The Peter Attia Drive

Cognitive decline, neurodegeneration, and head injuries: mitigation and prevention strategies, supplements, and more | Tommy Wood, M.D., Ph.D.

Mon Jun 05 2023

LongevityCognitive declineBrain stimulationDementia preventionHead injuriesMultitaskingFormula One racingAlzheimer's diseaseHomocysteine levelsStrength trainingConcussionsCooling therapyHyperbaric oxygen therapySupplements

Description

The Drive podcast focuses on translating the science of longevity into accessible content. Dr. Tommy Wood discusses age-related cognitive decline, brain stimulation, dementia prevention, head injuries, multitasking, Formula One racing, Alzheimer's disease, homocysteine levels, strength training, concussions, cooling therapy, hyperbaric oxygen therapy, and supplements. The episode provides insights into maintaining cognitive function and optimizing brain health throughout life.

Insights

Exercise as hormetic stress

Exercise can be seen as a hormetic stress that benefits certain organs. Cognitive demand is relative to the individual and what they want their brain to function best at. Focused attention on specific tasks drives plastic reorganization and increases functional capacity in cognitive function.

Multitasking and cognitive performance

Multitasking can lead to decreased productivity and focus. Certain tasks require more attention and cannot be done while multitasking. Traditional work-based multitasking often leads to minimal cognitive benefit despite the perceived demand.

Preventing cognitive decline

Engaging in late-life cognitive activities, such as playing chess or dancing, can protect against cognitive decline. Cognitive training, like computer-based brain training, can improve cognitive function in older adults. Early-life education and lifelong cognitive activity are the most important protective factors against cognitive decline.

Amyloid plaque and Alzheimer's disease

Pathological hallmarks of Alzheimer's disease do not always correlate well with symptom burden and disease progression. Accumulation of amyloid beta may be a response to neuronal stress rather than the underlying problem. Targeting amyloid reducing therapies earlier may be more effective in preventing cognitive decline.

Supplements for brain health

Homocysteine levels and B vitamin supplementation can reduce the risk of Alzheimer's disease by 20%. Thorne and Pure Encapsulations are trusted supplement brands with stringent regulatory processes. Having a comprehensive approach to Alzheimer's prevention is important, including lifestyle changes, supplements, and medications.

Strength training and brain health

Strength training has a strong association with reducing the risk of dementia and improving survivability. Resistance training can improve white matter connectivity, cognitive function, blood sugar regulation, and reduce inflammation. Multiple factors contribute to the benefits of strength training on brain health.

Concussions and brain injury

Concussions can result in disturbances of neuronal function and various downstream processes. Sub-concussive impacts or blasts over time can accumulate damage and affect cognitive function. Managing normal body temperature is important for post-concussion management.

Hyperbaric oxygen therapy

Hyperbaric oxygen therapy may improve cognitive function and restore metabolic function within the brain. Several rounds of hyperbaric oxygen therapy, with at least 30+ exposures, seem to be required for optimal results. Supplementation with creatine monohydrate and omega-3 fatty acids (DHA and EPA) may have benefits in traumatic brain injury (TBI).

Formula One racing and cognitive performance

In Formula One (F1), attention to the health and performance of drivers has increased compared to focusing solely on the car. Drivers have limited time and cognitive resources to prioritize their health and performance due to travel and media commitments. Understanding the balance of the car and adapting it to different circuits is crucial in F1 racing.

Chapters

The Drive podcast focuses on translating the science of longevity into accessible content.
Cognitive decline can lead to mild cognitive impairment and eventually frank dementia, such as Alzheimer's disease.
As your library gets bigger, your brain becomes more selective in what memories it stores.
Exercise can be seen as a hormetic stress that benefits certain organs.
Multitasking can lead to decreased productivity and focus.
Professional racing drivers rely on their extensive experience and learned subroutines to adapt quickly to changes in the car setup or new regulations.
Natural decline in cognitive function with aging is influenced by how we use our brains in society.
Online brain training systems, such as a subscription service, have been used in clinical studies and show evidence of translational improvements in cognitive function.
Alzheimer's cases are very different from each other and may not necessarily be grouped together.
Amyloid reducing therapies applied earlier may be more effective in targeting Alzheimer's disease.
The study may underestimate the preventability of late onset Alzheimer's disease due to not including sleep and nutrient status.
Homocysteine levels and B vitamin supplementation can reduce the risk of Alzheimer's disease by 20%.
Having a variety of approaches and interventions is important in addressing cognitive decline and Alzheimer's disease.
Strength training and muscle mass are important for the quality of life, even if they don't add days to your life.
Sub-concussive impacts accumulate damage over time, even if each individual impact doesn't cause symptoms.
External cooling devices have not been shown to be beneficial for concussion or traumatic brain injury.
Hyperbaric oxygen therapy may improve cognitive function and restore metabolic function within the brain.
DHA supplementation mitigated the increase in urophilament light, a marker of neuronal injury, in athletes across the season.

