Producer: Welcome back to Full PreFrontal where we are exposing the mysteries of executive function. I am here as always with our host, Sucheta Kamath.

Good morning, my friend. We had a wonderful conversation with Dr. Ken Kosik last week on the show. We are preparing for our follow-up conversation with Dr. Kosik today. If you will lead us off, however, by sharing with us some information about a finger study that has nothing to do with fingers. Explain please.

Sucheta Kamath: Yes. Great to be with you and I can’t wait to have our second conversation, but as we get ready to talk to Dr. Ken Kosik, I am very interested in talking to all of you about looking at dementia or Alzheimer’s, and having some innovative approaches and thoughts about management, and this study am going to share with the angle which has quite a bit of relevance with our conversation that is coming up. So, in 2015, group of researchers published a study that was the acronym was FINGER which stands for Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, and in this study, more than 1000 people participated. I think 1200 people between the ages of 66 and 77 who are at high risk for developing Alzheimer’s disease, and what they did crafted the street, intervention, which was centered around more nutritious and healthy eating habits, regular exercise, and engaging in intellectual pursuits, and what they found is at the end of the study, there was a significant change in these individuals. They used neuropsychological test batteries including Stroop Trail making test, and they found that there was a 25% improvement of memory skills, problem solving skills, and even on the executive function measures, strooping, one of them, like working memory test, those skills were 83% higher than at the start. What it did collectively was delayed diagnosis of dementia by two years. So, all these individuals were already identified to be at a high risk, and by making these changes, there was substantial benefit that was shown.

So, I think it’s very, very interesting that we have this wonderful study giving us hope and the reason I started off with this study for us to get into a discussion is because I really think about executive function and the continuum on the spectrum of life, so in that younger years, you need to understand how do children develop and how do they regulate themselves, and in older years, you’re thinking about how to prevent the decline that is actual to aging and still live a healthy and [0:03:30] life, and to me, the common thread – so these are pearls on a string in the string is executive function. Executive function is, how do you take charge of your life? How do you develop knowledge about yourself? How do you manage yourself? How do you recognize what tendencies you have, what kind of high-risk factors that you come with? And how do you kind of really take charge of your life and bring upon change that is going to be essential?

And, that is why having the second conversation with our guest today is a very special friend of mind as you heard me talk to him last time, that is Dr. Kenneth Kosik. He has served as a professor at Harvard Medical School from 1996 to 2004, and after which he became the Herrmann professor and codirector of the Neuroscience Research Institute at the University of California Santa Barbara. He is a recipient of many, many, many awards including a few that I’m going to name which is Whitaker Health Science Award, Milton Foundation Award, More Award, Metropolitan Life Award, NASA Group Achievement Award to NeuroLab Team, and finally, a fellow of the American Association for the Advancement of Scientists which is AAAS and Santa Barbara Innovation Star Award.

So, he is an exceptional researcher, educator, and a truly passionate individual who takes his work and uses the lives of that artistic viewpoint about life is worth living and every bit of work that we do using the scientific lens can really and should be helping individuals live a better life, and he has co-authored two particular books, Outsmarting Alzheimer’s Disease and Alzheimer’s Solution: How Today’s Care Is Failing Millions and How Can We Do Better? and we will be discussing a lot about that today, at his work, including the corrector is a shared in Columbia of the largest family of the world with familial Alzheimer’s has appeared in many important publications, including the New York Times, Wall Street Journal, the New Yorker, BBC, CNN, PBS, and CBS 60 Minutes, and so it’s a great pleasure for me to have this second set of questions answered by him, and you are going to certainly find it extremely helpful. I can promise you that.

Producer: Oh, I have a feeling that will be exactly the case. As we discussed last week, my mother is dealing with Alzheimer’s, and so I am particularly interested in Dr. Kosik’s comments about some things we might do to help prevent it, so this promises to be a very, very important conversation.

So, let us get to it, here is Sucheta's conversation with Dr. Ken Kosik.

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Sucheta: Welcome back to the podcast, Ken, I’m so delighted to have you, and thank you for sharing the framework last time so that we can understand Alzheimer’s disease.

