Allison: Welcome to Defy Dementia, the podcast for anyone who has a brain. Jay: Defy Dementia is all about living in ways that keep our brains healthy and reduce our risk of dementia. Because dementia is not dictated by our genes, genetics can play a role, but lifestyle risk factors, like poor sleep, social isolation, and a lack of exercise may also have a significant impact. Allison: And as we've said many times on the show, the best evidence tells us that if we make healthy changes to key lifestyle risk factors, we could reduce dementia cases worldwide by at least 45%. And that is huge. Jay: Not too long ago, Allison and I made some brain healthy resolutions, changes we said we were going to try in our own lives. And today we're reporting back. We're calling this episode Jay and Allison's Excellent Brain Health Adventure. And spoiler alert, it hasn't all been excellent because we're human and change is hard. Allison: But we do have an excellent show for you and we've also got some fascinating news stories from the world of aging and brain health that we think deserve a lot more attention. Jay: I'm Jay Ingram, I'm a Science Journalist. Challenges to brain health, especially dementia, have been a long time interest of mine. Allison: And I'm Allison Sekuler, President and Chief Scientist at the Baycrest Academy for Research and Education, and at the Center for Aging and Brain Health Innovation. Jay: Join us as we defy dementia because you're never too young or too old to take care of your brain. Allison: When we began to fight dementia two years ago, our focus was very much about spreading the word that dementia is not inevitable as we age. And we also wanted people to know that healthy lifestyle changes are really key to lowering everyone's dementia risk. Jay: On earlier shows, Allison and I shared our brain health New Year's resolutions with you, our listeners. We talked about our plans to reduce our own dementia risk. In today's show, we'll update you on where we are on our quest to be the owners of healthier brains. But up first, some brain health news stories that deserve more attention. Allison: One of the biggest recent stories is the release of the results from the U.S. POINTER trial, a major brain health study. The POINTER study results were just announced at the Alzheimer's Association International Conference in Toronto just a few days before we're recording the show. What the U.S. POINTER study did, was to test over 2000 older adult volunteers who were at risk of poor cognitive health and dementia. And notably, this was a much more diverse group than previous trials that took place in Finland for example. The results confirmed that making positive lifestyle modifications and paying attention to things like physical activity and eating a healthy diet did indeed improve brain health, which is what we've been saying all along on the show. Jay: That's absolutely right. And what's interesting about the U.S. POINTER trial is that there were two different groups that were being tested. One had a lot of support to make healthy lifestyle changes, the others much less. So half of them attended a series of meetings, and had prescribed schedules for recommended changes. In other words, a really structured program. The other participants were much more on their own. They attended a mere handful of meetings and were encouraged but not scheduled to take action. And the study results showed that the group that had more support showed greater improvement in cognitive function than the less supported group. But important to note, that the less supported group still showed cognitive benefits. Allison: And the fact that there wasn't that much difference in the scheme of things in the benefit between the groups is very important because it means that the changes in lifestyle behaviors are sustainable and that you don't need really expensive programs to be able to keep them going and have lots and lots of support. It means that people can make changes largely on their own without all of that intervention. And that's good news even maybe for us, Jay. Jay: Maybe even us, we're going to find out later in the show. Allison: This is only an initial release of results from the U.S. POINTER trial. Other studies are going to follow, and they will include results from brain scans and blood data, which should provide a lot more detail on how healthy behaviors impact brain health. Jay: Another hot topic at the Alzheimer's Association International Conference was new blood tests to detect dementia, specifically Alzheimer's Disease. They're in the news now because they open up the possibility of diagnosing the disease earlier and then being able to administer new treatments earlier. And it's really only in the last couple of years that such treatments for Alzheimer's Disease have been approved and are already being used in drug trials. I should say that so far these treatments are not anything like a cure-all. But at the same conference, researchers announced results from clinical trials that suggest two of the drugs in use have lasting benefits for people at earlier stages of the disease. In one of these trials, two-thirds of those taking the drugs experienced no cognitive decline after four years, and more than half of them actually improved. That's really promising. But the drugs are expensive and their use can be accompanied by health hazards, like bleeding in the brain. However, even so, what has emerged from early treatment trials like these is that the earlier in the development of the disease the drugs are given, the more