Healthy Habits for the New Year and Modifiable Risk Factors for Alzheimer’s Disease

Transcript

Intro: I’m Dr. Nathaniel Chin, and you’re listening to Dementia Matters, a podcast about Alzheimer's disease. Dementia Matters is a production of the Wisconsin Alzheimer's Disease Research Center. Our goal is to educate listeners on the latest news in Alzheimer's disease research and caregiver strategies. Thanks for joining us.

Dr. Nathaniel Chin: Happy New Year and welcome back to Dementia Matters. This is your host, Nathaniel Chin, and today's episode is a solo one. It's unscripted and I do not have an expert guest with me. I promise not to be too long but I did want to make four points and end with the personal comment on healthy behaviors. Point number one is that we just finished our five years in production for Dementia Matters in October of 2022. For us, this is an incredible accomplishment. We're pleased that our listeners still enjoy listening to the show and are going back to older episodes. I'd like to thank some of the key members of our teams who have come and gone – Rebecca Wasieleski, Amy Lambright Murphy, Caoilfhinn Rauwerdink. We've had some wonderful students from the University of Wisconsin – Alex Wehrli and Bashir Aden. Of course, I'd like to thank the University of Wisconsin for their support, the Wisconsin Alzheimer's Disease Research Center, the WRAP study, the many guests who have come on to share their perspective, experiences, research findings, and stories. And then, of course, you, dear listener, for continuing to engage in this show, listen to the show, and hopefully talk about it with others. 

The second point I want to make is that we are funded by the National Institute of Aging. They fund our Wisconsin Alzheimer's Disease Research Center and it is the center and Dr. Sanjay Asthana who have allowed for my team and I to do what we do, and we sure love doing this. I mention that because we have no obligation to any sort of corporation or company. We have no sponsorship by private industry and that allows us to be unbiased in our pursuit of trusted information. That is the space we wish to occupy and it is our goal to translate good science to you. 

The third point is that our focus remains translating research findings and caregiver strategies to the public. We will continue to do this to the best of our ability. Please do reach out to us. We are always open to suggestions on different topics and speakers, but I also want to mention that in 2023 I would like to focus also on more clinically-relevant information. As a geriatrician in a memory clinic at the University of Wisconsin, at UW Health, I want this information to reach my patients, their families, their caregivers and frankly any person out there who's thinking about their thinking, that has concerns perhaps about their memory or their thinking ability. There's so much that can be done and that, of course, is speaking to brain health and reversible causes of thinking changes but we have to fight the stigma and the fear. So I hope this podcast is doing that and I hope it reaches you or I hope it reaches someone that you know and that you can share that with them. 

The fourth point I wish to make is that as your host I've done my best to be an impartial interviewer. However, I would like to share more of my own story and opinions when appropriate on this podcast. An example of that is this episode in particular. I'm not an expert, I'm a geriatrician who's engaged in Alzheimer's disease research and clinical care. I'm passionate about what I do and I certainly put in the hours to know as much as I can, but I also am aware that some of the things I wish to share with you are my own personal testimonies and that is not evidence-based. I'll always give you that disclaimer ahead of time.

