Aging and Brain Health w/ Catherine Diaz-Asper, PhD, Center for Optimal Aging, Marymount University 1/6/26

Brain changes affect our thinking, for example, calculating a tip or following a complex set of directions and becomes less efficient as we age. It's harder to tune out distractions and older adults might experience something known as the tip of the tongue phenomenon. Normal ageing tends to slow down that thinking process, but that's not the same as dementia, which is a progressive deterioration in cognitive function over time. [Music] Hello and welcome to Aging Matters, a program featuring aging-related topics for older adults and their families. I'm Cheryl Beverstorf, your host. The brain is the most complex organ in our bodies. A healthy brain means having the ability to remember, learn, plan, concentrate, and maintain a clear, active mind. When older adults have dementia, it affects their brain's cognitive health and changes their memory and/or thinking skills severely enough to impair daily functioning. Today, my guest is Dr. Catherine Diaz Asper, Associate Professor of Psychology and Associate Director of Research at the Center for Optimal Aging at Marymount University in Arlington, Virginia. She's going to talk about risk factors affecting brain health and what we can do each day to ensure our brains stay healthy. She'll also tell us about current research studies pertaining to brain health and how a healthy brain might prevent cognitive decline and dementia. So welcome, Catherine, and thank you for joining me today. Thank you, Cheryl. I'm really excited to check what you do this morning. Let's get started with getting some basics about anatomy and physiology. So, help us understand why does the brain change as we age? Talk about the structural changes that occur and perhaps maybe even the chemical changes. Sure. So the aging process affects the brain, just as it affects every other part of our body. As we age, we develop wrinkles and gray hair. Almitabilism slows down and our organs become less efficient. The brain is no different. It's thought that from around our 30s and 40s, the overall volume of the brain begins to subtly shrink, with the rate of shrinkage picking up in our 60s and beyond. The areas most affected tend to be the front part of the brain, called the frontal lobes, which are involved in planning and decision making, and an area deep within the brain called the hippocampus, which is crucial for forming new memories. At the same time, the brain's internal signaling slows down, due to less efficient connections, and the chemical messengers in the brain become less plentiful. These changes all result in a natural gradual slowing of certain cognitive functions, like our ability to process new information quickly. But we know that keeping good overall health and staying active and mentally and socially engaged, can slow these changes down and preserve brain function, in terms of structural changes, the most notable structural change is the subtle gradual loss of volume, which is called cerebral atrophy. Gray matter is the outer layer of the brain, which is called the cerebral cortex, and this layer gradually thins, particularly as I've said in the frontal lobes. White matter consists of the insulated nerve fibers called axons that form the high-speed connections between different brain regions. As we age, the fatty insulating sheath around these fibers called myelin can break down. This is called demyelination, which slows down the speed and efficiency of communications across the brain's networks. In terms of chemical changes, as we age, our brains generate and send fewer messenger chemicals or neurotransmitters, like a Cetal-Colene, Dopamine, and Serotonin. A Cetal-Colene, which is vital for the process of making new memories, tends to diminish making it harder to retain new information. At the same time, the brain loses many dopamine receptors, which can slow down our decision-making speed and make it more difficult to maintain sharp focus on complex tasks. These changes are often compounded by a decrease in serotonin, which can disrupt sleep patterns and mood, which can all impact our thinking as we age. That helps us get an understanding of what goes on as far as the anatomy and physiology. Tell us more about thinking. What happens as far as older adults' ability to think as well as they did when they were, you know, 50 years younger? The general effect of an aging brain on thinking for older adults is a gradual slowing down and a shift in efficiency, but not a loss of core knowledge or skills. The most consistent and notable cognitive change is a decrease in processing speed. This is the time it takes to perceive information, process it, and initiate a response. The brain's communication lines, the white matter I was just talking about, are slightly less efficient, and it simply takes more time for the signal to get from point A to point B. This means slower reaction times, so for example when you're driving, slower reading speed when encountering complex new text, and maybe feeling that thinking isn't quite as sharp as it used to be. So what I wanted to know then too in terms of thinking, what about cognitive function is there then changes that occur in that aspect of older adults? The brain changes we've been talking about do affect our thinking in certain ways, and in specific ways, there are a few examples I can think of. So working memory, as your ability to temporarily hold and manipulate information in your mind, so for example calculating a tip or following a complex set of directions, this skill often becomes less efficient as we age. Also, our attention can become affected as we get older, so this might mean it's harder to tune out distractions, and also maybe focus on doing two things at the same time. That tends to become a little more difficult. And then also older adults might experience something known as the tip of the tongue phenomenon. This is a difficulty in accessing information that we have stored in our memory. So for example, recalling a person's name or thinking of a particular word at a particular time, the memory is still there, it's just a little harder to access because the retrieval process tends to be slower and less reliable. This is distinct from having completely lost the memory. So in general normal aging tends to