effective they are. And here's the challenge. Up until now, it's been difficult to assess when a dementia like Alzheimer's has actually begun. And that's where the new blood tests come in. An accurate positive test could open the door to earlier treatment. And here's an example. A new blood test was recently approved by the Food and Drug Administration in the U.S.. It's accurate. This means it scores above 90% in both catching the disease when it is actually present, but not claiming the disease is present when it isn't. Those who test positive could potentially be candidates for early drug treatment. The other advantage of this test is that unlike other competing tests, this only requires a blood test, not a brain scan, not a spinal tap. This is only one of many candidate tests. When you compare the number of candidate tests to five years ago, it's moving ahead really fast. Allison: As a researcher in the field, I really feel like this is such an incredibly exciting time in dementia research. And I think that the field is really more active and feeling more hopeful than ever before. But as you've said, there is still a lot of work to be done. And just because these new treatments and approaches are out there, it doesn't mean people should disregard everything that we've been saying. The lifestyle effects are really important and we need to understand more about what we call combination therapy. For example, how do those drug treatments that you mentioned work in combination with some of the lifestyle changes that we've been talking about. Or what about the other sorts of treatment like brain stimulation, which are also an emerging area of interest. There's all different kinds of ways that we can combine therapies. We're really just at the earliest days looking at that. There are also some caveats that people need to be aware of with regard to those blood tests. The main caveat really is that the test is not meant to be diagnosing dementia in and of itself. It's not like you can order a test at home and not see a doctor, just take a blood test to know, yes, I do or do not have Alzheimer's. The new tests are really, as you said, a way of getting around some of the other tests that would be done in conjunction with seeing a doctor, like getting spinal taps or MRIs. Because those are a lot harder to get. So if you've been consulting a doctor and they suspect Alzheimer's Disease for various reasons based on cognitive testing, the blood tests could potentially be used in place of things like spinal taps or MRIs. They're markers for Alzheimer's Disease, they're not a cure diagnostic. We might be getting to that at some point though, but we're not there yet. It's important people stay a little bit cautious about how they use these tools because sometimes, as you and I know really well, they are overhyped in the media and we just want to be straight with folks. But there really is a lot of promise and hope here. Jay: And Allison, before we leave this topic of new tests and treatments, more interesting news came out just as we were recording this show. A team of American scientists announced that the chemical lithium is likely crucial for brain health. And the news is attracting attention because it might open the possibility of a future treatment for Alzheimer's, even though it still is very early days. The researchers discovered that lithium was reduced in the brains of people living with cognitive impairment and Alzheimer's Disease. And this backed up an earlier Danish study showing that rates of dementia were higher in areas where levels of lithium in drinking water were low. This new report added crucial data from mice. In the mouse brain, low lithium accelerates the brain damage typical of Alzheimer's Disease and a new class of lithium compounds reverses that damage without any accompanying toxic effects. Allison: This is also really exciting. It opens up a possibility for a new treatment for Alzheimer's Disease, but researchers obviously have to make sure that any kind of potential treatment would work in humans, not just in mice, and also that it will be safe for us. In addition to being a possible treatment, it also opens up the possibility that clinicians could actually measure lithium levels to screen for early Alzheimer's detection. Jay: We've heard a lot about new tests and new treatments, it's really exciting, but why wait? Right now, modifying lifestyle risk factors is still the most immediate actionable takeaway. Allison: A hundred percent. Now, another hot topic for you literally is wildfires. These have been very much on everyone's minds this summer and it's really in large part because of the wildfires that are burning in Canada and California. And the smoke can travel far, and that lowers the air quality. We've talked about air pollution before on the show because air pollution, especially the little particulates that can get into your body, are recognized as a dementia risk factor. Late last year, there was a research study in a neurology journal that added a little bit of a scary new angle to all of the wildfire news. And that is that there was a clear link between wildfire smoke and dementia risk. And that paper was focused on a certain kind of particulate pollution called PM 2.5. These are tiny particles that are the diameter of just 2.5 micrometers. Just to put it in perspective for you: If you take one piece of hair, you could line 30 to 40 of those particles up along the width of a human hair. That's how small these things are. And because they're so tiny, scientists are concerned that