🔑 Key Takeaways
- Cognitive decline with aging can be avoided by focusing on lifestyle factors such as exercise and muscle strength. Head injuries should be minimized to avoid cognitive impairment.
- Cognitive function decreases with age, but historical memory may be protected. Memory complaints are common, but decision-making and processing speed are also essential. Lifestyle interventions can prevent or mitigate cognitive decline and dementia.
- Memory has two stages, encoding and retrieval, and both can be affected by age or cognitive decline. However, by improving cognitive functions, individuals can enhance their memory capacity at any stage of life.
- Our brain has the ability to encode and store information, but as we age, brain decline could occur due to the atrophy of key memory areas. Adequate supply of energy, function, and avoiding negative factors are important for recovery and memory improvement.
- For optimal organ function, it's important to expose them to relevant and positive stressors, such as cognitive challenges, while avoiding chronic stress and negative stressors like alcohol. Understanding Hormetic stress can help us achieve this.
- Focusing on one task and taking breaks can increase brain plasticity and functional capacity, whereas multitasking and task switching may hinder skill development and reduce focus time.
- Multitasking requires specific training and subroutines to manage multiple variables and can be stressful for most people. Prioritizing and focusing on one task at a time can optimize productivity.
- Practicing subroutines and reaction-based games can improve focus, relaxation, and performance, including reaction times. Maintaining the highest level of physiologic headroom possible can minimize age-related decline, while fluid skill-based activities can help achieve peak performance.
- Age-related cognitive decline can be slowed by increasing headroom and absolute capacity through continued cognitive demand and social interaction. Retirement should not lead to the end of cognitive demand as a sense of purpose contributes to cognitive satisfaction and function.
- Continuing cognitive activities, like playing chess, dancing or doing computer-based brain training, can mitigate cognitive decline as retirement stops work-related cognitive stimulus. Complex and interactive activities offer greater cognitive benefits than closed-skill activities.
- Engaging in activities that involve complex interactions with the environment and others may improve cognitive abilities in Alzheimer's disease, while pathological hallmarks may vary and not correlate with symptom burden or disease progression.
- Amyloid beta presence does not always correlate with Alzheimer's symptoms severity, and other factors may be involved in the onset of the disease.
- While amyloid beta may contribute to Alzheimer's disease and dementia, it may not be the sole cause and lowering amyloid levels may not be enough to treat the disease. Early application of amyloid-reducing therapies may reduce the risk of developing the disease.
- Amyloid plaque may not directly cause neurological problems, but may still cause damage. Preventing late-onset Alzheimer's can be achieved through lifestyle changes and understanding upstream processes driving neurological stresses.
- Lowering homocysteine levels and supplementing with B-vitamins and DHA can slow cognitive decline and brain atrophy, as homocysteine may contribute to tau tangles and inhibit the creation of functional neuronal membranes. It's crucial for B-vitamin and Omega-3 status to interact effectively for DHA to be inserted into neuronal membranes.
- Taking supplements such as methylfolate, methyl B12, B6, EPA, and DHA can reduce dementia risk by 20%, but patients may need to take initiative in supplementing on their own due to systemic bias against non-pharmacologic interventions.
- To achieve optimal cognitive health, it is vital to consider an integrated approach that includes lifestyle changes, supplements, and medications. Seek high-quality, regulated supplements and approach treatment with a holistic mindset.
- Incorporating strength training into your lifestyle can improve brain function, reduce cognitive decline, regulate blood sugar, and reduce systemic inflammation, ultimately impacting overall health and longevity.
- Regular fitness training can improve the quality of life in later years by preventing limiting movements and pain. Concussions can cause severe symptoms, including memory and focus issues, as well as other brain-related concerns.
- Maintaining a balanced body temperature is crucial after a traumatic brain injury to improve outcomes. External cooling and Tylenol can help regulate temperature, while supplementation may improve resilience to subconcussive impacts.
- While cooling may reduce brain injury in animal models, there is currently no evidence that active cooling devices like cool caps prove effective for people with concussions. Instead, preventing and managing fever is important for minimizing injury.
- Pediatric brain injury patients require cooling therapy within six hours to prevent poor outcomes. Hyperbaric oxygen therapy can be harmful in the acute phase but beneficial in the chronic phase. Timing of treatment is crucial for effective brain injury management.