slow down that thinking process and make it a bit more difficult to do things that require rapid or new processing, but that's not the same as dementia which is a progressive deterioration and cognitive function and brain function over time. Let's talk about risk factors. I was thinking of maybe things like smoking or obesity, maybe high cholesterol or high blood pressure, perhaps there are others. How do these affect brain health and cognitive function and thinking for older adults? The things that you've been mentioning like obesity, diabetes, etc. These are all known as vascular risk factors. They're the primary drivers of poor heart health and blood vessel health and it turns out that what is actually bad for your heart is also bad for your brain. So each of these risk factors directly or indirectly damage the blood vessels that supply the brain, either individually or in combination with each other. So the good news is that these risk factors are all what is known as modifiable risk factors, meaning that they're something we can do something about to fix. So if we can effectively manage and treat conditions like obesity, diabetes, high blood pressure, high cholesterol, especially in mid life, that's one of the most powerful things we can do to actually preserve our long-term brain and cognitive health. And if I understand it correctly, some things are obviously a choice like smoking, but having these factors can increase the risk of cognitive decline. Zakara, absolutely. This is actually a really strong finding in the research literature and it turns out that having one of these vascular risk factors can increase the risk of dementia, but having multiple risk factors, for example having high blood pressure and diabetes, that creates a much greater risk for having cognitive decline than just having one of them. So it behooves us to try and get these conditions under control as best we can. And one risk factor that we haven't mentioned, but often comes up in programs that I've done before and that's alcohol, is alcohol also a risk factor that people need to be mindful about in terms of their brain health? Absolutely. Alcohol in greater quantities than the glass of wine a day would be considered a risk factor for declining brain function as we age. - Another factor that comes into play is that oftentimes older adults are taking a lot of medications for various health conditions. And so how about that? Can medications have an impact on brain health and if so how? - Yeah, they can because as we age, we end up processing drugs a little bit differently in our bodies and older adults are particularly vulnerable to side effects of medications that affect our thinking and memory. So there are certain kinds of medications that affect key chemical messengers in the brain or neurotransmitters. One of these is a CETAL colon which plays a role in memory and attention. So the long term use of certain medications that block this chemical can affect our cognitive function. So this would include certain kinds of anti-histamines and some drugs to block overactive bladder for example. There's another class of medications that sort of slow down the brain globally in these called benzodiazepines and also not benzodiazepine sleep aids. So these sorts of things can also affect our cognitive function. So in terms of making sure that we are keeping our brain as active and as healthy as possible, it's recommended that we have a healthcare provider like a pharmacist or your doctor conduct a full medication review annually. So that way they can check whether prescription drugs over the counter medications and supplements any of those are working in a way that's detrimental to your brain health. Thank you for mentioning about over the counter medications and supplements. Interestingly, I've talked with people on this program about the fact that supplements are not regulated. And so it's uncertain in terms of what ingredients are in the supplements. It's a little bit more regulated in terms of over the counter medications, but it seems like the interaction of the supplements and the over the counter medications with the prescription medications can cause problems for the brain. Have you found that? Absolutely. Yeah, absolutely. Okay. Well, then let's turn to a healthy lifestyle. And why is that so important for aging brains? What do we need to know? So there's actually an increasing body of evidence now that really strongly suggests that a healthy lifestyle can delay cognitive decline and potentially dementia as we get older. There are many components to what a healthy lifestyle is, but essentially the thinking is that engaging in these behaviors keeps the brain healthy if along the by providing that's necessary energy and for growth and repair and protecting it from further damage. Okay. Well, so no one is exempt from a healthy lifestyle. So let's start out with some of those components and break those down so we understand the importance. Let's start with physical health and exercise. What happens when we exercise that helps keep our brains healthy? So exercise, when you think about it, you're moving around that's going to increase your circulation and your oxygen supply, which of course is important for the brain. At the same time, exercise has been shown to suppress low grade inflammation in the brain, so that's another good thing. Exercise plays an important role in increasing the level of a particular protein in the brain called brain derived neutrophic factor, which is quite a long-winded term, but we call it BDNF. So this is a protein that helps brain cells stay healthy by supporting their growth and strengthening the connections between them. So as we get older, our natural levels of BDNF tend to decline, but if we are regularly physically active, especially doing aerobic activities like walking and cycling and swimming, they raise our BDNF levels and help counteract this age-related decline. So high BDNF levels are linked to better memory, improved learning, and greater brain resilience. So in other words, exercising not only increases our circulation and blood flow, which is the fuel for the brain, but it also increases this level of protein in the brain that's helpful. And I should point out it's never too late to start exercising. There was a recent study in the Journal of the American Medical