Today, I was hoping you can bring us a message of hope and we can get to the answers that people are looking for as to what to do once you have the disease, or more importantly, what to do to prevent the appearance of this disease. Before we jump into talking about Alzheimer’s, of the touch upon neuroplasticity. That is a relatively new idea in human biology. When I say new, that neuroplasticity is not new, but our understanding is new with respect to cognition and neuroscience, that brain is a remarkably resilient organ and harbors the capacity for self-healing. Do you mind talking to us a little bit about what does neuroplasticity mean and how does this resilience will come into play when it comes to managing challenges, as well as handling the cognitive load or difficulties of life?

Dr. Ken Kosik: Mm-hmm.

Sucheta: Or all of it.

Dr. Kosik: All of that. That is a big one. So, brain plasticity really, what it means fundamentally is that the brain is able to change when we learn something, and by change, I mean it makes new connections, it’s synapses can enlarge, genes get turned on. There’s a lot of things that are going on in the brain that we can actually see and measure that are associated with learning something. When you learn it, there is a physical change in the brain that takes place at the cellular level. That’s neuroplasticity in its most simple way. Now, neuroplasticity does allow us to perhaps be resilient because we have to adapt to many different situations. Everything around us is changing all the time, even in good ways and bad ways, you travel somewhere new it on vacation, you have to learn your way around, something – you have some sort of trauma, you had to figure out how to handle the trials of life all over again, you graduate from high school to college. Things are always changing for us and that means there is this constant flow of novel information into the brain that has to be dealt with.

So, we generally use the term resiliency applied to how people handle difficult situations and keep going on, but really, what people that are resilient are learning to do, what they are doing is learning how to handle something that changed, and that really is neuroplasticity, what it comes down to.

Sucheta: Wonderful. So, is it fair to say that when someone’s brain is undergoing these radical changes with the brain plaques that the very mechanism that allows you to adapt at a cellular level is less adaptive, and hence, behaviorally, that person is not going to be able to adapt to the life’s challenges?

Dr. Kosik: Precisely. So, the brain is a really unique organic in that it has electrical activity that’s going on. The brain is communicating via impulses, electrical impulses that are traveling in all these complex routes, different circuits, and those circuits are mediating everything we think and perceive, and do, so when those circuits get gummed up with the amyloid and when cells in those circuits are dropping out to the tangles, there is less ability to learn to do new things, neuroplasticity declines and to some extent, I’m sure resiliency declines as well. What we see for instance in a person with Alzheimer’s disease is another facet of what we were talking about in the other segment about memory and the future. Alzheimer patients are impoverished in their ability to imagine the future. If you ask a kid or even an adult, what are you going to do when you go to the beach this summer? I could will go into detail about sand castles and waves, and all kinds of things about the ice cream vendors – there’s many, many details that we fill in when we think about the future. You think you are, as an adult, you are going to Paris, you really want to see a particular painting in the Louvre or Musèe d’Orsay, you really can now visualize all of that. You Alzheimer’s patient, well, what are your plans for the summer? They don’t say much. They might say, “Well, the of the beach.” What are you going to do at the beach? There’s not that richness of the ability to imagine the future, and that is also part of what is mediated by these the vast numbers of synaptic conditions.

Sucheta: So, is it better to synaptic connections start dimming down, that is why they begin to lose the capacity to imagine or it is the other way around, or we can’t tell?

Dr. Kosik: The synaptic connections are being lost as the primary problem. There is stuff going on in the brain, the plaques, the tangles, other aspects of – there’s inflammation that’s going on, and they are damaging the synapses and the result of that, we are less able to perform.

Sucheta: Got it, got it, that makes perfect sense. So, let us talk about this issue that our society is facing. As the baby boomer cohort moves forward towards the age of risk, I believe that the researchers – from researchers the policymakers, everybody’s concerned that is potentially going to be an Alzheimer’s epidemic, and you think as a culture, are we prepared for it?

Dr. Kosik: No, we are not.

Sucheta: You are straightforward, no.

Dr. Kosik: Yeah, or it’s very hard to prepare for this. We have to prepare in different ways. There is the potential of bankrupting the medical system because of the expense. Alzheimer’s disease, these estimates are rough, but people put the numbers in $250 billion a year to do all of the caregiving and other support that’s necessary. It’s hard to figure out how were going to pay for it. It’s hard to figure out how we are going to have our families sort of have this burden on us, especially people that are in the so-called sandwiched generation where they have to take care of their parents as well as their children. All these factors are making the future look a little problematic unless we can figure out what to do.

