognitive function improves as well.

47:12Then there was a very interesting study that came out recently called Creative Experiences and Brain Clocks. And what they did was they created like a brain age. So people might have heard of like a biological age. So like how old is your body relative to how old you are in years? And they did something similar for the brain by measuring electrical activity in the brain. and when you measure electrical activity of the brain you can measure like which networks and areas of the brain are kind of talking to each other at different times and one thing that we tend to see that happens as people lose cognitive function is that the fidelity of those networks gets a little fuzzier right they're they're not as efficient as they have been previously so they basically created this brain age to say how old does your brain look based on the fidelity of the function of these different networks in the brain, if that makes sense.

48:11And so one of the most important networks for this metric was the frontopariatal network, which is just like the front of the brain to kind of like the middle back-ish of the brain. And that's really important for things like focus and attention. And the function of that network tends to decline with age. And what they found was that people who gained expertise in a creative art, And so they had tango dancers, they had musicians, they had visual artists, they even had video gamers. And actually, there's some very interesting evidence for complex sort of 3D immersive video games as being a potentially useful cognitive stimulus.

48:52As expertise was gained in these, as they call them, creative arts or experiences, they saw significant improvements in the structure of these networks and people's brains looked younger. um other studies have suggested uh particularly in musicians that amateur musicians have the youngest looking brains because it's it's hard for them right they're engaging in so they actually get less so they get more of a benefit compared to an expert or a professional where it's become you know it's no longer the same kind of challenge so there there are all these different pockets of evidence that suggest that engaging in something where you're a beginner that's challenging and And then gaining expertise over time significantly improves both the structure and function of the brain.

49:38Jonathan Fields: But I guess there's a warning in there also, right? Which is, you know, let's say I start learning Spanish. You know, I'm 60. I start now. And in five years, I'm pretty comfortable with it. And I can have an easy conversation with pretty much anywhere I go. Okay, so now my brain is able to focus and use the language. But the challenge part is not there anymore. So I've got to figure out, am I going to learn a new language? Am I going to do something else? Does that track? So, yes. And I think it is important to do it for long enough that you've actually gained some expertise, right? Because the alternative is the people are, well, I always want to be a beginner.

50:17So I'll do this for a month and this for a month and this for a month, right? So you really want to engage in it and challenge it and challenge yourself and build expertise. Then there's two parts of this. One is, do you want to maintain this skill? if you want to maintain the skill you have to still engage in it so there are studies that show that um older pianists right um it's but even if they were experts or professionals the thing that best determines how well they play is how much they practice and that seems obvious but you might think well if they're getting older they'll just have fewer skills because they're getting older but no actually the skills relate to how much they practice um and so that's that's one thing that you have to do is is think about how do i maintain the skills i want to keep and by practicing them and then the other part is well maybe i got so good at spanish that yeah it's time it's time to take up pickleball um or jujitsu or something else where you know you you get a novel