Association that found that higher levels of physical activity were particularly important in midlife and later life to reduce the risk of developing dementia. And in actual fact, they found that physical activity early in life was less of a notable predictor of dementia risk. So it's never too late to start. Just start safely, little by little. I would even add there that not only the physical aspects, but the mental and also the social aspects, oftentimes folks go to some kind of health center and they're doing exercises with other people. So the socialization is also a factor that helps keep a healthy brain. Would you agree? Absolutely. Yeah. There's certain aspects to a healthy lifestyle that include exercise, but also social interaction. And there's lots of studies, especially since the pandemic, where we had a lot of social isolation, that show that keeping socially engaged is a really critical component of keeping a healthy lifestyle and a healthy brain. Well, I would even add that personally, in order for me to keep my exercise up, I do the treadmill. And during the time that I do the treadmill, I watch foreign movies. And so that I don't irritate my husband by having the sound up. Foreign movies, of course, have the subtitles. So I can turn down the sound, but I also stay tuned to the foreign movies as well. And what's going on there, I get them from the library. And so it's another way. I'm not crazy about exercise, but at least I get on the treadmill every day for 30 to 45 minutes. And so it's just another suggestion for ways to get exercise. The treadmill is also quite a good choice for getting exercise. So absolutely, especially when the weather's not great outside or you don't live in an environment, we're walking as easy outside of treadmill's a great option. But that said, one factor that we always have to keep in mind for older adults is fall prevention. And so while one is doing exercises, one also has to be mindful of that, or even when they're not doing exercise, is there any relationship between false prevention and maintaining a healthy brain to make sure that we accomplish both purposes? Well, of course, preventing falls is really important, as I'm sure you're all aware that falls are the leading cause of injury in older adults, ages 65 and older. So preventing falls becomes really important because when you fall, of course, you risk sustaining a traumatic brain injury. Even if you don't hit your head, you can still injure your brain. So it's really important, of course, to avoid doing that because another risk factor for developing dementia is traumatic brain injury. So if you bump your head enough times, you will increase your risk of dementia. So of course, we don't want to do that. And also falling has a number of other very bad consequences in terms of poor sleep and depression and reduced social engagement. All of these things are linked to poor brain health. So exercising regularly, doing some balance and strength training, correcting any vision problems, making sure your home is safe, and reviewing your medications. These are all ways to reduce the risk of falls and protect your brain health at the same time. I think also it's important, even when folks are walking down the street to not be preoccupied with your phone, listening to music or whatever, because it's so easy to trip on the sidewalk to be cognizant of all those factors are important, because that step can come up so easily or some uneven pavement. And that happens at any age. You see the number of young people out there that are walking along with their headphones on and eyes on their phone and they're just not looking. So yes, that's a really major problem. Right, right. Well, we've talked about exercise now and the importance of a healthy brain. Let's focus on the diet and nutrition. Why is that so important? That's a great question. The simple answer is that your brain, even though it's only about 2% of your body's weight, it uses about 20% of your body's energy and oxygen to operate at its best. So it means that we need a consistent fuel supply and that's going to come from your diet. And the strongest connection between the brain and our diet is through the vascular system, which we've talked about already, our blood vessels. Right, so if we eat a diet that's high in saturated fats and trans fats and sugars and sodium, that contributes to conditions like type 2 diabetes, high blood pressure, high cholesterol. And we've already talked about the fact that these conditions will increase your risk of dementia. So in other words, eating well to avoid these other conditions will help you keep your brain in a better shape for longer. We know that the food choices we made directly affect the blood flow to the brain, the cell structure in our brain, the inflammation levels in our brain. So we want to focus on a nutrient-dense balanced diet because that is a relatively easy way and a modifiable way to protect our cognitive and brain health as we get older. And to that point, and I'd later even hear a little bit more about the types of diets, but maybe we should start with what we shouldn't be eating and one thing that seems to have occurred over my lifetime and perhaps yours is the increased amount of processed food and how that's not only impacting perhaps the occurrence of dementia but obesity and other factors. Can you talk more about that Catherine in terms of how that has been affecting adults as they eat? For sure, yeah. So there's actually again there's more and more studies coming out now solidifying the link between these ultra-processed foods and problems with brain health, problems with other diseases that we've talked about already like obesity, diabetes. So there seems to be you know more and more evidence to support the strong link between these things and I think the the issue with these ultra-processed foods in terms of every day is that they're widely available, they're usually quite affordable, they don't require any preparation, so it's an easy choice to make but in making that choice we should be aware that we're potentially increasing our risk for bad outcomes and so we want to try and avoid those ultra-process foods and stick to foods that we can see the origin of them, they are hopefully more plant-based than animal-based and that sort of thing. Well in fact I've often