Episode #13: We can lower our risk of cognitive decline

• Approximately 40% of the risk for cognitive decline is preventable through lifestyle changes and proactive measures.
• Nearly 7 million Americans are affected by Alzheimer's, with numbers expected to double in the coming decades. It's the sixth leading cause of death, costing the US around $800 billion annually.
• Not Inevitable: Cognitive decline is not an inevitable part of aging, as demonstrated by figures like Barbara Walters and Henry Kissinger, who remained mentally sharp well into their later years.

Part 2: Strategies That Work

1. Exercise: Regular physical activity is associated with a 28% reduction in the likelihood of Alzheimer's. Dancing, in particular, has shown benefits due to its combination of physical and mental engagement.
2. Sleep: Adequate sleep (around seven hours per night) is crucial, with poor sleep increasing the risk of Alzheimer's by 68%.
3. Smoking: Smoking cessation is critical, as smoking is linked to 5% of dementia cases.
4. Blood Pressure Control: Managing hypertension can greatly reduce the risk of cognitive decline
5. Obesity and Diabetes: Both conditions are associated with an increased risk of dementia.
6. Sauna Use: Regular sauna use correlates with a reduced risk of dementia, with benefits increasing with frequency of use and time/session.
7. Hearing Loss: Treating hearing loss may lower the risk of cognitive decline by maintaining cognitive stimulation.
8. Alcohol Consumption: Reducing alcohol intake can decrease the risk of cognitive impairment.
9. Social Engagement: Maintaining strong social connections is associated with a reduced risk of dementia.

Part 3: Strategies That Don't Work

• Omega-3 Supplements: No substantial evidence supports their role in preventing cognitive decline.
• Brain-Focused Diets: Diets like the MIND diet have not shown significant benefits in reducing cognitive decline in clinical trials.

Part 4: Unclear or Emerging Strategies

• Probiotics, Viagra, and Multivitamins may have benefits.
• Brain Training Games: While they may improve specific skills, there is limited evidence that they prevent general cognitive decline. Newer approaches have some promising results 

Chapters

• 1:13 Cognitive decline may be preventable
• 10:48 These approaches reduce risk of cognitive decline
• 27:51 These approaches don't seem to work
• 30:48 Approaches where evidence is "uncertain"

Transcript

Dr Bobby Dubois: 0:09

Hi, I'm Dr Bobby Dub ois and welcome to Live Long and Well, a podcast where we will talk about what you can do to live as long as possible and with as much energy and vigor that you wish possible, and with as much energy and vigor that you wish. Together, we will explore what practical and evidence-supported steps you can take. Come join me on this very important journey and I hope that you feel empowered along the way. I'm a physician, ironman triathlete and have published several hundred scientific studies. I'm honored to be your guide. Welcome to episode 13, where I'll explore what we all can do to reduce our likelihood of cognitive decline and Alzheimer's disease. Now this topic has been in the headlines. Our president's cognitive function appears to have worsened. More patients are ending up in nursing homes with dementia, and the new drugs for Alzheimer's disease, despite being positive steps, don't stop the disease. Setting aside stress-provoking headlines, I hope this episode empowers you and gives you a sense that you can make a positive impact on your risk. It turns out that perhaps 40% of the risk of cognitive decline is preventable, and we will talk, as always, in evidence-based and very practical terms, about what you can do to live long and well. This episode has been the most challenging for me so far. It's a difficult area with thousands of articles, many conflicting with one another. Now I've done the best I can to sort through what we know and what we don't know and curate that information for you. We won't focus on studies in mice or test tubes, but clinical studies in people what works and what doesn't work. Now I may end up with some unhappy folks, those who may promote or support one of the areas where I'm not convinced about the evidence. Now, since I haven't spent a career working on a particular approach to Alzheimer's disease, I hope that I can look at the area fairly and share that view with you. If I miss the mark, as always, please let me know, either on my website or on Instagram. As always, I will have links to the key studies in the show notes. Now I am fortunate that I don't have a personal case study to begin this episode Now.