51:13Jonathan Fields: challenge that you where you can start to build skills again yeah is there um a benefit in bringing on a new pursuit that is not just a cognitive challenge, but also a physical challenge at the same time? I think so. And partly because we have some of the best evidence we have for exercise and cognitive function comes from coordinative exercise. So if you compare two types of exercise, and there have been randomized control trials where like one group does cycling and the other group does badminton or one group does circuit training the other group does dance classes and everybody benefits in terms of cognitive function because we know that exercise is so critical for for cognitive function but there are greater benefits in the in the group doing a more co-ordinative type exercise so a racket sport a ball sport a team sport dancing martial arts something like that but then so not only is that a great way to do your exercise because you get additional cognitive benefit if that is then the way that you're doing complex skill learning you're kind of like getting the most out of your it's like the most efficient way to do it right so so for people who are trying to think about well what should i pick to do um especially if they're pressed for time i think learning a new coordinative movement sport dancing something like that gives you your bang for your buck you also get more social connection often if you're joining a club or a class or something like that so like you tick so many boxes at the same time by doing those kinds of activities um that not only do we have some like really nice evidence for it it's also efficient yeah so what i hear you saying is basically i have to start taking hip-hop as soon as we're done talking 100 yeah i'm on it um you you brought up a number of times now also the the social aspect of it tell me more about about that so we know from multiple um kind of strands of evidence that social connection is just like a fundamental part of you know a fundamental requirement for human health um and we know you know similarly if you're then socially isolated or you feel uh lonely or unsupported that that has a number of negative consequences for our health and there are some very interesting studies looking at individuals who've been socially isolated and looking at their brains so like uh prisoners in solitary confinement or um simulated mars expeditions which nasa has done a few times you sort of like lock somebody on their own for weeks at a time and see what happens to them or um arctic explorers who are on their own at the top of the world um for you know months at a time and you see changes in the brain that affect um regions of the brain that we know are susceptible to the processes of aging and are really important for our like complex cognitive functions like the prefrontal cortex really important for decision making they tend to sort of um atrophy if we don't get this input from other people and then then there are studies that show that um those who have fewer social contacts uh or become socially isolated over time they have more accelerated declines in cognitive in brain structure and function uh and cognition with that so it seems to be like this fundamental requirement of humans that we are connected to others feel supported by others and have this opportunity to to look after um look after others um a couple of interesting kind of caveats with that one is that actually doesn't have to be humans uh there are there's some evidence that pets uh sort of provide a similar function um in terms of maintaining uh cognitive health in in adult older adults particularly those who live alone so as you're describing that you know what what stands out to me also is that midlife and later life is often known as the time where social circles shrink um and that if i'm hearing you correctly that may not just be great just for our quality of life but it also may not be great for our brain health so a critical part of this is what's sort of societally driven versus what's like driven by our own personalities so um often when you talk about social connection and social contact and social support there's always people who are like well i'm an introvert and i don't like other people so like this sounds very stressful that you're saying that i need to go out and you know you know interact with all these people and so that that's not what what um what the research says or what i what i would say is that um there's it's all about quality rather than quantity so if you don't feel lonely and you feel supported and like there's um you feel like there's somebody you can reach out to if you need them then that's enough um so there's a colleague of mine uh ben rine wrote a book called why brains need friends and he kind of describes all humans as plants so and the amount of social contacts you you need is is the amount of water a plant might need so some are like tropical ferns and they need a ton of water constantly but like some humans are succulents or cacti and like the occasional rain once a month is plenty right so so this can be very much tailored um to the individual but beyond that we're thinking about how things change you know as we get older our groups get smaller because we're busy we're looking after the kids right we've got work um and so that's really where you kind of set the stage like we talked about midlife as this kind of setting the stage for what happens later i think that's you know where our social contacts can really shrink and that can set the stage for issues later on because you don't speak to your old friends or acquaintances for three decades then when you retire they're not there for you them to be you know for you to be able to reconnect with um and so that's where as you know as much as you can staying connected to a group in some way even if it's just like occasional touch points it doesn't have to be you're spending a ton of time with them or traveling with them right it's just it's just having these kind of touch points so that if if and when you need them they're available to you um equally right we we talked about learning new skills um classes like that is a great way for adults to make friends is go and volunteer for something that you feel passionate about go join a a new class where you're all beginners and you're all kind of in it together um i think that's a really nice way to do it because you know otherwise telling like grown adults that they need to go and make some new friends like that conceptually that's really hard right yeah exactly yeah i i love the invitation here to sort of say, okay, so we can bundle a lot of what you're saying into singular experiences in the form of classes or workshops or like go retreats, whatever it may be, where there's an activity where it's new to you.

58:37Jonathan Fields: You're not good at it. It makes you focus. It's really challenging for you. It integrates physical movement sort of like, and movement that also is not just repetitive, but requires novelty and adaptation. And then if we're doing it with other people at the same time, it's like we're just checking all of these boxes in one experience. And it's not just great for our mood and for our body and for our physiology. It's also great for our brain health and for the longevity of maintaining it. Absolutely. Yeah. You distill a lot of this into a fairly simple model, the three S's. Walk me through this.