- Hyperbaric oxygen treatment and creatine supplementation may offer neuroprotective benefits in TBI patients. However, further controlled studies are required to establish their efficacy, and supplementing with 20 grams of creatine per day for a week may increase brain creatine levels and offer short-term protection.
- Consider taking creatine, DHA, and choline supplements to prevent and mitigate TBI-related symptoms. Start with a loading period of 20 grams of creatine for a week followed by 5 grams daily, and prioritize DHA and choline intake for optimal brain health.
- Citakoline can improve psychological outcomes in traumatic brain injury survivors, choose a high-quality brand for best results. F1 drivers prioritize health to improve performance, optimizing car setup after each race is crucial.
- A multi-faceted approach, tested through tinkering, can improve a driver's reaction time. Finding the optimal reaction speed must balance with the driver's arousal curve for later in the race, and scientific, evidence-based methods can lead to better outcomes.
📝 Podcast Summary
Dr. Tommy Wood and Peter Attia Discuss Age-Related Cognitive Decline, Lifestyle Factors, and Head Injuries.
Dr. Tommy Wood and Peter Attia talk about age-related cognitive decline, root causes, and what skills are needed to avoid it. They also discuss lifestyle factors that can help prevent dementia and the importance of muscle. The conversation also covers head injuries, including concussion and traumatic brain injury, their various symptoms, and what can be done to minimize their severity. Dr. Tommy Wood has a varied background in animal preclinical research in brain injury as well as medical training that helps inform his work. Alongside his formal training, he has also spent a lot of time working with athletes, trying to improve their performance and overall health and longevity in sport.
Understanding Cognitive Function and Decline in Aging
Cognitive decline is a natural part of aging, with a linear decrease in cognitive function across all types of measurement except for historical memory which may be protected. However, some individuals may experience an accelerated decline leading to mild cognitive impairment and eventually dementia such as Alzheimer's disease. Different types of cognitive function include executive function and working memory. Complaints around memory are the most common and noteworthy component of cognitive function, but it is essential to note that cognitive function also entails complex decision making and processing speed. It is challenging to define these domains and measure them for the average person. Lifestyle intervention and improving population health may prevent or mitigate cognitive decline and dementia.
Understanding the Different Aspects of Memory and its Impacts
Memory has two different parts - encoding and retrieval. Encoding is the process of storing information in the brain and is lost in those with pathological cognitive decline. Retrieval speed slows down with age due to the accumulation of more information in the brain. It may be difficult to determine the relative contribution of library size versus librarian speed when it comes to accessing memories. Sleep impairment, subjective stress, and selectivity in storing memories may impair the retrieval process and make it harder. Cognitive functions are personal, and individuals can focus on improving the function they want to be better at. Improving cognitive function is possible at any stage of life.
Understanding Brain Capacity and Memory Decline
Human memory doesn't have a physical constraint like a hard drive, but the brain still has a finite capacity in choosing what information to encode and store for survival. As one ages, memory decline could be due to the atrophy of brain areas like the medial temporal lobe, which is important for memory and sleep. These areas are susceptible to both negative and positive outside influences and require sufficient supply of metabolic energy, neuronal membrane structure, and function, and the demands placed on them to increase capacity. Recovery and avoiding negative outside factors are also important factors.
The Importance of Relevant Stressors for Optimal Organ Function.
The demand placed on certain organ systems, including the brain, is important for optimal function and capacity, but it must be a relevant stressor that allows time for recovery and adaptation. Chronic exposure to certain stressors like alcohol can lead to upregulation of organ function. Positive demands on the brain, such as learning and cognitive challenges, can improve function and capacity, while negative demands like chronic stress can be detrimental. Understanding the concept of hormetic stress can help us apply it to different organ systems to optimize their function.
The benefits of single-tasking and rest for cognitive function
Focusing on one specific task for a short period of time at the edge of your current capacity, with some failure, followed by rest and recovery, helps drive plastic reorganization in the brain and increase functional capacity in some domain of cognitive function. Adults often perform in their day-to-day work with multitasking and task switching, which is not providing the stimulus to increase skill in a specific area. Humans cannot multitask in the way of focusing on one thing, then another thing, then another thing, as there's a loss function in terms of the time it takes to refocus, and the amount of time you actually have to focus on one task is dramatically reduced.