even heard now that the younger generations are getting colon cancer more. The findings as a result of processed foods again and they are urged to get colonoscopies at a younger age because of a large number of processed foods and also sugar, like sugar drinks and this kind of thing. So I've heard you say about plant-based foods, give us a little bit more detail about the foods that we eat that can really impact brain health. Are there something called super foods for the brain? What should we be looking for when we go to the grocery store this week or next week? These excellent questions. So you know there are a number of different diets out there that people could follow that have some great recommendations. Without sort of you know talking about one in particular I think the common factor across all of them is this focus on fruits and vegetables and perhaps grains over things like red meat, sugar and unhealthy fats. So for example if I bring up a diet I can then sort of talk about some of the super foods included in it. You may have heard of the mind diet before. This is a hybrid of two of the most sort of recognized heart healthy eating plans which are the Mediterranean diet and the dash diet which stands for dietary approaches to stop hypertension. So the mind diet basically uses components of these two other diets to provide the strongest evidence that we have to date to protect the brain. So it emphasizes foods rich and things like antioxidants and B vitamins and omega-3 fatty acids which you may have heard of but these are all ways to keep the brain healthy for as long as we can. So the diet focuses on frequent consumption of vegetables particularly green leafy vegetables as well as berries, whole grains, nuts, beans, seafood, olive oil and even a little wine going back to what we were talking about earlier with alcohol. You are a little wine on the mind diet. Things to restrict though, things like again butter and stick margarine, cheese, red meat, fatty and fast foods, pastries and sweets. So the research and the literature shows that if you strictly follow the mind diet you tend to have a slowing of cognitive decline with aging and reduce risk of developing Alzheimer's disease. So there's pretty good evidence now that what we eat can affect our brain function. And most of the foods encouraged in the mind diet are actually on the sort of superfood list right because they're high in these key compounds like antioxidants and contain specific vitamins that help our nerve cells communicate with each other. An example of this would be something like nuts and seeds which are an excellent source of healthy fats and vitamin E and B vitamins. So for example walnuts are actually high in plant based omega-3 fatty acids which are very good for you. And we talked also about these sort of ultra processed foods that we should avoid. The reason to avoid them is that they tend to be linked to increased inflammation in the brain and vascular damage and of course these are going to contribute to cognitive decline and dementia risks. So we try to avoid those to keep our brain as healthy as we can. Just recently also have seen our plastics are influencing our diets as well because so many food items are packaged in plastics and that especially if we heat them or something in the microwave that the plastics can be absorbed and that also has really increased health issues. Have you studied anything about that Catherine? I haven't personally. It's been in the news a lot recently about these microplastics in our world around us and in us and what those microplastics could actually be doing to our brain and the rest of our body as we age. It's a fairly frightening thought but you know at the end of the day I think that all we can do is try and look after ourselves as best we can in the given moment meaning that science is always uncovering new things 10 years ago we weren't so concerned perhaps with microplastics in our diet and maybe in another 10 years it'll be something else but in the meantime we have to follow the latest and greatest advice and just do the base we can. Well I had a whole new look at my plastic spatula that I had been using for many years and wondering maybe I need to throw that out and start using the metal spatula as well and those the pots that don't stick you began to wonder when you hear these things. Before we move on to another aspect I just wanted to get your feedback about beverages you've mentioned about alcohol and limiting that but I also just wanted to ask about caffeine you know tea coffee or even milk nowadays there's a big focus on almond milk plant-based milk versus regular milk any thoughts on that and so far as enhancing our brain health right so you know in terms of beverages I think a lot of the the talk about you know which ones are better for you has to do with their nutrient profiles and the amount of sugar and the things that they have in them right so for example sodas and things like that tend to have a high sugar content so having those in large quantities isn't particularly good for you in terms of the caffeine content in drinks certainly a little bit of caffeine as we know sort of makes us more awake and alert which is why many of us need our morning coffee to get going but of course there's evidence that things like too much caffeine are not good for you also caffeine later in the day can affect your sleep which is another potential risk factor for cognitive decline and dementia so a lot of these things you know have sort of effects on our body and our lifestyle that can end up affecting our brain health maybe not directly but through these indirect pathways so the issue with things like you know different types of milk again depending on the nutrient profile of them obviously dairy milk can be high in fat if you have whole milk so if you do have whole milk and you like it just don't drink you know enormous amounts of it but certainly the plant-based milk are probably all fine again you want to make sure that they're complete with their vitamins that a lot of things like almond milk and soy milk have added vitamins and calcium and things like that to make sure that we're getting our daily requirements so I think again there's that old adage everything in moderation which I think is fine for some things but I would argue that others like fried