Dr Bobby Dubois: 2:58

Cognitive decline occurs in my family as members age, but true dementia has not been common in my immediate family. The challenges of dementia have hit others in my life and for you, the listeners, likely have impacted many of you and those around you. Well, let's begin with the take-home messages First, there are many ideas out there of what may lower your risk of cognitive decline, and I will divide them into ones that appear to have compelling evidence that they work, ones where the evidence is pretty clear they don't work, and ones that fit in the we-don't-know-yet category. There are about a dozen things you can do or not do to really lower your risk. This is why I hope you'll feel empowered. As mentioned, 40% of our risk of cognitive decline is preventable. And number three, take-home message good news. Many of the factors you can control you may already be doing as. We've discussed them as part of the six pillars that we talked about in the first seven episodes. Feel free to listen to those again or for the first time. But there are additional important risk factors that I will add in today. My theme for today let's not just wait and worry, let's act to reduce our risk. So the plan for today after some background, I will walk through the three areas what works, what doesn't work and where do we just don't know yet. To keep this episode brief, I won't talk about types of dementia, how it's diagnosed or what the newly approved drugs do or don't do. Perhaps for another episode, another time, if listeners wish. Just let me know.

Dr Bobby Dubois: 4:57

Okay, part one, some background. Cognitive decline is a big deal. It takes a toll on the person, their family and society. Almost 7 million Americans have Alzheimer's and that likely will double in the next few decades. It's the sixth leading cause of death and it's been estimated that about $800 billion are spent in the US related to it. $800 billion are spent in the US related to it. But cognitive decline is not an inevitable part of aging. Let me repeat that Cognitive decline is not an inevitable part of aging.

Dr Bobby Dubois: 5:36

Warren Buffett, at 93, is still an active investor. Nelson Mandela was in his 90s and on the world stage before he died. Barbara Walters continued into her 80s and 90s. Pablo Picasso painted until he died at age 91. Jane Goodall, the primatologist, continued to add to the science in her 80s. And Henry Kissinger died at age 100, and he was mentally active until close to the end. If you want to be inspired, you might watch his final interview, which I will have linked, just before he died at age 100. It's quite remarkable. Physically, obviously, he looks quite worn out, but mentally he seemed very much there and it was really very inspiring for me.

Dr Bobby Dubois: 6:25

Well, here are some additional numbers by your late 60s. About 2% of people will have dementia a pretty small risk at that age, but that risk doubles every five years. And when you're 90, about a third of people will have dementia. Now that is a large number. I want to point out that Alzheimer's disease generally affects older individuals, but about one in 20 with Alzheimer's disease will develop symptoms under age 65. Now I mentioned one in three people in their 90s is a large number to have dementia. But looked at it the other way, two-thirds of people won't have dementia at that age, like Henry Kissinger.

Dr Bobby Dubois: 7:17

So how can we be in that group of individuals who function so well into their 80s, 90s and beyond? That is the key question for today. There are a few things you can't control. Genetics are an important element and the APOE4 gene, if you have it, puts you at increased risk. It doesn't mean you're going to get Alzheimer's disease, but it does put you at increased risk. If you've had a traumatic brain injury, that's important and will increase your risk. And finally, education is an important predictor as well. But for the folks listening to me now, you've probably ended your formal education, so not necessarily something to work on now. So we won't focus today on things we have little control over, like genetics or whether we have a traumatic brain injury or our level of education, as important as they truly are. What we will focus on are things we have control over and what we might do to reduce the risk of cognitive decline and be in that group of older individuals where that is not a problem.

Dr Bobby Dubois: 8:31

Now I would like to divide our approaches into three categories. The first category are those things risk factors, things we might do that have pretty compelling evidence that it makes a difference and which gives us the agency to do something. And there are nine of these exercise, sleep, smoking, high blood pressure control, obesity and diabetes, sauna use, hearing loss and treatment of it, alcohol use and low social engagement. And of course, we're going to walk through each one of these. The second category of interventions are those where we have pretty good evidence that it doesn't make a substantial difference in reducing your risk. Omega-3 fatty acids fit into this, and general brain or mind-focused diets also seem to fit into this, where it doesn't seem to help. And then the third category are what I would call unclear. We don't know yet. There may be pilot studies, there may be uncertain studies. We just don't know and there are a number in this category that we'll talk about the role of probiotics. Believe it or not, viagra, multivitamins, brain training and perhaps even the shingles vaccine may have a role.

Dr Bobby Dubois: 9:59

Before diving in, there was a British working group called the Lancet Commission and they put together a really, really excellent report on dementia prevention and care. It has some great figures and summarizes a lot of evidence. Take a look if you wish. The link will be in the show notes. The commission found that 40% of dementia cases could be prevented. It's true, we don't control our genes and we don't control bad luck, but 40% is a lot of agency and I view this number with great empowerment. And, once again, today's theme is we don't need to merely wait and worry if this will Okay. Part two the nine factors that evidence shows matter and we can do something about.