59:14Jonathan Fields: It's a nice model to just kind of like hook into when you're trying to figure out what can I be doing right now. Yeah, absolutely. So we've talked about a lot about a lot of stuff. And there are even more risk factors that we haven't touched upon yet. And when it comes to long-term cognition and dementia risk. And it can very easily be overwhelming. I could give you a list of 20 things that are very evidence-based. um and you know anybody who's worked as a coach i've worked with as a coach in a multi many different arenas and like one thing you will know as a coach is that if you give somebody 20 things to do they will do zero things um and that is completely normal as an entirely it's entirely normal um so as i sort of like spent time with the research and like doing the various strands of work that i do i think most of the factors that build and support brain health coalesce into these three nodes of an interacting network that I call the 3S model.

1:00:16So the first S is stimulus. And we've talked about that a lot already, right? But we know that we need to challenge our brains if we want to build and maintain function. When you then challenge the brain or engage it in some complex task, the first thing it does is those areas of the brain being used um ask for a greater supply of the things it needs to do that job so the supply is the second s so you need a healthy blood supply because that kind of responds to different areas of the brain as they're being activated um and so we know that heart health is really critical and we kind of talked about this right at the beginning so that's a critical component of supply of is heart health we also need a good supply of energy so metabolic health blood sugar regulation is is really critical to and we need a supply of nutrients that kind of build the structure help make the the neurotransmitters um you know the the run these different processes in the brain and there are some nutrients that we have very good evidence for when it comes to long-term coagative function so omega-3 fatty acids b vitamins iron and vitamin d those are the ones we have the best evidence for there are some others um but those are like critical things we need to get from from the diet um then right you stimulated uh the brain you brought in a supply of everything the brain needs to respond to the stimulus then we want to adapt to that stimulus right we want to think about memory think about consolidation that's the same for skill building that happens during sleep um and periods of rest So now we're in the third S, which is support.

1:01:55So a big part is sleep. Are we giving our brain a chance to rest and recover from the stimulus that we've applied to it? Are we supporting those adaptations through other factors? So hormonal status is really important. Also, we can produce factors that help to support adaptation, trophic factors. A lot of those are produced during exercise. And then we want to avoid things that impair adaptation. and these tend to be things like smoking uh excessive alcohol air pollution gum disease that causes um a lot of sort of inflammation in the body and in the brain um and something like chronic stress which actually is is almost like if we go back to the athlete analogy it's almost like over training for the brain like it just like never lets it switch off and and recover and sort of really like rest and and recover and so all of those things are connected as well and And what that means is this isn't like some long laundry list of things you have to do perfectly.

1:02:57You can identify one factor. And as you start to make changes, the whole network shifts in your favor. So sleep is a great example. If you start to sleep a little more, say you sleep six hours a night and you're able to make a few changes, you can sleep for six and a half hours a night. Over time, we know things like your blood pressure will improve. Your blood sugar will improve. the next day you're going to feel a bit more sociable because we don't feel very sociable when we're tired you're also more likely to engage in cognitively challenging activities because we avoid those when we're tired so like all those areas i talked about starts to shift just because because of one thing we changed and exercise is the same you start to exercise more you you you that could be could create a cognitive stimulus could create a social stimulus right if it's pickleball right but you also sleep better right people who exercise more tend to sleep better or people who add a new cognitive activity tend to sleep better the next night so all of this kind of interacts and so you can identify one thing where you're like oh you know what i haven't been to my doctor and checked my blood pressure and my cholesterol right those are those are a couple of things you can very quickly measure you can very quickly address if you need to then the whole sort of system starts starts to improve so that's the that's how i think about it and that also helps us understand that even just one change in one area can actually create knock-on effects in