fast foods ultra-processed foods I don't think there's any moderation in those I think we just should be avoiding them as best we can but things like beverages you know if you have the odd cup of tea or coffee or a wine or sugary soda every now and again you know that's not going to make a huge difference to things you just mentioned several times about a good night's sleep help us understand a little bit more because I think sometimes folks pride themselves of not getting too much sleep and being able to survive on say six hours of sleep or whatever tell us why a good night's sleep is really important for a healthy brain when we sleep it allows our brain to sort of clean and repair itself and reorganize itself after a heavy day of processing information one of the most critical functions of the brain that's actually only been relatively recently discovered by scientists is that the brain has this unique waste clearing system known as the glimphatic system. And when I was a student, we didn't know about this. So this is all sort of relatively new and exciting in my lifetime. So during sleep, the space between our brain cells actually increases, which allows our cerebrospinal fluid to flush out any toxic metabolic-bore product, such as beta-amoloid. And beta-amoloid is one of the proteins involved in neurodegenerative diseases like Alzheimer's disease. So without this nightly, good night sleep and this cleansing of these toxins, they can build up leading to potentially all sorts of problems, like cognitive decline and dementia. But beyond sort of cleaning, sleep is a primary time for our brain to consolidate our memories as well. So during the day, we're busy doing things, we're learning, but all of this information is sort of temporarily stored during the day and it's only at night when we're sleeping deeply that temporary storage from the hippocampus in our brain goes to our cortex and becomes solidified, if you like. So that's an important role of sleep to help us remember information. Plus when we sleep, our brain sort of prunes out some of the unnecessary connections between brain cells, which is known as synaptic plasticity. So this keeps our brain's communication network efficient and prevents us from being overwhelmed by the sheer volume of information that we encounter when we're awake. So all of these things argue for the fact that sleep is really important. Now as we age, our sleep patterns actually naturally shift. So we tend to go to bed earlier, we wake up earlier and we spend less time in the sort of deep, restorative stages of sleep. And that's when the brain does all of its cleaning and repair work, if you like. But research still suggests that older adults need seven to eight hours of sleep for optimal cognitive function. So you don't want to skip out on sleep because we found out that it is so important. So that means cutting down on that during the day, the longer you nap during the day, the less you're going to sleep at night. So you want to try and keep those naps to a minimum during the day. And if you do feel tired to nap earlier rather than later in the day. Any thoughts as to long term use of either melatonin or sleeping pills to make sure that what happens as far as seven or eight hours of sleep a night. There are some safe medications that they are not addictive and be don't affect your cognitive function long term if you take them for sleep. So melatonin and some over the counter sleep aids, but I would always encourage people to chat with their doctors if they're going to take anything for sleep and that includes melatonin, it includes other supplements and over the counter medications because they could very well interact with other prescriptions. Typically sleep aids are recommended as short term fixes to help you get into a better sleep hygiene schedule rather than using them as a long term goal. So I wouldn't recommend being on them in the long term unless you have your doctor's permission to do so. Okay, well let's talk about cognitive activity. Nero in on that particular focus are there certain kinds of activities that help older adults stay mentally active and keep their brains healthy? For sure, yeah, I think any activity that you're going to do to increase your mental activity if you like, you really want to pick something that's pretty new and challenging for you, but also enjoyable. At the end of the day, you want to be doing some thinking tasks and activities that you enjoy doing, right? So you could learn a new language, you could start learning a new musical instrument, take a class or a workshop, these all count to sort of cognitively engaging activities. You could also perhaps enjoy some strategic games that require focused attention, logic, problem solving, this would include games like chess or bridge, scrabble, Sudoku, crosswords, jigsaw puzzles, all of these things can challenge you to think in a new way and that you hopefully enjoy doing and that will encourage you to keep being mentally active, which is all good for the brain. Well, I just did a television program on Ma Zhang and Ma Zhang is so popular now. It has been quite popular with older adults before, but now it seems it's expanding to folks of all ages, but Ma Zhang has been a favorite in many different locations and their folks that I interviewed on the TV show are giving lessons on so many different levels. Ma Zhang is very popular. And so let's also address, just as we talked a little bit before, but the social engagement why it's good for brain health, expand on that, Catherine, what are some other activities that can help to reduce depression and disability and even mortality? Yeah, so social engagement, like I said, is you know, it became a huge research focus during the COVID pandemic because of the fact that we were isolated from each other. And so it became sort of this prime lab, if you like, to study the effects of social engagement or the lack of and the effects of loneliness on cognitive and brain health. And unfortunately, you know, being disengaged socially and being lonely is very bad for your brain. So we want to stay as engaged as we can because if you think about it, social interaction, things like conversations are inherently complex cognitive activities that are working your brain, right? You're getting a constant mental workout by having a conversation