Sucheta: So, why was this not a concern of ours as a society earlier? Is it because people are living longer, or are we getting more afflicted with Alzheimer’s disease, or all of it?

Dr. Kosik: I think it’s actually – it may be, it may not be either of those.

Sucheta: Oh, I see.

Dr. Kosik: If you go back, gosh. Now, if you go back maybe 40 years or 30 years or so, we had different words for these conditions. You might know the word senility, you may know the word hardening of the arteries – these were ways in which we could sort of put elders into a category that sort of allowed us to essentially disregard them. It really wasn’t until the 70s that the knowledge became known, that we began to know that people who had – elders with these dementing illnesses actually had an illness. It wasn’t that they were just getting old which was one way to think about it. It was just oh, grandpa is old. Of course, he does all that stuff. Now, we see that that’s an illness. So, we never really categorized it as an illness, number one. Number two is that because of the baby boomer bubble moving into the age of risk that is also contributing to the epidemic.

Sucheta: I see. Oh yeah, I think that really speaks to my heart, that I think – I see that with so many developmental disorders that children suffer from that we have stopped labeling it as a child being difficult or uncooperative, or just not worthy of receiving education or support, but are beginning to understand that it’s actually an anomaly, a difficulty in developing these abilities. Just like Alzheimer’s is a disease, this is a developmental disorder. So, I’m happy to see that as a culture, we are becoming more sensitive and knowledgeable.

So, let us talk about Alzheimer’s disease and its treatment. Can you tell us how should we think about a month and we begin to think about the disease for treating the disease once we know we have a disease, or should we look at it before we develop the disease, or do we do both, how do we best go about it?

Dr. Kosik: Well, Alzheimer’s disease is very common. So, number one, it’s very common, and number two is, we currently do not have a treatment that’s very – any treatment that’s effective. So, given that information, we really think – I really think, most people think that prevention is the most important thing we can do, but prevention is not quite the right word because if I give you a vaccine for measles, I’m going to prevent measles, but no matter what we do, I can’t promise you that we are going to prevent Alzheimer’s disease. All I can say to you is that if you follow a prevention regimen which we can talk about, you will reduce your risk, and that’s the best we can do right now, but because Alzheimer’s is so serious, we really ought to do it. If everybody followed a prevention or a decreased risk regimen, we can have a very big impact on the prevalence of Alzheimer’s disease in the world. So, it’s probably worth saying a word about what a prevention or a decreased risk regimen would look like.

Sucheta: well, before we talk about that, can you quickly tell us what are the risk factors for somebody to develop Alzheimer’s? I think from medical point of view, as well as the lifestyle point of view.

Dr. Kosik: Guests. So, the risk factors that we know about go hand-in-hand with the treatments that I’m going to also talk about because for every risk factor, we want to see, what can you do about it? So, I’ll talk about them a little bit together here. The greatest risk factor is one that we can’t do anything about and that is aging, but after that, there is a lot of things that we can do, and they fall into two categories. One are what we might call medical risks, and I’ll talk about what they are in a moment, and the other one, what we might call lifestyle risks which I will also talk about. So, for medical risks, we have by far and away, the number one risk is elevated blood pressure, and in fact, if you have read the news just today, very major study has been completed that has really now for the first time completely confirmed the fact that elevated blood pressure is a risk for dementia. We sort of knew it before, but we didn’t know well enough to really try to intervene as a national level, and now we do. So, you have to know your numbers. You should have your blood pressure taken regularly, and people should get a blood pressure cuff in their home, so they can actually track their blood pressure and not rely on having to go into a drugstore where they may have a defective cough or wait till you see your doctor.

Sucheta: So, it’s interesting you say that because from my work with strokes, we, for years have heard that cardiovascular – how your blood pressure in its relationship with cardiovascular diseases, and that its correlation to stroke was always talked about, but there was never a conversation about Alzheimer’s disease.

Dr. Kosik: That’s absolutely right, and now, we really realized that the risk factors for cardiovascular disease and Alzheimer’s disease greatly overlap as a big [0:18:23].

Sucheta: Wow.