Summary

Transcript

The Drive podcast focuses on translating the science of longevity into accessible content.

00:11 - 07:14

Dr. Tommy Wood, an assistant professor of pediatrics and neuroscience at the University of Washington, is the guest on this episode.
They discuss age-related cognitive decline, including memory, reaction time, executive function, and more.
Root causes of age-related decline are explored, along with cognitive demand and distractions.
Different types of brain stimulation and their benefits are discussed.
Theories on pathology in dementia and neurodegeneration are examined.
Lifestyle factors that can help prevent dementia are mentioned, as well as the importance of muscle.
Various supplements for preventing dementia are touched upon.
Head injuries such as concussions and traumatic brain injuries are explained, along with symptoms and ways to minimize severity.

Cognitive decline can lead to mild cognitive impairment and eventually frank dementia, such as Alzheimer's disease.

06:49 - 14:01

Memory complaints are common, with people noticing a decline in their ability to remember names.
Cognition includes executive function, memory, processing speed, and reaction time.
Individuals have their own areas of cognitive function they want to improve.
Memory has two parts: encoding and retrieval. Encoding is often lost in pathological cognitive decline.
Retrieval speed slows down with age due to accumulating more information in the brain.
Sleep impairment and subjective stress can impair memory retrieval.
As the brain accumulates more memories, it becomes more selective in what it stores on the 'bookshelf' of memory.

As your library gets bigger, your brain becomes more selective in what memories it stores.

13:37 - 21:00

There is a debate about whether comparing human memory to a hard drive is accurate, but there are still limits on what the brain chooses to store.
Age-related changes in the brain can affect memory retrieval and other cognitive functions.
The frontal and medial temporal parts of the brain, including the hippocampus, are particularly vulnerable to atrophy with aging.
Multiple factors contribute to maintaining a healthy brain, including vascular supply, metabolic substrate, neuronal structure and function, mitochondrial function, demand placed on the brain regions, recovery through sleep, and avoiding negative outside factors.
Exercise can be seen as a hormetic stress that puts demand on muscles for growth and maintenance.

Exercise can be seen as a hormetic stress that benefits certain organs.

20:44 - 27:43

The liver, for example, upregulates its function in response to chronic alcohol exposure to better metabolize ethanol.
Stressing an organ with relevant stressors and allowing time for recovery and adaptation can lead to increased capacity.
Cognitive demand is relative to the individual and what they want their brain to function best at.
Focused attention on specific tasks drives plastic reorganization and increases functional capacity in cognitive function.
Multitasking and task switching in day-to-day work may not provide the same stimuli for functional change in the brain.
Excessive task switching and distraction can impair productivity and cognitive performance.

Multitasking can lead to decreased productivity and focus.

27:15 - 34:18

Humans cannot effectively multitask when it involves switching between different tasks.
There is a loss of time when switching from one task to another, which reduces the amount of time available for focused work.
Certain tasks require more attention and cannot be done while multitasking, such as high-intensity cardio workouts or weightlifting.
Traditional work-based multitasking often leads to minimal cognitive benefit despite the perceived demand.
Formula One drivers have to manage numerous variables simultaneously, such as adjusting brake bias, altering slip angle of the differential, and communicating with their engineer through a radio button.
The ability to handle multiple variables while driving at high speeds is likely due to years of experience and training in the sport.

Professional racing drivers rely on their extensive experience and learned subroutines to adapt quickly to changes in the car setup or new regulations.

34:01 - 40:55

Race craft, which involves reacting to other drivers, requires most of their attention during a race.
Coaches help drivers transition between different racing categories by providing opportunities for practice and skill development.
Physical and cognitive games before races can help drivers feel prepared and optimize their arousal levels for performance.
For individuals reaching middle age, maintaining specific skills relevant to their desired activities can help delay age-related decline.
Language skills, memory, and social interaction are important factors in preserving cognitive function as people age.
Cognitive function tends to decline with age due to reduced demand on the brain and societal factors that limit skill building and stimulation.

Natural decline in cognitive function with aging is influenced by how we use our brains in society.

40:39 - 47:40

Retiring earlier may lead to cognitive decline sooner due to the decrease in cognitive demand from work.
Actively working on ways to increase headroom and absolute capacity throughout life can help maintain basic cognitive functions.
Retiring without adding any cognitively stimulating activities may result in cognitive decline.
Engaging in late-life cognitive activities, such as playing chess or dancing, can protect against cognitive decline.
Cognitive training, like computer-based brain training, can improve cognitive function in older adults.
Early-life education and lifelong cognitive activity are the most important protective factors against cognitive decline.
The complexity of replacement activities after retirement may affect their impact on cognition. More complex activities tend to have a higher level of cognitive load and provide greater benefits.
Online brain training systems like Brain HQ have shown evidence of improving verbal memory and executive function through complex training games.