those particles can get into the blood via the lungs and pass through the blood brain barrier and impact brain health. Jay: One thing about that report in the Journal of the American Medical Association: Neurology is that it was retracted because of some incorrect coding that affected the results. When a paper is retracted, it can raise a red flag about it, but in this case, the study was corrected, re-submitted and accepted. There's nothing wrong with it. And in fact, that's really how science works, is that results are tested, they're examined, and sometimes some small corrections have to be made. But in this case, there's no doubt in my mind that wildfire smoke and dementia risk are linked. Allison: The revised paper does still say that wildfire smoke exposure is associated with a greater odds of being diagnosed with dementia than other kinds of pollution. And it also says that that association was most significant for people under 75 years of age and from certain minority groups such as the Asian and non-Hispanic black communities. Exactly why that is still needs to be determined. But the findings suggest that reducing wildfire smoke exposure could potentially decrease your risk of dementia. So the takeaway is that it's worth keeping an eye on that research as it develops and evolves because wildfire smoke is just having a bigger and bigger impact on our lives. And if you think about it, Jay, one of the reasons that wildfire smoke probably is having this extraordinary impact compared to other kinds of pollution is because in wildfire, it's not just trees and forests that are burning, it's houses and cars and all kinds of chemicals and so on. So in addition to the PM 2.5, there's this toxic soup of nitrogen dioxide and polycyclic aromatic hydrocarbons or PAHs and heavy metals. All of these things coming into the body can lead to inflammation and oxidative stress and potentially increase that risk of buildup of proteins like amyloid and tau that are linked to Alzheimer's Disease. Jay: And Allison, you did point out that we have discussed general air pollution earlier as a risk. And there's just been a recent study that looked at air pollution, not just the PM 2.5 particles that you've talked about, but also nitrogen dioxide and soot. And this boggles my mind. The study concluded that all three increase the risk of dementia even if you're just standing at the side of a road. And in this case, one of the main roads they looked at was in London, England. So air pollution, including car pollution and wildfire smoke, are things we have to keep in mind. Allison: There are things that we can do. For example, one of our producers, Rosanne Alleong, will wear a mask while she's walking along a really polluted street in Toronto. She's protecting herself at those roadside levels. If the air quality is bad outside, you can wear a mask. They get those tiny particles, they filter them out, they reduce the likelihood of them getting into your body. You can also obviously stay indoors when the air quality is poor. And when you're inside, remember some bad air might leak inside. You always want to make sure that you've got air purifiers in your house running. You can even make your own air purifier, which I think you've done Jay. And our website has information on how you can make one of those Corsi-Rosenthal boxes. Jay: Now we're going to check out some very interesting new studies on viruses and how they may affect dementia risk. In particular, the virus that causes chickenpox when you're young and may come back as shingles when you're older. Three independent studies have now been published that show if you get the shingles vaccine when you're an adult, you could reduce your risk for dementia by as much as 20%. And Allison, I like this new finding because on my new list of resolutions, I'm going to say I'm getting the shingles vaccine. But [to go back to the studies] and I'll use Wales as an example. What happened was that in 2013, the Welsh government decided that anybody that is over 80 years old on a particular date is no longer eligible for the shingles vaccine. Anyone under 80 is. What that meant was you had a cluster of people right around that cutoff date, some of whom were like three days younger than people on the other side of the divide, and yet they could get the vaccine, the people over that date couldn't. Lots of other things have to be controlled for, but it was kind of an ideal control situation. A large population separated very precisely by no vaccine or vaccine. And that's how they were able to do these studies. That was an old version of the shingles vaccine. There's now a newer one and there are suggestions that it might be even more effective. So I think that's very, very exciting. And boy, it hints that viruses have a bigger role, doesn't it? Allison: It does, and many people may not realize this, but there's been something called the viral hypothesis linking viruses to neurodegeneration and Alzheimer's for quite a long time. So there've been other examples where viruses have been specifically linked to dementia. So this particular example, I think, is really exciting because it's a vaccine that we've got in our hands right now that we could maybe use and do something with. But it's also something we might be hearing a little bit more about down the road because the virus behind COVID also has been making the news and it's now linked to cardiovascular issues like stroke, which we know are risk factors for dementia. But COVID also is increasingly being linked to diminished brain health, and work that