Dr. Kosik: So, as we go down through the medical risks, and these are very important to know because just like blood pressure, the other ones I will tell you are also treatable. There is good blood pressure medication. You can get your blood pressure under control – most people can pretty easily. Risk number two is if your lipid profile is abnormal. Cholesterol is high, whether your different HDL, LDLs, all these numbers – triglycerides, if they are in the abnormal range, your risk goes up, the data is not as good as it is for blood pressure, but lipid disorders are very, very treatable, and most people in this field would recommend that you treat it if you have an abnormal level in your lipid profile. That would be number two, and number three – these are all numbers, very easy. The third one is to follow your glucose. That is, if you have a diabetic tendency, your fasting glucose is over 100. Some people want to say even over 90, but say over 100, then you should do something about it. That can be losing some weight, taking some medication, but high glucose, high lipids, high blood pressure are all medical risks for her Alzheimer’s disease and every single one of them can be treated. If we have treated them, we would really make a dent on this problem.

Sucheta: So, Ken, how do we think about drug and alcohol you and how does that relate to Alzheimer’s disease?

Dr. Kosik: Well, I assume that when you talk about drugs, you’re talking about drugs – everything from marijuana to prescription drugs.

Sucheta: Everything.

Dr. Kosik: Yes, so there’s no evidence that drugs or alcohol will increase your risk for Alzheimer’s. They are not good, they increase your risk for a lot of things including perhaps other forms of dementia, there are dementing illnesses that’s associated with a lot of alcohol consumption. None of them is good, but I can’t put it on the list for an Alzheimer’s risk.

Sucheta: Okay, so now, what about the next set of risk factors?

Dr. Kosik: Yeah, so now, were going to go over to lifestyle and here, we can again but one lifestyle factor as the top of the list. It’s like higher than all the others I’ll talk about, the data, it’s the best date, and it can do something to change your lifestyle around this concept. You might already guess what it is: exercise.

Sucheta: Exercise. Okay.

Dr. Kosik: Yeah, you sound like you weren’t so pleased with that.

Sucheta: I’m wondering if I’m going to develop dementia just simply by hearing you say exercise.

Dr. Kosik: Yeah. Well, let it be an incentive for you to think about doing some exercise. Exercise is good to try to reduce your risk for many diseases including Alzheimer’s. The data, as I say, the data is pretty good, and then there some questions naturally follow, like you might say, well, how much exercise? What type of exercise? All of those things are questions that are still not precisely answered but it’s pretty clear that if you can get some exercise in everyday or most days, even if it’s only brisk walking, that you are really going to help your future. Now, some people, and this is modifiable, we can do something about it, but for some people, it may be difficult. Maybe they get a little dizzy, maybe they have a bad knee, maybe they’re not motivated. So, I think this is a role where getting some help can really be useful, either you can afford a personal trainer, physical therapist where there is the trouble, or joining a group of people in which you use peer pressure to keep you going, but exercise is really important, number one. As we go down the list, another one that has gotten a bit of attention and there is good data for it is your diet. People have given a lot of attention to the Mediterranean diet as a risk reduction diet. I think the data is pretty good, but I’m sure that a Mediterranean diet is not the only way to do it. There are other diets that are high in antioxidants, high in vegetables, low in a lot of fatty stuff, and those diet are probably also good. We just don’t have as many studies. So, if you want to take like a take-home message here is that is easy, I would simply suggest just watch calories, stay away from fast foods, and take it from there. That is really probably the key message in the area of diet.

Sucheta: You know, it so interesting. I think what I love about this message, it is beneficial now an extra beneficial in the future. So, if you exercise and if you eat well, you will reap the benefits as you live in. It’s not like when I save, in two years, I will be able to buy a house. When you save today, you will be able to buy a house the day – it’s that kind of benefit that you are going to see so people should be really, really jazzed up about preventing Alzheimer’s.

Dr. Kosik: I agree with you, I completely agree with you, and just to put a little plug in here, maybe I should be doing that, but there’s lots of books out on this. I have one of them. It’s called Outsmarting Alzheimer’s Disease which lays out all of these things that can be done – the lifestyle and the medical things that you can pay attention to and decrease your risk.

Sucheta: And I take studio picture of that book that I was reading in my library in the house, you saw with my little dog on our sofa chair, but I’ve been carrying that book this whole week and reading. I mean, I have not thought about that book for myself, but now that I was getting ready to interview you, so I’ve been reading, and I was wondering if – I took it to my hair salon and I wondered if people around me are thinking that, my God, she’s afraid of developing dementia. She must have some signs of it or something, but I highly, highly recommend that book. I will be putting out all the information about your book on and we will have a link on our website, but Ken, I think that was the most incredible book I read in a while that comprehensively talks and particularly, as a scientist when you endorse lifestyle, to me, I just feel it so validates the marriage between art and science because taking care of life, how much of our knowledge you have about facts and details, it comes down to implementation and the emotions that go into making changes to yourself or to your lifestyle, but we have to do it by keeping the future in mind. So, I really appreciated the way you organized and lay down all the details.