Online brain training systems, such as a subscription service, have been used in clinical studies and show evidence of translational improvements in cognitive function.

47:21 - 54:54

Video games that are more complex and interactive, like Mario 3D, result in better improvements in working memory and executive function compared to simpler games like solitaire.
Physical activities that involve open skills, such as dancing or playing table tennis, lead to greater improvements in cognitive abilities compared to closed skill activities like exercising on an indoor bike.
The more domains or complexity involved in an activity, the greater the associated improvements in cognitive function.
Walking outside on an uneven surface with constantly changing slopes is more beneficial for cognitive function than walking on a treadmill or around track circles.
Alzheimer's disease is characterized by neuropathology including amyloid plaques and tau tangles within the medial temporal lobe of the brain.
Different types of dementia include vascular dementia, frontotemporal dementia, lewy-bodied dementia, and other forms that may not fit neatly into these categories.
Pathological hallmarks of Alzheimer's disease do not always correlate well with symptom burden and disease progression.
August D., who was initially classified as having Alzheimer's disease based on her brain pathology, may have had a different variant of the disease that is genetically predetermined.

Alzheimer's cases are very different from each other and may not necessarily be grouped together.

54:28 - 1:01:27

Removing someone from their environment and social interaction can trigger cognitive decline.
The presence of amyloid beta on a histologic sample does not always correlate with dementia-related symptoms.
There is only a small percentage of variability in cognitive function explained by the amount of amyloid plaque.
Amyloid plaque and tau tangles are commonly found in individuals with dementia, but some people have them without cognitive decline.
Microglial function phenotype and lysosomal function are being investigated as potential factors in Alzheimer's disease.
Accumulation of amyloid beta may be a response to neuronal stress rather than the underlying problem.
Amyloid beta may be necessary but not sufficient for amyloid plaque formation, and reducing it has not shown significant results in treating the disease.
Targeting amyloid reducing therapies earlier may be more effective in preventing cognitive decline.

Amyloid reducing therapies applied earlier may be more effective in targeting Alzheimer's disease.

1:01:05 - 1:08:29

Amyloid plaque accumulation can occur inside neurons, leading to cell death and the formation of plaques.
Removing amyloid plaques is not sufficient to treat Alzheimer's disease.
The critical response to the intracellular accumulation model is the need for evidence in humans and consideration of other factors that can cause damage.
Other theories for Alzheimer's disease include vascular, metabolic, and genetic components.
Prevention and treatment funding should focus on environmental and lifestyle-based risk factors.
A Lancet Commission report estimated that 40% of dementia cases are preventable through various risk factor interventions.
Additional factors like sleep and nutrient status may further contribute to preventing late-onset Alzheimer's disease.

The study may underestimate the preventability of late onset Alzheimer's disease due to not including sleep and nutrient status.

1:07:59 - 1:15:05

Population attributable risk assessments assume linear and additive effects, but in reality, risk factors interact.
Homocysteine has a population attributable risk of around 20% for late onset Alzheimer's disease.
Managing homocysteine aggressively with methylated B vitamins can help reduce cognitive decline and brain atrophy.
Homocysteine may contribute to the accumulation of tau tangles in neurons.
The methylation cycle is important for creating functional neuronal membranes.
There is an interaction between B-vitamin status and omega-3 status in terms of cognitive decline and brain atrophy.
Lowering homocysteine levels and taking DHA supplements can potentially reduce the risk of all-cause dementia by 20% or more.
There is a disconnect in how we think about prevention, with many people unaware of their elevated homocysteine levels and low DHA levels.

Homocysteine levels and B vitamin supplementation can reduce the risk of Alzheimer's disease by 20%.

1:14:44 - 1:21:47

This information has not been incorporated into prevention guidelines or widely recognized in the medical community.
There may be a bias against non-pharmacologic interventions and supplements in the medical community.
Supplement industry is generally unregulated and lacks quality control, but not all supplements are bad.
The speaker personally takes several supplements including methyl folate, methyl B12, B6, EPA, and DHA.
Thorne and Pure Encapsulations are trusted supplement brands with stringent regulatory processes.
Prescribing supplements can be challenging due to regulatory issues and lack of guidelines.
Some physicians in lifestyle medicine are against recommending supplements despite evidence of their benefits.
Having a comprehensive approach to Alzheimer's prevention is important, including lifestyle changes, supplements, and medications.

Having a variety of approaches and interventions is important in addressing cognitive decline and Alzheimer's disease.