with someone else. And in fact, studies show that people who are highly socially engaged may actually develop dementia symptoms on average about five years later than people who are less social. So that component that social engagement is actually key, I think, in protecting our brains for longer. So strong social connections also provide a buffer against chronic stress. And of course, we know that stress releases hormones like cortisol, which are problem and it's not that it's traumatic if you have it chronically floating around because it's bad for your brain health. And of course, being lonely and socially isolated also increases your risk for depression. And depression is another risk factor for cognitive decline and dementia. So I think the key here is being able to find activities that provide a sense of purpose and provide some sort of meaningful interaction. So you could think of perhaps service activities, group health and wellness activities, clubs and interest groups. These are all great places to start to try and make some social connections or strength in ones that you already have. I think also a lot of older adults volunteer at different kinds of activities and that provides interaction and a purpose and people feel like they're accomplishing something and making a difference. And that's so important as you get older, especially if you're no longer working full time that you want to have some reason to get up in the morning and volunteering is really important. As I was preparing my questions, I did notice that there's a page on the Alzheimer's Association website called 10 Ways to Love Your Brain. Can you share some of the tips and maybe we can advise our listeners to check those out but share a few of those that you saw on that website. Yeah, so the website sort of emphasizes how we can adopt some key lifestyle habits that can reduce the risk of cognitive decline and hopefully dementia as well. So some of the things that are recommended there are engaging in regular cardiovascular activity. So this exercise component, right? So that's going to elevate your heart rate, increases your blood flow, all good for the brain. It talks also about managing and monitoring risk factors for cardiovascular disease and stroke. Such as high blood pressure or obesity and type 2 diabetes. Again, if we can make sure that those aspects of our health are under control, that's going to help our brain as well. Talks about being socially engaged. Talks about being curious and putting your brain to work by doing something new and challenging. Also eating a healthy diet, getting that good seven to eight hours of sleep a night and managing stress. So these are all some of these lifestyle factors that we've been talking about today that have got good evidence in the literature now to be able to prevent cognitive decline. These are all things that we can be doing to maintain our brain health for as long as possible. We've been talking about all of the ways to have a healthy brain and now of course the cognitive activity in your experience as a educator at the university. Have you studied the fact that there is an increase in dementia? Is it because of some of the negative factors that you've already talked about or is it because people are living longer and so we're hearing about it more often and I also am aware that there's many different kinds of dementia. It's kind of an overview of what you're seeing in dementia as to why you're hearing about it so much more now. Yeah. I think there is this perception that there is an increase in dementia cases and that's an accurate perception although The research suggests that increases primarily demographic rather than the disease suddenly becoming more common for any reason, right? So it's thought that the total number of dementia cases are increasing simply because There are more older people in the world, right? We're living longer So the likelihood because age is the greatest risk factor for dementia The fact that we're living longer means that we're going to have more people with dementia But the research also suggests that the rate of new cases within a specific age group, let's say 75 to 79 Is actually holding steady or even declining in some high income countries due to better health management So we've talked about the fact that aging is the main sort of risk factor for dementia, but certainly Changes in lifestyle and health conditions are contributing more to the global burden. So we've talked about Many of these issues that become more common in middle-aged populations high blood pressure high cholesterol That's going to raise their risk later in life. So there is this Potential for the risk factors that we've talked about if they're not under control They will absolutely lead to an increase So basically getting back to this idea that anything that's bad for your heart is going to be bad for your brain and the long term as well I've also heard of something called early onset dementia Is that a factor just as we talked about perhaps processed food and other factors contributing to younger folks getting cancer is early onset dementia quite prevalent The most common type of dementia is Alzheimer's disease which of course is very well known And then we have vascular dementia is right that have a higher component of these blood vessel related disorders contributing to the dementia But there are also a huge number of dementia cases that are actually considered mixed meaning that they have some components of Alzheimer's disease some Vascular risk factors and so a lot of the time the actual sort of cause of the dementia is not as clear But the outcome is more or less the same now early onset dementia has typically been a relatively less common type of dementia because it typically involves a familial component So it has a genetic risk factor that's passed through families So it's not usually what's considered idiopathic meaning it doesn't just sort of show up randomly in people They usually has to be a strong family history of people that have developed dementia in their mid-life rather than later life So it's not that common in the general population Well, and let's talk about that a little bit more Catherine because So often now there is a occurrence of dementia in the family so people who are my age or perhaps even younger are beginning to look