I have a question in closing, can you quickly talk about sleep and how does it fit into all this? I see technology really creating so many roadblocks for us. We never took our television to our bed, but we are taking our phones to our bed. We are going in the dark and just don’t have any that we have incessant contact with information and the world, and I wonder if that is going to make us – affect our attention, affect our working memory, and any thoughts about that? 

Dr. Kosik: I do, and in fact, on the list of lifestyle things that I will mention, let me go into a little bit of depth on that one. Let me just ask so we just make a comprehensive, let me just mention the other lifestyle factors very quickly. In addition to exercise and good diet, want to avoid long-term chronic stress. It’s easier said than done, we can talk about that as well. People want to avoid social isolation. I think friends is good for the brain. We can talk more about that. Having cognitive challenges, that doesn’t necessarily mean doing this the New York Times crossword puzzle you’ve been doing for the last two decades. I mean, it’s new cognitive challenges like learning a language or playing a musical instrument, traveling, these are all things to do, but you asked specifically about sleep which is also on that list, and again, the evidence is really growing that having a good night’s sleep is also good for the brain. I think that that – when I talk to patients about that, it’s really a mixed message because you can sometimes, by telling people about that, and they should know about it, but by telling people about that, you can then sometimes set up this anxiety, like oh, I’ve got to fall asleep, I’ve got to fall asleep, I can’t sleep. I’m going to be damaging my brain because I’ve been lying here awake. Sleep is a physiological thing and it’s very hard to make yourself do it, and if you worry a lot about it, you can be sometimes making it harder. On the other hand, you pointed out some real serious typical sleep interrupters that are things we can do something about. Turning over your cell phone at night, even if I turned mine off, I can still hear and vibrate on the night table, so it has to be in another room. It’s really important to try to do every – you don’t have coffee before bed. There’s a lot of things we can go to and has the likelihood of getting a good night sleep, but I don’t think people want to go so far as to say that oh, I’m not getting the typical 7, 8 hours and I need – I’m going to start creating all kinds of anxiety. You really want to titrate the amount of sleep you need which is different in all of us and the quality of the sleep you’re getting.

Sucheta: Wow, I think I need to consider the quality of my sleep. Even when I’m awake in the morning, I don’t quickly swiftly get out of bed. It begin my business of checking emails in bed, so I need to have some good habits, like instead, start exercising.

In closing, you did mention one of the very important effective steps which was to try and develop a circle of friends. Can you talk a little bit about that, having bearing on preventing or postponing, delaying Alzheimer’s disease? People may not see the connection, actually.

Dr. Kosik: Sure. Yeah, well, in this case, it’s simply a correlation. People with friends tend to live longer and healthier lives, don’t get as much Alzheimer’s. We don’t know if it’s cause and effect. Maybe the people that have lots of friends, have an active social life are just predisposed to do that. The same way they are protected from Alzheimer’s disease, we don’t know if you suddenly go out and make a lot of friends, if you are necessarily going to reduce your risk, but it is a fact that people with friends and avoiding social isolation are somewhat protected from dementia, and I think that it makes sense to me. I can’t give you a deep neurobiological reason to why it’s true other than the fact that human beings are just inherently social animals, and to deprive ourselves of friendships, social interactions is going against who we are.

Sucheta: Well, one the thought that comes to my mind is one of the items that you mentioned much is tease your brain with cognitive activity or challenge, socializing is one of the most deeply provocative process of challenging your brain process. You have to theorize the minds of others, you have to protect and anticipate what others are thinking. You are to adjust in self-control, exercise self-control with relationship to others, and more importantly, interacting with people is one thing, forming friendship and social bond requires a lot of self-sacrificing gestures which requires that self-regulation, and to me, that exercising self-regulation is again, sounds like you are bringing that prefrontal system on, and so that practice may also strengthen some of these connections in the brain. I don’t know, but that’s kind of a thought that came to my mind.

Dr. Kosik: I totally agree with you.