Dr Bobby Dubois: 10:57

Number one exercise. Now we've talked about exercise in so many ways and in so many of our episodes that it helps us truly live long and well, it helps us feel better, it helps to control our weight, it reduces our risk of heart disease and it's very, very relevant to lower our risk of cognitive decline. There's been a number of observational studies, obviously not as good as some. That might be randomized controlled trials, and there was a meta-analysis, meaning a summary of studies, and they looked at 29 studies, about 2 million people, and what they found are people that exercised regularly had a 28% reduction in the likelihood of Alzheimer's disease, and that's really interesting and important. What they also found was that the more exercise people did, the greater the risk reduction. So that's very exciting data that suggests that exercise is helpful.

Dr Bobby Dubois: 12:05

Now where it gets a little tricky and as always I want to be fair with the evidence, both on the positive and the negative side is that when they tried to examine some of these benefits in a randomized controlled trial, they didn't find as much evidence that it made a difference. So we, on the one hand, have the observational studies that show benefit. We've got a small number of randomized trials that don't seem to show benefit, but one type of exercise has been shown to reduce risk Believe it or not, it's dancing. That a meta-analysis of seven studies that had about 429 adults these are folks that are in their 70s did a 10 to 18-week intervention that was dance-based, so it could have been line dancing, jazz dancing, latin dancing, and what they found was a significant maintenance of cognitive function or a lesser rate of decline. So these people did better than the ones that didn't do dance. Now you might ask why is that? Isn't it just exercise in general? No, to do dancing takes choreography. It means you have to learn the steps. Your brain is doing something to help you in the dance process and that dancing and the choreography and learning the steps may affect what happens in your brain and deterioration. So that's a fun one that folks may consider and may want to start dancing a little more often than perhaps they have. Okay, number two Evidence is also strong about sleep.

Dr Bobby Dubois: 13:51

As you've heard me say, sleep is the unsung hero. In episode three we talked about how seven hours of sleep a night is a really important benchmark. Above that, it's really good. As you work your way below that, it gets to be problematic. Well, it turns out, not only does poor sleep affect all sorts of things, it affects our risk of cognitive decline, and there was a large analysis of 27 studies and those people that had sleep challenges had a 68% increase in risk of Alzheimer's 68% increase in risk of Alzheimer's and people have estimated that maybe as many as one in six Alzheimer's disease cases could be attributed to sleep problems. In that episode three I discussed 12 do's and don'ts that can really help you improve your sleep. Take another listen if you wish. This one is an important one to helping us maintain our cognitive function.

Dr Bobby Dubois: 14:54

Third, probably not something that affects a lot of you, but smoking. It's probably about 5% of cases of dementia are related to smoking. In the 1960s, perhaps 40% of adults smoked. Today it's down to about 11% Now. Even though it's fallen a lot, there's still 480,000 deaths due to cancer and heart disease and the like that are attributed to smoking. Now, as much as traditional smoking has fallen, vaping, especially among the youth, is a growing concern and we don't yet know what vaping does in terms of dementia risk, but it may be just as problematic.

Dr Bobby Dubois: 15:42

Okay, number four hypertension or blood pressure control. Hypertension is an important risk factor also for cognitive decline. If you have inadequately or untreated high blood pressure, it affects your heart, it affects your brain with strokes, kidney failure, all sorts of different things, and also dementia. A very large study, the Framingham study, found again people with hypertension had a 60% increase in the risk of dementia. Now that may be due to damage to blood vessels in the brain. It may be lack of blood flow. It's a little less clear how it comes across. Also, what's less clear is how much lowering your blood pressure reduces the risk of cognitive decline. The data aren't as clear as I would like them to be, but hypertension control is so important across the body that whether it has a large or small impact on cognition isn't critical, because it's so important for our heart or stroke or other problems that could occur.

Dr Bobby Dubois: 16:52

Number five another risk factor that we have some control over is obesity and diabetes. In a summary of 27 studies in people with obesity or diabetes, they had a significantly increased risk of cognitive decline. Now we're going to talk about weight and weight loss and weight loss approaches and how we might think about this. It's a hugely challenging area. There is no simple, easy way to solve the problem, but if you're looking for another motivation for why you want to keep working at it, this would be another one for why you want to keep working at it. This would be another one.