The Pros and Cons of Multitasking for Athletes and Formula One Drivers
Multitasking demands a high level of cognitive processing and can be unproductive. Athletes who overexert themselves may experience a physiological no man's land and receive minimal benefits for their hard work. Formula One drivers have an impressive ability to manage multiple variables while driving at high speeds, which highlights the importance of sport-specific training and experience. Developing the ability to multitask may require building automatic subroutines for certain tasks while dedicating full attention to others. In general, switching between multiple high-demand tasks can be difficult and stressful for most people, making it important to prioritize and focus on one task at a time for optimal productivity.
The Benefits of Practicing Automatic Processes in Professional Racing and Everyday Life
Professional race car drivers rely heavily on automatic processes developed through years of experience. As they progress and encounter more complex cars, coaches may have them practice subroutines and reaction-based games to become relaxed and focused while in the right state of arousal to perform effectively. As people age, it's important to maintain the highest level of physiologic headroom possible to minimize age-related decline and avoid pathologic issues. While not everyone may need complex motor skills and cognitive skills in their daily life, practicing skills in a way similar to pro drivers can be beneficial in improving focus, relaxation, and performance, including improving reaction times. Practicing a balance of skill-based activities that require fluidity can help reach an appropriate level of arousal for peak performance.
Maintaining Cognitive Function Through Active Headroom and Absolute Capacity
To maintain cognitive function throughout life, it is important to actively work on increasing headroom and absolute capacity. Cognitive function declines with age and is related to the amount of demand placed on the brain. Social interaction is also crucial for long-term cognitive function. Cognitive demand mainly comes from work, and those who retire earlier experience cognitive decline sooner. Retirement should be thought of as a financial decision and should not lead to the end of cognitive demand. Sense of purpose is also vital as it may contribute to cognitive satisfaction and function. Increasing absolute capacity throughout life can slow cognitive decline, allowing individuals to engage in activities for longer.
Replacing Work with Stimulating Activities for Cognitive Health.
Replacing work with cognitively stimulating activities can mitigate the risk of cognitive decline, according to studies. While retirement removes the cognitive stimulus from work, studies have shown that continued cognitive activity late in life, such as playing chess or dancing, can be protective against cognitive decline. Evidence also suggests that cognitive training, such as computer-based brain training, can improve cognitive function. Early in life education increases headroom and provides protective factors, along with late in life cognitive activity. Not all cognitive activities are created equal, and the complexity and interactivity of an activity determine cognitive load. More complex and interactive activities, such as 3D video games or dancing, offer greater benefits for cognitive function compared to closed skill activities such as circuit training or paint by numbers.
The Relationship Between Physical Activities and Cognitive Abilities in Alzheimer's Disease
Physical activities that involve complex interaction with the environment and other people may result in greater improvements in cognitive abilities compared to those that do not, despite providing a similar cardiovascular stimulus. The neuropathology of Alzheimer's disease is characterized by amyloid plaques and tau tangles within the neurons, particularly in the medial temporal lobe, but the correlation of these pathological hallmarks with symptom burden and disease progression is poor. The genesis of the eponym 'Alzheimer's disease' and its classification were based on these pathological hallmarks, but the accumulation and significance of them may vary from person to person. The disease that August D had, which inspired the initial classification, may not have been the typical Alzheimer’s that 99% of people with the disease have today.
The correlation between Alzheimer's disease and amyloid beta
Alzheimer's disease can be caused by autosomal dominant mutations or environmental factors such as social isolation, but the presence of amyloid beta on a histologic sample does not necessarily correlate with the severity of dementia-related symptoms in a person while they were alive. The variability in cognitive function is only explained by a couple of percentage points in the amount of amyloid. The accumulation of neuropathological hallmarks does not necessarily result in cognitive decline beyond what might be expected given a person's age. Hence, there is a possibility that there are other factors involved in the onset of Alzheimer's disease.
Microglial Function Phenotype, Lysosomal Function, and Amyloid Beta in Alzheimer's Disease and Dementia.