Sucheta: So, with that, Ken, this was such a delightful conversation, and I really thank you for giving us a detailed outline and laying down these very important and sometimes often dismissed to have – and the steps that you mentioned, for example, an ordinary day, we may dismiss its value, but it has such a profound long-term impact. So, I really appreciate you helping us see through the signs eventually connecting the art of living.

So, thank you for coming on the podcast and sharing your knowledge, and it has been a great, great joy talking with you.

Dr. Kosik: Thank you very much, too. Bye-bye.

Producer: Alright, so that was Dr. Ken Kosik. That was your second conversation with him, Sucheta. Wow, particularly from someone like me who is dealing with a mother with Alzheimer’s and worried about my future, what an important conversation that was. Lead us off with some of your initial thoughts, however.

Sucheta: It really was very helpful to have this conversation, and you and I have had a lot of off-line conversations about what you are dealing with, so I am hoping that this gave you a lot of thought as well, and I don’t think you are alone in worry about your brain, and just as I am worried about my brain giving me the support and partnership until the end of life. A few thoughts that I think that makes sense to me is the relationship between neuroplasticity and resilience. The brain plasticity, as Ken was defining it, that it is his capacity to change when we are exposed to opportunities for learning, and when we experience something new and familiar and difficult, we are changing the way the brain is responding to those opportunities, and that’s nothing but the plasticity, and these brain changes are not just hypothetical or proposed, but they are measurable and tangible. There is more current that flows through the nerve cells as one is exposed to unfamiliar and difficult task and is navigating that learning opportunity. Genes, as he was talking about, genes get turned on, synapses enlarge, and their actual cellular changes with each become evident upon observation. So, it’s a real thing and it’s something that we can take advantage of, of resiliency. I have had experts like Sam Goldstein and Robert Brooks who are experts in concept of resiliency, and that’s self-evident as the brain navigates the incoming flood of novel information and begins to make sense or impose order by formulating a plan to deal with it. So, having an intentional engagement with something that was not anticipated through resiliency including mindset and including cognitive thought process, you are and laying it, and as you adapt and adjust, you are really changing the way brain is wired, and so that’s the relationship between the two, and so we are looking here is for one’s capacity to handle the cognitive load, adapt and shift successfully in order to yield success, jewelry, and a sense of equilibrium being in a state of equanimity as you are finding and navigating yourself.

So, what I really think, at heart, helping people cope, whether it’s a disability or disorder, or a disease, one must really, really keep resiliency in the center of it.

Producer: Well, in discussing resiliency, I mean, I suspect it should be obvious that brains with Alzheimer’s are not as resilient as others, right?

Sucheta: Yeah, because we discussed this last time. So, not a matter of will when it comes to Alzheimer’s, that means why don’t you stop being forgetful? We can’t really say that to a person with Alzheimer’s. The ability to actually – there is a genuine decline in the brain function, the ability to imagine the future escapes these brains who are fighting Alzheimer’s, and so such impoverished brains lack the strength imagine different outcomes for yourself, but that originates in the change the brain chemistry or synaptic junctions and the way neurons are structured, so there’s a structural change at the brain level, and so the impact of that one’s own capacity to understand your condition, and that also, one’s own ability to affect the future by imagining it with the richness and texture that is essential to the vitality for one’s emotional and cognitive landscapes, so to speak. And so, the brain level, there is declined electric exchange, there is activity in the brain, and the fading of synaptic connections, and all that, of course, affects the health of the brain and less wired brain is likely to experience a lot of setback because it then is not able to be as resilient and be able to kind of imagine alternatives because those alternatives is having a communication between different parts of the brain that is taking over, so some of that be really lacking. So, the important thing is that once these changes that in, you can’t really focus on building the brain or revitalizing the memory skills, or preventing the disease from then that point on, but really helping people are the loved one to live a life of meaning and maintaining Joel a when you meet with them.