1:21:19 - 1:28:36

The unifying theory is that all these factors, such as homocysteine levels, omega-3 fatty acids, glucose hypometabolism, and microvascular disease, contribute to neuronal damage and leave a common tombstone.
Strength has a strong association with reducing the risk of dementia and improving survivability.
High levels of grip strength are correlated with a significant reduction in incidence and mortality associated with all-cause dementia.
Resistance training can improve white matter connectivity, cognitive function, blood sugar regulation, and reduce inflammation.
Multiple factors like neuromuscular stimulation, glucose flux regulation, myokines release from muscle tissue, and anti-inflammatory effects contribute to the benefits of strength training on brain health.

Strength training and muscle mass are important for the quality of life, even if they don't add days to your life.

1:28:15 - 1:35:40

Poor movement, pain, and low strength limit one's capacity for daily activities.
A concussion is a mild traumatic brain injury caused by force or blast wave to the brain.
Concussions can result in disturbances of neuronal function and various downstream processes.
Severe symptoms of concussions include photosensitivity, auditory sensitivity, difficulty processing things, and irritability.
The frequency of severe symptoms after a head trauma is difficult to determine due to unreported cases.
Concussions can have effects on verbal abilities, memory, focus, reaction time, and systemic immune response.
Concussion is a type of traumatic brain injury (TBI), with varying severities.
Sub-concussive impacts or blasts over time can accumulate damage and affect cognitive function.

Sub-concussive impacts accumulate damage over time, even if each individual impact doesn't cause symptoms.

1:35:24 - 1:42:23

Formal medical assessment and baseline cognitive testing are used to manage concussions in sports.
Strategies to mitigate the effects of an impact and support recovery are being explored.
Managing normal body temperature is important for post-concussion management.
Heat-stressed environments can worsen outcomes after a brain injury.
Cooling down the body and using external methods like Tylenol can help regulate body temperature.
Preventing fever within the first 24-72 hours after a concussion is crucial to avoid exacerbating energy production issues in the brain.
There is no evidence that laying down or cooling the head with ice is beneficial for concussions.
Hypothermia has shown neuroprotective effects in animal models but has not been successful in human trials for traumatic brain injuries.
Maintaining normal core temperature seems more effective than active cooling below it.
External devices like cool caps have no high-quality evidence supporting their effectiveness for concussion recovery.

External cooling devices have not been shown to be beneficial for concussion or traumatic brain injury.

1:42:06 - 1:49:01

There is uncertainty about whether the brain is actually being cooled in these studies.
Timing of cooling therapy is crucial, and many studies may not cool soon enough after the injury.
In some neonatal cooling trials, the control group was kept at a higher temperature, potentially skewing the results.
Hyperbaric oxygen therapy can be detrimental in the acute phase of brain injury due to increased oxidative stress.
In the chronic phase, hyperbaric oxygen therapy may show some improvement, but most studies are uncontrolled and lack a proper control group.
Multiple rounds of hyperbaric oxygen therapy over several months may be required for cognitive function improvement.

Hyperbaric oxygen therapy may improve cognitive function and restore metabolic function within the brain.

1:48:35 - 1:55:14

Several rounds of hyperbaric oxygen therapy, with at least 30+ exposures, seem to be required for optimal results.
Supplementation with creatine monohydrate and omega-3 fatty acids (DHA and EPA) may have benefits in traumatic brain injury (TBI).
Creatine monohydrate supplementation can increase brain creatine levels and provide short-term pH and energy buffering.
Brain creatine levels decrease with impacts, suggesting a potential protective role of creatine in TBI.
Prophylactic creatine supplementation may be beneficial for those at high risk of TBI or after a concussion.
Creatine supplementation can offset cognitive deficits caused by sleep deprivation and improve cognitive function.
There is evidence that creatine supplementation may help improve mood in individuals with depression symptoms.
DHA supplementation may be more important than EPA for concussion-related neuronal structure and function.
Supplementing with DHA can mitigate the increase in urophilament light, a marker of neuronal injury, seen during a football season.

DHA supplementation mitigated the increase in urophilament light, a marker of neuronal injury, in athletes across the season.

2:01:09 - 2:06:37

Supplements like DHA and creatine should be considered for brain health and muscle performance.
Coding as citicoline or cdpcoline is worth considering for brain health improvement.
Taking one to two grams of colein per day may improve neuropsychological outcomes in survivors of traumatic brain injuries.
Citicoline is recommended as a supplement format for colein.
High-quality brands like Thorne or Jero are suggested for supplements.
In Formula One (F1), attention to the health and performance of drivers has increased compared to focusing solely on the car.
Drivers have limited time and cognitive resources to prioritize their health and performance due to travel and media commitments.
The demands on F1 drivers vary, with some focusing more on their health than others.
Working with professional endurance athletes requires selecting impactful interventions with minimal risk.
Understanding the balance of the car and adapting it to different circuits is crucial in F1 racing.