With that, I'd like to end this podcast by commenting on modifiable risk factors. It's one of my favorite topics. I give community talks on building a brain buffer, the things that we can do that we have in our power that may lead to the prevention of dementia, that may delay the development of dementia, but certainly will lead to a better quality of life and better well-being. You're going to hear or you've already heard that 40 percent of dementia is modifiable, which I think is a powerful statistic. 40 percent of those cases of dementia may have been preventable. Not always but may have been. There's a Lancet Commission that has scoured the literature and the research to put together the strongest evidence for known risk factors that might prevent or delay up to 40 percent of dementia. They started with nine, and in 2020 they gave a wonderful presentation – they have a wonderful document – on those nine risk factors and how they came to those. Those nine risk factors are as follows: less education, hypertension or high blood pressure, hearing impairment, smoking, obesity as defined by a body mass index of greater than 30, depression, physical inactivity, diabetes, and infrequent social contact. They more recently added three new ones: excessive alcohol consumption, head injuries, and air pollution. Now Dementia Matters has actually covered two of those new additions – excessive alcohol consumption and air pollution. I strongly encourage you to go back and listen to those podcasts. They are fascinating and those are the researchers conducting the studies that are eventually being used by the Lancet Commission to propose the increase in the number of evidence-based risk factors. I also want to mention that the AARP has a Global Council on Brain Health. They have a wonderful easy-to-read website. I have interviewed a representative from the AARP, so go back and look at that podcast. On this website they talk about the six pillars of brain health, which are exercise brain stimulation, reducing stress, restful sleep, social engagement, and eating healthy. Those happen to be the same brain health pillars that our program at Wisconsin espouses, that we talk to our participants and our clinic patients about, what we do research on and are trying to show the value of in a long-term sense. When I talk about in the community – when I talk about building a brain buffer – those are the behaviors that I'm speaking to.

Based on that experience, as a geriatrician, as a researcher, as a member of our program, I try to live the healthiest life I can. I am the son of someone who lived and died with Alzheimer's disease. My father developed it at the age of 61 and passed before 67. For those listeners who have a family history they know exactly what I'm talking about, especially the children, that once you live through that, you're changed forever. The change can be horrific for you or you can use it and ideally make your life better, and I mean better as in healthier. Obviously it's not better without the loss of your loved one but you do what you can so that you can ideally prevent or delay the development of dementia. 

With that experience I'd like to share with you my perspective on the brain health pillars. When I give these talks and I go over that list of the pillars, I’m always asked, “Well, what's the most important one? What's the one that I should be doing?” It's a really complicated question because depending on who you are as a person, the things you're already doing, the answer is going to be different. I think ultimately it's really important for us to move from learning, understanding and believing in these brain health pillars, talking about these brain health pillars, to actually living it. There is a different scientific field dedicated solely to behavioral change to behavioral psychology. I'm so grateful for that field because it really is what is needed for us who are passionate and want to live a healthy life to move from knowing about it, reading about it, talking about it, to actually doing it. This is another thing that I enjoy reading in the mainstream. There are two books that I have found to be incredibly insightful and entertaining and helpful. One is called The Power of Habit and the other is Atomic Habits. I don't know these authors. I've not received anything for mentioning the books but I found these to be great reads and useful as I try to change my own life. The other thing I have found in my journey of behavioral change is that you will be told and you will read that you should do one behavior at a time. The reason for that makes sense, that it took years of different cues and responses and triggers to be who you are now. It didn't just happen overnight and so it's not – it doesn't make sense that in one month or twelve weeks you can undo that or just all of a sudden be this better, healthier person. It's not that easy. We wish it could be, but it's not and so you really have to put in the effort and you have to understand your behaviors and habits so that you can change them. Along those lines, it's been said that you can't you shouldn't do more than one behavior at a time, that by engaging in or trying to change four or five different things you're less likely to succeed and stick to that new behavior. Again, it's for the same reason. These are very complicated behavioral habits and so you really have to focus on one. Now within that one behavior there are certain ones that are easier to do and or more important. There's such a thing as a keystone habit, that when you are able to master that habit and make that change, it makes it easier to make subsequent changes. It makes it easier to engage in the other ones because you've already changed that one keystone habit. I got that from one of the two books I mentioned to you, but that is commonly studied in the field. 

Going back to that question of, “Well, what is the most important one?” For those of you that listened to my other episodes, I ask that question to the experts. What do you do to keep your brain healthy? I want to know from them who are immersed in this field. What are they doing? You'll often hear exercise, mental stimulation, eat well. There's a variety. When I give my talks to the community I often tell people exercise. It's the most studied. There's great evidence to its benefits, to the benefit of well-being, to your heart health. You can go back to the episode with Dr. Ozioma Okonkwo where he explains all the details of why exercise is so helpful. It improves blood flow. It leads to increases in this protein called Brain Derived Neurotrophic Factor (BDNF), which leads to healthier brain cells and better connections between brain cells or among brain cells. There's great evidence to that and so that's what I've been telling people. 