Microglial function phenotype and lysosomal function are potential factors that contribute to Alzheimer's disease and dementia. Amyloid beta may not be necessarily sufficient to cause dementing processes but may be a response to neuronal stress that is supposed to be protective. However, up to a certain point, amyloid plaques can become damaging in their own right. The causality and necessary but not sufficient argument are central in understanding Alzheimer's disease and dementia. Lowering amyloid may not be sufficient to remove the disease, and there is no evidence of amyloid-reducing strategies working. It is possible that if amyloid reducing therapies were applied earlier, it could be beneficial in reducing the risk of Alzheimer's disease and dementia.
The Dangers of Amyloid Plaque in the Brain
The plaque in the brain is a marker of something potentially harmful, but removing it doesn't erase the damage that may have already been caused. While the presence of amyloid may not necessarily be an absolute marker of a neurological problem, its accumulation inside the cells could still be damaging. Further research is needed to understand the process in humans. The prevention of late-onset Alzheimer's disease may be achieved by addressing lifestyle and environmental factors, such as diet, cardiovascular health, and hearing loss, which account for at least 40% preventable risk factors. Refocusing efforts to understand upstream processes that drive neurological stresses can lead to the development of more effective prevention and treatment strategies.
How B-Vitamins, DHA, and Homocysteine Levels Affect Cognitive Decline and Brain Atrophy.
Reducing homocysteine levels through B-vitamin supplementation and taking DHA can slow cognitive decline and brain atrophy. Homocysteine may contribute to the accumulation of tau tangles and inhibit the creation of functional neuronal membranes. There seems to be an interaction between B-vitamin and Omega-3 status in terms of cognitive decline and brain atrophy, both of which are required for DHA to be inserted in a functional way into a neuronal membrane. Taking one to two grams of DHA along with lowering homocysteine levels can be beneficial.
The Benefits and Bias of Supplementing for Dementia Prevention
Supplementing with methylfolate, methyl B12, and sometimes B6 in addition to high quality DHA and controlling homocysteine levels can reduce the risk of all-cause dementia by 20%. However, there is a systemic bias in the medical community against non-pharmacologic interventions, including supplements, despite significant evidence supporting their benefits. Patients may need to take initiative and bypass their doctors to measure their homocysteine and EPA, DHA levels and supplement on their own since these interventions are cost-effective and easy to manage. Despite being critical of the supplement industry, Peter Attia himself takes a dozen supplements a day, including methylfolate, methyl B12, B6, EPA, and DHA.
Incorporating a Systems Approach to Cognitive Health
Supplements can be beneficial for cognitive health, but there are challenges with regulation and prescribing. It is important to consider a wide range of treatment options, including lifestyle changes, supplements, and medication, to effectively combat diseases like Alzheimer's. Siloed approaches to medicine can be limiting and it is important to take a systems approach, considering the various risk factors and potential pathways to cognitive decline. It is also important to seek out high quality supplement manufacturers and ensure that the supplements are properly regulated and certified.
Resistance Training and its Multi-Pronged Benefits for Brain Health
Strength training can mitigate the risk of dementia and all-cause mortality by up to 70%. Research shows that resistance training can improve white matter connectivity and cognitive function in older individuals. The movement itself acts as a cognitive stimulus that supports brain function and plasticity by stimulating new nerve connections in the brain. Resistance training also plays an essential role in regulating blood sugar and reducing systemic inflammation, two significant contributors to cognitive decline and dementia. The benefits of strength training are due to its multi-plyotropic effects that are at least additive and synergistic. Incorporating strength training into your lifestyle at any stage can be an important intervention that can positively impact your overall health.
The Importance of Fitness and How Concussions Affect the Brain
Even if strength training, muscle mass, and cardiorespiratory fitness do not add a single day to your life or shorten it, they are still worth it for the quality of life, especially in the final decade. Poor movement, pain, and low strength limit capacity for doing essential activities such as playing with kids or going for a walk. Concussion, a mild traumatic brain injury, can cause disturbances in neuronal function due to the transmission of force to the brain, resulting in a neuron firing when it shouldn't, downstream processes, mitochondrial damage, and the accumulation of pathological proteins such as tau. Concussions can result in various severe symptoms such as sensitivity to light and sound, memory, focus, and reaction time problems.