So, just a thought in terms of how do we view this, there are people or dealing with the loved ones and are trying to see how to connect and how to support, and it’s a big financial burden, and it is also a social emotional burden, but what I found in a recent story in the Atlantic which was very encouraged, in Holland, outside Amsterdam in the small town of Weesp – Weesp, I think, Weesp, there is something called Dementia Village, and I was reading about it and it was so fascinated, and I’ve now obsessively watched videos of how actually, the village works, but it is a cutting edge elderly care facility that houses around 152 residents. They have their own theater, garden, post office, restaurant, and even a town square, and all members of the village are individuals with Alzheimer’s, and their disease has progressed indefinitely. So, it’s not a kind of elderly home or community, but it’s actually for those who are suffering with dementia, and I think what is so fascinating about the way they are doing it is they haven’t built a community, that community that takes care of the elderly by the elderly having a role and responsibility in their community, so if you want to shop, you can actually go to the grocery store, you can actually have dinner at a restaurant, but it’s all part of the nursing care facility, and the results are outstanding. It shows that the clients who belong to this village require far less medication, they tend to eat better, they in fact, tend to live longer, and they see to have much more happier lives or reporting joy compared to the standard elderly care facilities anywhere else, and it’s a remarkable approach to me as once we have identified the disease and once we know that we are not looking at the individual with Alzheimer’s going back to developing memory skills so that they don’t forget anymore. We are only going to now look at either preventing the decline of memory skills and skills that go into living an independent life but continuing to have meaning. So, it was an outstanding example of one can do it well.

Producer: Yeah, no, I’m anxious to learn more about that community, spending so much time with my mother’s facility which is an assisted living facility that’s obviously cater to memory care, and I love the commentary around joy because I look at my life and my role with my mother in terms of looking at it through one lens, and my job is merely this, it’s to create as many small moments of joy as I can, and that’s all we can do. So, lots to think about there.

So, we did talk a lot about prevention and treatment. So, how should we view those two?

Sucheta: Yes, so I think again, treatment is using a disease model and we just saw the example of using a lifestyle model once that the individual is diagnosed with the disease, but there is another way to look at it which is prevention. So, the lens on management should be lowering the risk of developing Alzheimer’s rather than preventing the disease, because we really don’t have a way to know. Other than having high risk factors, we really don’t know how it develops and progresses. So, what we can do this with the age of risk on the horizon, it really is important that we all look at having a healthy lifestyle, and particularly in Ken’s book, Outsmarting Alzheimer’s, he talks about something called SMARTS curriculum and his protocol is S stands for Social Smarts, M stands for Meal Smarts, A stands for Aerobic Smarts, R stands for Resilience Smarts, and T stands for Train Your Brain Smarts, and finally, the S stands for Sleep Smarts, and so each individual strength, he goes in depth and gives recommendations how to do it, but I think there is a way to understand your own relationship to your brain and treating your brain and body with great respect, and taking all the care that we need to do. It is literally [0:41:08] to saving money, so instead of just focusing on saving money for your old age, how about saving your cognitive funds for having a better brain life?

So, just to go into some of the habits that he talked about, but using this SMARTS acronym, I think the social smarts, for example, as a preventative method, is for us to cultivate socializing skills, throwing parties, getting organized in a community event, participating discussion or book clubs or film clubs, connecting in building communities, going and volunteering, sharing interests, or getting together with people that you have similar interests. So, those kinds of socializing or building a social – robust social life can inoculate your brain from experiencing decline. The second was the meal smarts, talking about healthy eating habits, simply, I think even reducing the intake of high calorie and unsavory foods that are not good for your body’s chemistry, I, myself, I’m a vegetarian. At best, I try to be gluten-free and dairy free, and sugar-free as often as possible, and kind of eating in small portions and spacing out meals, and really keeping 12-hour fasting. Some of these habits I have picked up simply by understanding the thinking brain and how to keep it robust in thinking. The aerobic smarts which is the biggest struggle for me is to exercise regularly, but just even 30 minutes of walking keeping your body motion has shown to have very strong results. I read recently that setting is the new smoking, I guess, or smoking 21st century, so we have all become technology-centric. So, I myself have gotten a walking desk which is a treadmill and there is a standing desk on top of it, and I try to be on it in the evenings, particularly, and of what slouching in the sofa as I’m still working, and last three items, resilience smarts is having a life of purpose, developing some sense of purpose, some sense of bringing – making a difference in the lives of others, having some central kind of thread that runs through your life where you have found a connection to the large meaning, and you know, in previous podcasts, Todd, you and I kind of heard Dr. Pychyl talk about this. Often, without her plate is full as we don’t have the best management skills, we tend to get into this existential crisis: why should I do this? Why does this matter? And again, I think in those podcasts, I also talked about bringing purpose back, and this is, again, at the tail end of life, having subscribed to that principle of meaningful life can bring great joy, even as you age, and then training your brain, and that is what I specialize in. I was just recently – I just saw an Instagram post today that talked about communication, it’s an international committee edition project, and one of the things they talked about was there are 7099 languages that are spoken in the world, and imagine, one of the ways you can challenge your brain or train your brain is to learn a language, and I myself speak five languages, and I have found that to be so, so helpful in code switching and linguistics switching when I’m in different groups, and I always tell my children how they don’t have that kind of advantage simply by not growing up in India – me speaking five languages, not spectacular, by the way.