1:04:23Jonathan Fields: multiple other areas as well okay so i'm going to ask you the obvious question here based on the fact that as you just shared a couple minutes before you've been a coaching role and you know that if you give people 20 things to do they will do absolutely zero and i'm raising my hand here because i've been i've been the zero person many times and i've probably been given been the person who's given 20 options and also seen everybody just like you know deer in headlights um so somebody's joining us i'm like okay nodding along yeah i get all these different things and there's the whole bunch of things i could see um is there sort of like a a first domino that you think would be the most effective lever um for people to start with so i think this changes a little bit by life stage and so say in kind of you know midlife you're sort of like still working um maybe 40s 50s kind of time there are two things that that really stand out a lot to me so so one is that's the period of time when when we start to see some changes in our physical health um just because we don't have the time to move we don't think we have the time to eat we're not sleeping properly we're stressed so it's a really good time to just like you know get a checkup check your blood pressure check your blood sugar check your blood lipids um check your nutrient states if you can you know measure homocysteine for b vitamins measure vitamin d stuff like that it's one trip to the doctor and you know some of you know many of those things can be addressed with lifestyle some might need some medication but like uh you know so midlife is a really important time to sort of like get on top of that if you can because that's when risk starts to kind expand on that front so one checkup to kind of take take a take the status of your physical health and address anything that pops up is really important yeah so it's like get your benchmarks get your benchmarks yeah um and then the other is that that group of individuals they're probably like like you and me like probably the majority of the listeners this they're probably getting lots of stimulus right they probably you know have high levels of educational attainment they have complex stimulating jobs what they're probably not doing is thinking about the support bucket are they getting like are they getting sleep are they giving themselves breaks during the day are they structuring their work day so they're not constantly task switching multitasking just like this overwhelming feeling of stress that your brain never gets a break right so i think that um get your benchmarks see if you can start to build in some habits around um you maybe improve sleep a little bit maybe you just like give yourself some breaks during the day just to like let yourself take a breather let your and it doesn't take much studies show that even just like five minutes outside bit of breath work something like that is enough to sort of recharge you and you can go you can go back into it um then as you sort of like transition into that later period of life maybe when we're nearing or thinking about retirement um this is this is the kind of stuff we were talking about earlier that's the time to think about what what classes can i join where can i volunteer what's going to be the next phase where i can engage you know stimulate my brain engage with other people that's going to be you know bring back some meaning you know learn new skills um that's where stimulus i think really comes to the fore that makes a lot of sense to me feels like a good place for us to come full circle as well so in this container of good life project if i offer up the phrase to live a good life what comes up i think this this process of um being challenged and and building skills and then using those skills to kind of help others or help the world around you like i think this is something that is just so fundamental to to the human experience that and that can look different for everybody but there's something about you know developing expertise, being engaged, and then using those in the world around you that I think is really important.

1:08:30And then sort of as part of that, I think in reality, if your brain and body have done what you would like them to do, when you would like them to be able to do it, that's, that's, that, I think that, like, if you manage that in the, in, in that sort of like earlier context, I think that's a good life. It's often around other people. It's often around the skills that we build and the way that we engage in the world. And then just being able to do the things we love for as long as possible. That's essentially it. And all those little bits are baked into it.

1:09:09Jonathan Fields: Thank you. So let's talk about some of the big takeaways here. One thing I'm really sitting with is how much of what we call brain decline is really just a brain that stopped being asked to do anything hard. Tommy's 3S model, stimulus, supply, support, is one I keep coming back to. And that distinction between encoding and retrieval change how I think about every, like, wait, what's that person's name moment that I have? I also loved his distinction between doing things that require focus and doing things that are actually challenging, that are hard. And the power of putting yourself in the role of a newbie, of not knowing how to do something, of being a beginner and struggling and fumbling so your brain can get the thing that it needs to really keep healthy.

1:09:56Jonathan Fields: Bringing it all together into one experience is fantastic too. So social interaction, physical movement, and brain challenge. All of these things are things I'll be thinking of as we move forward. And hey, before you leave, next week, we're sitting down with Dr. Jessica Shepard along with a guest host, a dear friend of mine, Karen Walron, to talk about why so much of what we've been told about menopause is either outdated or just flat out wrong and what personalized care for this stage of life actually looks like. Be sure to follow Good Life Project wherever you get your podcasts so you don't miss that or any upcoming episode.

1:10:32Jonathan Fields: And do me a favor, a quick seven second favor, share this episode with just one person, especially anyone who you think has been kind of thinking about their brain health lately or leave us a review wherever you get your podcasts. It really helps us get discovered and reach more people. This episode of Good Life Project was produced by executive producers, Lindsay Fox, and me, Jonathan Fields. Editing help by Troy Young, Chris Carter crafted our theme music. And of course, if you haven't already, please go ahead and follow us wherever you get your podcasts so you never miss a conversation. Until next time, I'm Jonathan Fields, signing off for Good Life Project.

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