The Peter Attia Drive - Qualy #16 - How much does cognitive activity ward off cognitive decline?

Episode Date: August 30, 2019

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer’s prevention. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

Welcome to the Qualies, a subscriber exclusive podcast. Qualies is just a shorthand slang for a qualification round, which is something you do prior to the race, just a little bit quicker. Qualies podcast features episodes that are short, and we're hoping for less than 10 minutes each, which highlight the best questions, topics, tactics, etc. discussed on previous episodes of the drive. We recognize many of you as new listeners to the podcast may not have the time to go back and listen to every episode, and those of you who have already listened may have forgotten. So the new episodes of the quality is going to be released Tuesday through Friday,

and they're going to be published exclusively on our private subscriber-only podcast feed. Now occasionally we're going to release quality episodes in the main feed, which is what you're about to hear now. If you enjoy these episodes, and if you're interested in hearing more, as well as receiving all of the other subscriber exclusive content, which is growing by the month, you can visit us at pterotiaemb.com forward slash subscribe. So without further delay, I hope you enjoy today's quality. How much does mental activity ward this off? You know, we hear so often the anecdote of Bernie was working his little tail away, beavering

away, and then when he retired to play golf, it all went to hell in a hand basket. And then the other one you often hear anecdotally is, once so-and-so's spouse passed away, oh my God, the remaining spouse just regressed completely and seemed to have this accelerated case of all some of those events. So the idea here being, once that person retired and they weren't cognitively engaged and they weren't not to say golf is cognitively bankrupt,

but presumably it's less cognitively engaging than whatever that person was doing before. Or once the sense of purpose, the social support vanishes, again, anecdotally, this seems overwhelmingly the case. Is there any data to support that? So, yes.

But it's complicated. The cognitive reserve. Can't one thing just be free-consumplified? No, all-time-ers prevention. No, no, man. This is the situation. You sound like me, man. simple. No, Alzheimer's prevention. No, no, man, this is the situation. You sound like me, man. Yeah, everything's complicated.

Everything's complicated. Yeah, I wish I could give you a concise bullet point state, you know, like I'm a bumper sticker. Yeah, the live TV, you gotta give them like a quick snapshot, not on this topic. So early life risk factors for Alzheimer's are different than midlife and late life. And early life risk can be mitigated most so

by long-term educational attainment. That's the best evidence we have. We also have to be clear. Has that been normalized for socioeconomic status? It strikes me as almost impossible to normalize that for socioeconomic status. Above my pay grade, don't know the literature as well as I mean. The point here being like, people who go on

to get secondary and interciary education are gonna have lower risk. Is it because of the things that enable them to do that, perhaps having more resources, lead to them doing other healthy lifestyle things that go beyond the education as well? I hope the studies have controlled for that, but I know it's impossible to control for everything.

But that being said, I think, early life educational attainment. For example, musical experience, midlife and midlife musical experience as well as early life absolutely can give build up greater cognitive reserves that when you get Alzheimer's, you're more resilient, you have this resiliency. The other aspect is- And I don't know enough about music, but when you were the cello playing, two bass guitar playing guy, what part of the brain is getting exercise when you do that?

It's very multimodal. It's the parietal lobe, it's in music side, maybe on the right side. The reading music notes is kind of like language. So it'll be the left side of the brain, and that's visual. It's basically an association, chordacies, basically. The whole brain is talking to each other. So I think music is a great way to recruit different parts of the brain to work together and the stronger those pathways get the better the person does. And again, teleologically, that makes so much sense. I guess it begs the question. I would argue we will never

know the answer to this question because if we're going to have to rely on very loose epidemiology, which can never be fully controlled and suffers from all of the usual problems that epidemiology suffers from. The question ought to be, is there any harm in believing that the epidemiology is right, attaining a higher level of education, staying more mentally engaged, sustaining more loving social supporting relationships, having a greater sense of purpose, learning to play a musical instrument? I mean, is there a chance that doing those things increases your risk? Well, I don't think that there's been any evidence to suggest that it increases risk, but then there's this whole, you know, the naysayers will say, well, what is the cost? What are the trade-offs?

What's the opportunity cost? Yeah, what's the opportunity cost? What's also the, how much does it, like, music lessons? You're going to pay money to do music lessons or buy a guitar, but shouldn't you be, like, buying healthy food? So there's a lot of confusion, and there's, when we get reviewers of our papers, this comes up all the time. So I'm not sure. All I can say is when you build a better backup pathway in the brain and you,

there's a saying, if you don't use it, you lose it. Well, someone that has Alzheimer's and is very cognitively engaged and has a good backup pathway, they're not gonna decline as quickly. That being said, once the disease takes hold and maybe they stop working or they stop the losing sense of purpose, you can have a much more sharper decline. So people with high cognitive reserve, high cognitive backup systems are resistant to the effects of the amyloid, but there's a time that comes when they decline and those people decline much more sharply than others, because they had like this emergency backup system, but sometimes when the parachute fails, the person goes down and in Alzheimer's disease. That's a subtle, that's a nuance I wouldn't have predicted.

It makes sense. The mechanism that you postulate makes sense. And you gave the other example of the woman whose husband passed away and then she just went downhill, because when you have a collaborative relationship and you know when one person's brain isn't working well, but you have another person to cover for you and do the dishes and feed you and and then that person has gone aside from depression, serotonin and you have all that. Oh, I see this all the time.

Like I knew she had it but then the husband and you know caregivers of Alzheimer's patients have terribly higher medical illnesses and when the husband dies and he was the primary caregiver and the wife has Alzheimer's, that person will decline absolutely exponentially. I saw this in a high school teacher of mine. I see this all. I hope you enjoyed today's quality. Now sit tight for that legal disclaimer. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services, including the giving of medical advice. And note, no doctor-patient relationship is formed. The use of this information and the materials

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