Dr Bobby Dubois: 17:35

Number six sauna. We talked about sauna before, about exposure to heat and cold, and there are really good, although observational studies that show that sauna use regular sauna use reduces our risk of Alzheimer's disease or other kinds of dementia. This was the study that was done in Finland. They followed thousands of people for about 20 years, which is a long time to follow people, and what they interestingly found was the number of times per week people did sauna directly correlated with their risk of dementia. So if you were doing it once a week, you had a 22% reduction. If you were doing it two to three times a week, there was a 66% reduction. And that 66% reduction actually is for four to seven times a week. 66% reduction actually is for four to seven times a week. So when we see what's called a dose response relationship meaning the more times per week you end up in the sauna, the lower the risk that helps us feel somewhat more convinced that this study is giving us really important information and, like a lot of other studies, they did adjust for lots of different things.

Dr Bobby Dubois: 18:55

Well, number seven is one we haven't talked about before we may talk about it in the future again and that is hearing loss. It turns out that people with hearing loss have a 30 to 50 percent increased risk of dementia and that likelihood of dementia goes up with the greater decibel loss. So in other words, if you have a mild loss, you have a modest increase in your risk of cognitive decline. If you have more hearing loss, then that goes up further. Now, if you have more hearing loss and that goes up further Now it's again one of these things that we don't know for sure how this happens, but it may be that when you aren't able to hear as well, you get less brain stimulation. You're not hearing the conversations fully. You may not be hearing the music as fully that you're listening to. Also of interest that when they examine people who had hearing loss but were wearing a hearing aid now this was an observational study the folks with hearing aid use did better on memory scores and appeared to have a slower rate of deterioration. So this is something as we age. It's not just a matter of saying well, my hearing's not as good as it used to be, but I can get by. This might be a reason to actually do something about it, because there does seem to be a correlation with risk of cognitive decline.

Dr Bobby Dubois: 20:26

Number eight alcohol. I am going to do an episode on this in the future and I'm sure I'm not going to make a lot of friends because there is no great amount of alcohol to drink, but I would like to explore with folks what we know about the safe amounts, if there are any safe amounts, and where the damage may be something to be concerned about. Well, in the last few years, my wife Gail and I we've greatly reduced our alcohol intake because we started to look at some of the studies about what alcohol does to our brain and it was enough of a wake-up call for us that we do something in terms of how much we drink per week. We do something in terms of how much we drink per week. Now, in the episode on sleep, I discussed how alcohol can really impair our sleep. You may feel like you're going to sleep quickly, but you might wake up at two in the morning and not be able to go back to sleep. You might feel like you slept, but you don't feel rested in the morning because of the sleep architecture. The stages of sleep were all quite disrupted.

Dr Bobby Dubois: 21:34

So here's the study that got our attention. It was based on what's called the UK England. They have a biobank. They follow people for years and years, and years and they measure a bunch of things periodically and then they try to see what they can predict with that information. So there's about 36,000 middle-aged and older adults, and on this group they did sophisticated brain scans and what they found was that alcohol use was associated with loss of brain matter, neuronal loss. Those are the neurons or the cells in the brain, and white matter fiber, which is the connections between the brain cells, and they controlled for lots of confounders or the things that might make the relationship murky. And what they found that was perhaps the most worrisome for us was that this deterioration in the brain, the substance of the brain, occurred even for people who had 7 to 14 drinks per week 1 to 2 drinks per day, which is what historically people thought was safe. But at least from the basis of this study suggests that even that modest amount may be a problem, and so we are trying to cut back below the seven a week. That's our view of things. The data is supportive and we'll talk more about this in a future episode.

Dr Bobby Dubois: 23:06

Number nine low social contact. Now, this is an area we've talked about before. In a meta-analysis of 33 studies, they found that poor social engagement, poor interactions, poor social network increased the risk of dementia by 10 to 20 percent. And other studies have looked at things from a different angle, looking at married people versus not married people, and they also show that social contact good social contact and connections reduces your risk of dementia. Now, the final area of things that look like it really can help is not a new one, but it's rather a combining of many of the nine I've just talked about.