we've done at Baycrest and with our group and others around the world are showing now that COVID actually can be getting into the brain and can be causing different kinds of problems. There's many, many more studies on this happening, so just everyone should be on the lookout for that. But I think that there is great hope with the vaccines. Jay: Well, you might think, well, it's so soon after COVID, how could you possibly link it to dementia? But there has been at least one study strongly suggesting that people who lived through the COVID pandemic, have their brains aged more quickly than people who went through the same ages and circumstances before the pandemic. Now it didn't seem to matter whether you got that virus or not. So that opens up another mystery. But these are things that I think we're all going to have to keep track of. And so if you're concerned about viruses, get the shingles vaccine for sure. Wearing a mask is both good for wildfire smoke, air pollution, viral infection, you name it. And we're going to stay focused on all of these stories that are in development. Allison: On this podcast we've covered most of the lifestyle factors that increased dementia risk and those risk factors were also the basis of brain healthy New Year's resolutions and other plans that Jay and I publicly announced on the show in 2023. So Jay, you were talking about working on physical activity and music and diet. How is all of that going? Jay: Well, the worst part about this is that you just said we did this in 2023 and it's well into 2025. So I admit I've had mixed success. I would say things are going okay, I'll just go down them very quickly. So when it comes to fitness, I think I'm doing pretty well. I go hiking in Victoria a lot with my dog, Robbie. There's lots of uphill and downhill. So it actually requires a certain degree of fitness. I'm quite disappointed in my failed goal of playing more music, mostly because the band that I am in, where I played electric violin and every once in a while played the bongos - skillfully, I might add - it's just not the same when I'm in Victoria and they're in Calgary. The incentive to play music is much diminished I find when it's only you sitting there with an instrument. And when I say the word incentive, it reveals something about me that is not helpful in this area, and that is that I've always worked better when I have deadlines, and if I'm going to "play more music," there's no deadline associated with that, so I need to do something different. But I'll tell you what I have achieved, Allison, and this may be of great interest to you too. And it's the whole idea of resolutions. Why do so many people, I think only 7% of people who make New Year's resolutions actually carry them out? Well, I have some tips for our listeners who may be sharing some of my frustration in not being able to come through with everything. And here they are. I'll just give them to you quickly. Resolutions should not be complicated. They should be simple and straightforward. Remembering what we just said about the POINTER study, it's really helpful to have some sort of reinforcement support and even feedback, preferably from friends not ordering you what to do. The study actually suggests that having a schedule is best. And it is. That's sort of my deadline thing. And it's also best if the motivation comes from you and not from somebody saying, "Oh, you should lose weight," or, "What are you eating that hot dog for?". And goals have to be realistic. Even small gains are good. I do have one funny anecdote, and it is that there's a general belief, at least online, that establishing a new habit, which is really what we're talking about, takes about three weeks. And it turns out, this was first stated in a book called Psycho-Cybernetics published in 1960, and it was based on the idea that the author knew that it took people about three weeks to get used to the plastic surgery they'd had. So I think three weeks is not generally applicable. And there was a good study in 2009 that said the range of time it takes to establish a new habit is anywhere from 18 to 254 days. Allison: Wow. So the internet is not always right, is what you're saying. Jay: No, I know. And that's stunning in itself. But if you're like me and you're having difficulty in doing some of the things that Allison and I in a heartfelt way suggested you should do, just remember it can take as much as several months. Now, that's me. I would [give myself] a C plus. What about you, Allison? Allison: I also have not done everything that I publicly said I would. And again, I think that that's good for people to hear that, that we're saying we're going to try it and we're good at some things and we're less good at other things, because that's just life. And so for example, I did start working out again, lifting weights like my hero, Ernestine Shepherd from our exercise episode. I love lifting heavy, but then travel and other sorts of issues really just disrupted my schedule. And I think like so many of us, those sort of normal life events just threw a wrench into that part of my brain health plans. And so when I'm traveling, I always think I'm going to go to the gym and I never end up doing it. I end up walking more. So I have the cardiovascular, but it's just hard for me to be doing the weightlifting and resistance, which are really key for brain health. So I would say probably on that, I'm not even a C plus there. I'm probably like a D on that one. Jay: Well, if I could just say quickly, you travel an awful lot, and I do much less traveling