and remembering G dad had dementia or grandma had dementia Am I going to get it and so Is that concern realistic? Are there more tests that are becoming available so that people can find out if that might occur with them What do we need to know about that in terms of moving forward? In terms of tests FDA approved tests have come out fairly recently I continue any to come out looking at bio markers for Alzheimer's disease and dementia So these are tests that look at either cerebro spinal fluid or even blood tests to find markers for the disease and your blood Things like the amount of amyloid or towel present these are these abnormal proteins in the brain that signal the presence Well can signal the presence of Alzheimer's disease. So those tests are becoming more available Now they're not going to tell you definitively, but they will give you a strong indication of the likelihood that you know might carry these conditions In terms of the sort of genetic component there isn't an Alzheimer's or a dementia gene that we can say you've inherited it Therefore you will get this disease. It's likely that with many of these conditions in fact with Many medical and psychiatric conditions that there are many multiple genes that are involved many with very small effects So it's hard to be able to say that because your dad had it you will have it kind of thing Remember too that we've been talking about sort of lifestyle risk factors. So oftentimes Family share a lot of the same genetics obviously, but also many of the same lifestyle factors. So if you grow up in a household where For example healthy eating was not a priority and neither was exercise. So you know generations may in fact Inherit for want of a better word the kind of poor lifestyle factors that may contribute risk to dementia So I think the jury still out on that as to whether the fact that dementia may run in families might be because of For example that vascular risk factors run in families right if you have a history of hypertension in your family because of Various factors that will increase your risk as well. So remember that dementia can be Trigged by many of these other risk factors that we have medically and if listeners are concerned about what we're just talking about that there is a prevalence of dementia in the family Would they be talking with their primary care physician or would they need to see a say a geriatric neurologist any Suggestions in terms of where folks might look if they did want to get tested to see if there was a possibility Usually the first stop for most people is going to be their primary care doctor and In recent years primary care doctors have received much more education and information about screening for dementia and talking with families about it But that being said they're not necessarily experts in the field of being able to detect these things So oftentimes your primary care provider might well refer you on to as you say a geriatrician neurologist You know provider perhaps in a memory clinic or something like that where they have a little bit more expertise And they can talk to you about these risk factors that you may have family history that sort of thing and probably the kind of testing that you would undergo would be First-pass cognitive testing to see whether your thinking skills are You know the same as other people of your age and education level And then perhaps more detailed testing beyond that for things like brain scans or blood tests that sort of thing One of the things that I'd like to hear from you because you are also involved with research is the idea of different kinds of research studies in connection with the relationship between brain health and dementia What is the direction is it finding a cure? Finding a medication or living with it What are you seeing in the field going forward given the fact that we're all getting older and our risks are greater There's a lot going on in the field in general which makes it a very exciting time prior to the last few years The only sorts of treatments Medication treatments for dementia were basically symptomatic right to try and deal with the symptoms that people had whereas Just within the last few years they've brought out these disease modifying drugs that are now able to decrease the amount of these abnormal proteins in the brain So that's an exciting time for the field I think But in terms of sort of the chicken in the egg, you know Should we be looking at healthy brains as they age or should we be looking at People whose brain function is deteriorating and try and help them and I think the answer to that is there's actually Both right we can be doing both certainly the research studies are looking at dementia prevention and reduction and they include things like Identifying these risk factors and running trials to see if we deal with these risk factors whether the incidence of dementia goes down So this is things like where the lifestyle interventions can prevent cognitive decline and there's a number of studies that have indeed shown that Then the other track of researchers looking more at improving overall cognitive function regardless of your sort of risk of Developing dementia. So this is looking at sort of normal age-related changes in memory and processing speed and attention as we age because It's important to be able to tell What are the consequences of just a normal healthy aging brain versus those That are the result of a declining brain. We need to be able to tell the difference between those two things in order to be able to First of all identify people that might have these brain changes and then help them So those two types of research studies are really important and they're ongoing and To the point about these kinds of research studies Are there any barriers that Prevent them are they being conducted In spite of maybe a lack of funding or is more funding being requested What's that aspect of how much research can be done in these areas that you're talking about Yeah, so obviously funding is a huge issue the kinds of studies that researches want to do require a lot of money and so you know funding is always an ongoing issue. But beyond funding, there are ongoing issues in these sorts of studies to do with recruitment and retention. So dementia trials are notoriously slow to enroll people and they take a huge