Now I'm starting to change my tune. The reason for that is that I recently had my second son, Bennett, and he's a wonderful, healthy boy. I'm grateful for him every day that he's been with me. However, he's not the best sleeper. For the past four months, I have not slept – or I have not had optimal sleep. I define optimal sleep as seven to nine hours of restorative, uninterrupted sleep. Prior to this I was sleeping well. Thank you to my first son, Auggie, who's a great sleeper. I've never experienced this before and so I now know what it is to not sleep well. Because I'm not sleeping well, I now recognize I can't do the other brain health pillars the way I used to do. In fact, I don't even engage in some of them anymore when I'm not sleeping well. I'm not going to be exercising to the same degree or at all. I'm certainly not going to be eating well. In fact, I go the other way and I eat unhealthy things. I'm craving unhealthy things. I'm not socially active and more isolated. I'm certainly having a hard time controlling my stress. I’m not as emotionally resilient. All these things that I talk about, these six pillars of brain health, are so much harder when you are not sleeping well. I've changed my tune and now my recommendation; my own personal N-of-1, non-evidence-based recommendation, is to start with sleep. If you agree with me or you are interested in learning about why sleep matters, I would encourage you to read the book, Why Sleep Matters by Dr. Matthew Walker. Again, I don't know Dr. Walker. He's not given me anything to mention his book or his name on this podcast. Although, if you do know Dr. Walker please do mention this podcast to him. I would love to have him on the show and do a couple episodes with him. He has not responded to my emails, so please if you know him, connect me, connect him to me and the show. Also if you follow our Mind Readers Book Club at the Wisconsin Alzheimer's Disease Research Center, we will be showcasing this book, Why Sleep Matters, at one of our upcoming events, again, because we know how important sleep is and we wish to share these tips and tricks and reasons for why it matters with the public. 

I want to end with the fact that willpower is a finite entity. We recognize that towards the end of the day it's harder for us to stay strict to the things we care about. We might binge eat or we might do things we normally wouldn't do in the morning and that is because we have used our willpower up. Now that there is science behind. I experience it on a daily basis. I'm sure you do as well, but if you aren't sleeping well you are not starting with a full reservoir of willpower and so it's much easier for you to fail going forward. You might not have the energy to exercise so it's easier to just not do it. You might binge eat or eat unhealthy or eat too late in the day. I'm a big believer in food and so that's a big focus for me. (laughs) It may not be for you but it certainly impacts. There's a ripple effect in not having enough sleep. For me, there's nothing better than having a great night's sleep followed by equally great aerobic exercise in the morning. All the other habits follow after that one. 

With that, I'd like to thank you for listening. Happy New Year. I hope that's been – it's going to be a great start to you. As you journey through this healthy brain lifestyle change with me, as well as learning more about Alzheimer's disease research and caregiver topics and clinically-relevant topics in memory, I thank you, Stay safe and tune in for some great episodes for this year, as well as some different types of episodes going forward.

Outro: Thank you for listening to Dementia Matters. Follow us on Apple Podcasts, Spotify, Google Podcasts, or wherever you listen or tell your smart speaker to play the Dementia Matters podcast. Please rate us on your favorite podcast app -- it helps other people find our show and lets us know how we are doing. Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center at the University of Wisconsin--Madison. It receives funding from private, university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode of Dementia Matters was produced by Amy Lambright Murphy and edited by Caoilfhinn Rauwerdink. Our musical jingle is "Cases to Rest" by Blue Dot Sessions. To learn more about the Wisconsin Alzheimer's Disease Research Center and Dementia Matters, check out our website at adrc.wisc.edu, and follow us on Facebook and Twitter. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.