relative to you, but I find when I go somewhere else, first of all, jet lag might be involved. And secondly, you're in a place to do something and there's a lot of socializing, which is good, but there's a lot of eating, which may not be good. So I really empathize because your travel schedule makes it much harder. Allison: And when I'm traveling, it's just sort of work, work, work. I'm not taking vacations, it's just giving talks and going to meetings. So it is hard to fit that in. And that's also made it a little bit difficult on the music front because I play the drums, and I can't carry my drum kit with me wherever I'm going. I do sometimes bring my sticks with me, but I haven't been playing as much with my band as I'd like in part because a lot of people on my band travel a lot too. So just having time to practice together isn't as often as I'd like. We do have a show coming up, and so for me, like you, a deadline is good. Since I know I've got a show coming up, I have to practice more to get these new songs just really down because I can't look at music when I'm playing, especially outdoors. And so that has been a real impetus. But what I did end up doing is spending a lot more time doing theater and improv, which I've had a lifelong interest and passion in, and that has included a little bit of music because I was actually doing a course at Second City on hip hop improv. So sometimes we can have a freestyle rap battle, maybe about brain health if you'd like. Jay: Great. Allison: I think the one thing that's great about that is that it has this combination of cognitive engagement and social engagement and memory training and physical activity. I played a bird flapping around the stage in a show a few weeks ago, so [I was] running around the stage. It really is that mixed bag of benefits. The one thing I do like about it is no matter where I go, I may not be able to play the drums with a band, but I can always get in on an improv jam somewhere. So it is something that even if I'm traveling, I can keep doing it. So I'm hoping that that works. The other thing I was really focusing on was my sleep. And there I have to give myself at least an A minus because I actually figured out how to sleep better, what works for me. It's going to be different for every person. I've been tracking my sleep to monitor my progress. I've slept through entirely, not waking up once in the middle of the night, really rare for me, a couple of times even this week. So I think that I haven't completely solved it, but have gotten much better. Still eating healthy as much as I can. We live near a farm, so summer's a great time to get some fresh berries and vegetables. And our producer, Ben, even gave me some kale that he grew, so keeping me healthy. My husband was on a weight loss journey, so I stopped baking and cooking as much. And since he wasn't eating as much, I wasn't eating as much, and I actually sort of accidentally lost weight along with him. That was great. The last thing that we didn't really talk much about before, but because of the episode that we did on alcohol, I have consciously been drinking less, if at all. So when I'm eating out, for example, everywhere has non-alcoholic cocktails. So I'm ordering those and they are delicious. So overall probably I'll take a B minus. Jay: Yeah, I'll give you a B plus. What these do both illustrate, you and me, is that they are challenges and personal circumstances have been set in a certain way, with certain routines, rituals, and those get pushed around when you're trying to change. And that's hard. We have habits and rituals because they generally make us comfortable, and now we're getting pushed away from them. So all I can say is we're trying and we're going to keep trying and maybe we'll keep reporting too. Allison: And Jay, I'm proud of us just for trying and talking about it. And have we gotten A pluses? No, but that's not what's important. What's important is we're trying, and I know that all the listeners out there are trying too. Jay: To find out more about how we can all boost our brain health and reduce the risk of dementia or slow its progression, please visit us at defydementia.org. There you can check out other episodes of the podcast as well as our videos, infographics, and other resources. Allison: Our podcast production team is Rosanne Aleong and Sylvain Dubroqua. Production is by Podtech, and music is by Steve Dodd. Our cover art is by Amanda Forbis and Wendy Tilby. And our writer and chase producer is Ben Shaub. Jay: We'd also like to thank the funders of this podcast, the Slaight Family Foundation, Center for Aging and Brain Health Innovation, and Baycrest. Allison: And we are very grateful for your support too. So please click that subscribe button for Defy Dementia wherever you get your podcasts. And don't forget to leave a like, a comment or maybe even a five-star review. Jay: Next time on Defy Dementia, smoking and dementia risk. We all have heard that smoking is dangerous to health, but the details on what it does to your brain are truly alarming. If you smoke or love a smoker, you really need to tune in because it turns out smoking is a huge risk for dementia. Allison: But take heart, this will be a show about hope. And the cool thing is that the brain is surprisingly forgiving after you quit smoking. It returns to health very quickly. Jay: That's smoking, next time on Defy Dementia. I'm Jay Ingram. Allison: I'm Allison Sekuler. Thanks for listening to Defy Dementia. And don't ever forget, you're never too young or too old to take care of your brain.