time commitment for participants and their families and caregivers because we're looking at years of follow up to see if people go on to develop decline and throughout those years of follow up there might be frequent visits and expensive brain scans and sometimes invasive procedures. So it's one thing to be able to recruit enough people and it's another to be able to keep them in the studies as time goes on. Another pretty big barrier is that there's a really distinct lack of diversity in terms of the participants in these sorts of trials. So minority communities are historically underrepresented in dementia research but they often face a higher risk of developing dementia and so because they're not in the studies to begin with it limits the generalizability of the findings and potentially leads to ineffective treatments for these groups that need the treatment the most. You know because there's historical unethical research practices that have affected these sorts of communities that have created a mistrust making recruitment in these communities really difficult. So luckily inroads are being made research is a partnering with trusted community leaders and faith-based organisations and that sort of thing to conduct the research within the communities themselves and ensuring that research staff are culturally and linguistically competent is really important. And also to increase research participation I think many research centres are now starting to be a bit more flexible with their studies so they offer home visits they offer flexible scheduling they might cover transportation costs and they'll compensate participants in their caregivers for their time. So these are all improvements that will hopefully improve not only the participation but also the representation of diverse groups in these sorts of clinical trials. Are there any resources where if listeners are interested in participating in these kinds of studies that folks could follow up? Yeah there's clinicaltrials.gov is a website that has research opportunities I think other places to look would be the Alzheimer's Association so they just have great information in general for people that want to learn about brain health but they also have links to local groups and things that might be useful. The National Institute of Aging which is a part of the National Institutes of Health they have some great resources and connections at their website Alzheimer's.gov and there's also the AARP has a website called the Global Council on Brain Health and that provides recommendations as well as links to other sources. So this website in particular the Global Council on Brain Health has some great expert videos that your listeners could watch. I talk about there six pillars of brain health which are exercise cognitive stimulation, sleep stress reduction, social engagement and good nutrition. So we've covered all of that today but there's some great little videos to watch from experts in the field on those but in terms of specifically looking for studies I think clinical trials.gov is a great place to start. We're almost out of time but I just wanted you to mention because I think this has also been a part of your work is the focus for caregivers and the fact that depending on say the stage of dementia people sometimes can be at home versus at some point needing to go to a memory care unit. Any comments that you wanted to share because I think the caregiving aspect of dementia is so important. Yeah so there's also a great body of research now that is fairly strongly showing that caregiving while such a obviously important and really critical activity can create a lot of burdens for the person providing the care so it's really important I think for caregivers to look after their own health, their own brain health, their own physical health and get some respite because like I said that the research suggests that there is quite a burden and a stress associated with caregiving that of course can lead to some less than optimal outcomes for caregivers. So my recommendation is really to make sure that you speak with your provider, your healthcare provider and also get the sort of social support that is really critical. We know that social isolation and loneliness is a large factor for many caregivers and they feel that because they're looking after their loved one that they don't have so much time for themselves and yet that is a critical piece of their own self-care that really needs to be paid attention to. Well that is wraps it up quite nicely. You gave quite a few resources already in connection with clinical trials and research. Any others you wanted to share yet in connection with healthy brain since you've talked so much about that? Any final comments? Sure. Well I think again there are three main websites I think are useful for people to look at and that is the Alzheimer's Association Alzheimer's.gov which is from the National Institute of Aging and the ARP. I think those are sort of main good websites to get some good information if you would like to know more. I think my closing comment to sum up would be that again sort of to encapsulate what we've talked about today that healthy habits produce a healthy brain and although the best time to engage in these healthy habits to protect the brain may have been years ago the second best time is right now. All right well that is certainly an appropriate way to close and think about it at this time of the year so I want to thank Dr. Catherine Diaz-Esperr again an Associate Professor of Psychology and also the Associate Director of Research at the Center for Optimal Aging at Marymont University in Arlington, Virginia. Thank you so much Catherine for joining me today. Thank you. Now to learn more about aging matters you can visit our website which is AgingMattersOnline.com and of course at that site you can access all of the Aging Matters radio programs that we've produced in the past. The podcasts are posted on Apple and Spotify and Red Circle and the TV show episodes which we produce every month so again that is AgingMattersOnline.com. Aging Matters is produced in association with Steve Black Audio to learn more about that company visit SteveBlackAudio.com. Thank you for listening to Aging Matters today and remember age is just a number not a label. I'll be back again with you next week. [Music]