And lastly, sleep matters. I think I know developing good hygiene around sleep can also allow your brain to restore itself, and just do the healing and the handwork that the brain does at night to consolidate memory and to also revitalize our attention for the next day. So, these are some of the things that I think were outstanding in our conversation that are also very well described in his book, and I think we should really plan better our lives using those principles.

Producer: Nothing spectacular about speaking five languages, she says. [0:45:32] are you? I can’t even speak English very well, so goodness gracious. So, thank you for going through those. We should be doing those kinds of things anyway, but it’s particularly gratifying to know that that can have real positive impact on your brain health, so good stuff there.

So, Sucheta, before we go, any closing remarks you want to share?

Sucheta: Sure. Over these two episodes, we discussed fear of developing Alzheimer’s, devastating effects of the disease on an individual and their families, and ways to manage once someone has the disease versus ways to live a life so that we can prevent the disease. The question is, how does this all relate to executive function which is the topic of this podcast? And, that takes me back to defining executive function. So, executive function is your capacity and ability to orchestrate your life by taking charge of your own self by understanding self by connecting your actions to the goals you have for yourself, and monitory yourself through passage of time, and so there are a lot of barriers to living a fulfilling life with respect to executive function because you may not have the motivation that is essential for it, we may not have good insight into itself, or we may not have what it takes to really sustain your effort throughout the passage of time. So really, we have to keep connecting our current day to our future selves, and talking about Alzheimer’s, it is one thing to be in your old age and have the diagnosis, and then kind of work from there on, but leading up to it, even you may be 25 years old, you may be 36 years old, or you may be 52 years old, how do you kind to live a robust mental and physical life that will afford you all the resilience and inoculate you from decline that can affect your brain? And so, kind of a really important part of that goes into that self-management. So, preventing future diseases recorded connection to that future self, as I was saying, and that also requires executive function skills. We had Hal Hirschfield on our show who talked about that difficulty connecting emotionally or cognitively to that future self or psychologically to that future self. Our capacity to imagine our future self from now to 10 years, or next 20 years, how would I look? How would I feel? What would I be capable of doing? We just don’t have the capacity is well billed as the capacity to imagine ourselves it may be less next six months, and so understanding that about ourselves is really, really important. So, to develop lifestyle changes, one must have great self-knowledge and know thyself principle requires possessing strong executive function skills, and that requires a key, key component which is delaying gratification. So, whether it is not eating fast food, whether it’s stop yourself from binge watching and getting on the treadmill instead. Last couple of episodes, we talked about that procrastination, so knowing something – you are supposed to do something but not wanting to do that, and so that shortsightedness is the biggest reason we may get ourselves in a pickle. So, there’s growing evidence that not just good habits, but brain healthy habits can go long ways, and how do we develop them is by moderation or self-control. We need to have future in mind become less future-blind, or current self-centric. We must work on reducing stress and better manage anxiety on days that we encounter on a daily basis, and we need to work on diminishing procrastination, and finally, I think we need to live a life of purpose, and together, I think we can shift our thought process from that preoccupation with the disease and prevent – I mean, managing disease but more building cognitive savings for the future self by taking on novel, challenging and relevant difficult tasks on a daily basis to tease the brain to become very strong and healthy, and be able to bounce back from challenges with great resolve and consistency, and that is what is going to prevent future decline in our brain skills – using executive functions is what’s going to help us.

Producer: Well, two very impactful interviews with Dr. Ken Kosik, Sucheta, and if you don’t mind me saying this, after that second interview, we had some post-show banter with him, and I asked him a point-blank question: when will we have a cure for Alzheimer’s? And, he was optimistic that we would likely have a cure within a generation, so we are optimistic and hopeful for that day.

Alright, that’s all the time we have for today. On behalf of our host, Sucheta Kamath, and all of us at Cerebral Matters, thank you for listening and tuning in today, and we look forward to see you again right here next week on Full PreFrontal.