Importance of Thermoregulation in Post-Concussion Management
After a traumatic brain injury, a systemic immune response can contribute to the symptoms, and managing body temperature is crucial for short-term post-concussion management. Thermoregulation should be done to balance the normal body temperature as a hotter brain after injury worsens outcomes. External cooling methods and Tylenol can help regulate the body temperature. Inflammatory responses can occur a few hours later and can cause a fever, but the duration of power of Tylenol intervention is still being studied. Additionally, subconcussive impacts or blasts in sports or military may accumulate and cause cognitive function issues, and strategies such as supplementation can potentially make the athlete more resilient to impacts and support recovery after the injury.
The Effectiveness of Active Cooling in Reducing Brain Injury after a Concussion
Preventing fever is crucial in the 24-72 hours after a concussion, as fever exacerbates the injury by increasing the gap between metabolic rate and capacity to produce energy. Cooling has been shown to reduce brain injury in animal models, but there is no evidence that it works for people with concussions. Instead, maintaining normal thermia is recommended. External cooling devices like cool caps have no high quality evidence to prove their efficacy. Additionally, there are issues in measuring brain temperature in these studies. Therefore, preventing fever and managing it is important, but there is no evidence that active cooling is effective in reducing the risk of brain injury after a concussion.
Cooling and Oxygen Therapy in Pediatric Brain Injury Management
Pediatric patients are more susceptible to insensible losses and need cooling therapy within six hours to avoid poor outcomes in an acute brain injury. Original cooling trials in neonates were flawed as the control group was kept at 37 degrees Celsius, artificially creating a gap and potentially worsening their outcome. Hyperbaric oxygen therapy can be detrimental in the acute phase of brain injury, but may be beneficial in the chronic phase. Exposure to multiple rounds of hyperbaric oxygen can improve outcomes for those with concussion or traumatic brain injury. It is important to consider the phase and timing of treatment in brain injury management.
Exploring the Potential Benefits of Hyperbaric Oxygen Treatment and Creatine Supplementation in TBI.
Hyperbaric oxygen treatment may have potential benefits in improving cognitive function and restoring metabolic function within the brain. But, most of these trials are single arm uncontrolled studies and creating a control group in high back oxygen studies is quite tricky. An early data suggests that at least 30 plus exposures of hyperbolic oxygen is required to see the benefit. Furthermore, supplementing with creatine for several days before a traumatic brain injury may be significantly neuroprotective. Dosing 20 grams a day for a week has been shown to increase brain creatine levels, which may offer short-term pH and energy buffer that is protective when there's an impact. Lack of good quality prophylactic studies and its difficulty in predicting make it hard to study TBI.
The Role of Supplements in TBI Prevention and Recovery
For those at high risk of TBI or who have had a TBI, creatine supplementation is worth considering for various reasons such as prevention, cognitive function, mood, and memory. A loading period of 20 grams for a week may increase brain creatine before the impact, after which 5 grams daily can help. DHA supplementation is also important as it mitigates neuronal injury due to concussion, reducing circulating neurofilament light. Choline supplements like citricoline or CDP choline should also be taken if metabolic health and homocysteine levels are good. Supplements such as creatine, DHA, and choline should be part of everyone's toolkit as we never know when we might be at risk for TBI.
Choline Supplementation and Health Optimization in F1 Drivers.
Choline supplementation may lead to improvement in psychological outcomes for survivors of traumatic brain injuries. The recommended form of choline supplement is Citakoline, as it has been more studied than other forms. It is important to choose a high-quality brand even if it means paying a little bit more. Another surprising aspect of F1 is the attention paid to the health and performance of drivers, which historically took a backseat to the car. Due to the demands on their time and cognitive resources, drivers must focus on the most impactful changes to their health and performance in order to improve. In the world of F1, every race requires a different car setup, which must be optimized quickly after each race.
The Science of Improving a Driver's Reaction Time
To improve a driver's reaction time off the start line, various methods were tried, including training reaction time, caffeine and creatine supplements, and skills such as playing the drums. However, it was also important to balance the optimal reaction speed with the driver's arousal curve for later in the race. The outcome improved through a scientific process of tinkering with different methods, although it cannot be definitively stated whether any one intervention made the difference. Overall, it highlights the importance of a multi-faceted approach when it comes to improving a driver's performance and how a focus on scientifically-backed methods can lead to better outcomes.