Dr Bobby Dubois: 23:55

So many of the studies looked at each one individually. What do we know about sleep? What do we know about high blood pressure? What do we know about exercise? A number of studies said well, wait a second, why don't we combine four of these approaches, or five of these approaches, or six of these approaches, and see what happens? Now, keep in mind there's a few words of caution.

Dr Bobby Dubois: 24:20

Up until now, I've been talking about people who did not have cognitive impairment and whether it could prevent that from occurring. The studies I'm about to mention were in people who already had cognitive decline, albeit mild, but they already had it. So it wasn't preventing it, it was reducing or improving the impairment that was there. So that's the first thing to keep in mind. The studies showed some benefits, real benefits, but what we don't know is which of the modalities so if they did four things, were all four of those critical, or was really just one or two of them more critical and the other two they did them, but it didn't make much of a difference. The problem is, you can't analyze it in that way. So there was a study that came out not long ago by Dean Ornish, who's a well-known physician in the area of cardiovascular health and now brain health, and this is really the first randomized control trial of using multiple approaches to try to address the problem. So they took and this is where the real problem is they only had 25 patients in each group. The whole study only had 50 people, so half of them got this multi-domain lifestyle intervention and the other half did not, and they measured a whole bunch of things related to cognition and they did find improvements in those that had the multimodality intervention and the people who were in the control group actually worsened.

Dr Bobby Dubois: 26:00

Now, this was a very intensive lifestyle intervention. They had people on vegan diets with complex carbs and nuts. They did 30 minutes of exercise aerobics a day and three times a week with strength training. They did stress management an hour a day, meditation, yoga or breathing. They did group support about an hour a week and then personal Zoom calls with the people in the study three times a week and then they gave them a whole raft of supplements and probiotics. So it was a randomized trial, which is good. They had blinded observers, so when people assessed the patients they didn't know whether they actually got the intervention or they did not.

Dr Bobby Dubois: 26:52

But as I said before, we don't really know what caused the improvement. I'll just give you a hypothesis I'm just doing this to be sort of devil's advocate that maybe all of the benefit was due to exercise or all the benefit really came from the group's support and it really had nothing to do with the stress management. It had nothing to do with the diet. And that's the problem, because what often happens is people will look at a study like that and say, see, everybody needs to be on a vegan diet. So this was not a test of the vegan diet alone. It was the test of a vegan diet plus a whole bunch of other things. The vegan diet may have helped. It may not have helped. We just don't know. So just be careful when you hear about these things that it doesn't get over-interpreted in that way. So that ends part two, which is the areas that we actually feel like we have evidence that it works. Part two, which is the areas that we actually feel like we have evidence that it works. Now on to part three, the approaches that don't appear to work.

Dr Bobby Dubois: 27:59

Almost every day I see advertisements, supplements to improve brain health, and each one has their kind of proprietary blend of ingredients. Well, one area that's been studied pretty well in randomized controlled trials has been omega-3s. These supplements are very, very popular as probably the number two or three supplement that people take in the United States. In a summary of 15 randomized controlled trials, there was no improvement that was shown. So I'm not bullish on omega-3s generally and it doesn't appear that it helps cognitive decline. There's been a number of studies that suggest that olive oil is helpful and nuts are helpful. Again, these were observational studies, although they may be intriguing and may show benefit. Wait a moment until I tell you about this randomized control trial, which, for me, kind of undoes what I was thinking about olive oil and nuts. Now, olive oil and nuts are wonderful foods. They have fats, so they help you feel full. They might have broader benefits to your body Great but it just doesn't seem, perhaps, that they're going to prevent cognitive decline.

Dr Bobby Dubois: 29:18

There was a very large randomized control trial on what's called the MIND diet. Now, the MIND diet was. Can we put together a diet based on the Mediterranean diet, based on the DASH diet that has all the goodies that people think might reduce our risk of dementia, like whole grains, leafy vegetables, nuts and beans and berries, and they basically said we're going to give you all of this good stuff. And then, of course, we're going to have a comparison group that doesn't have that. And it was a three-year study and they looked at cognitive decline by measuring people's memory and such and MRI scan changes and they found no benefit. This was a really, really important study.

Dr Bobby Dubois: 30:05

What do I take from all this is that there's no compelling evidence that supplements help. The MIND diet, which had all the goodies in it now it's true they weren't supplements, that was part of their food didn't reduce risk. Now, I did mention the multimodality Dean Ornish trial and they used a plant-based diet, but, as I said before, they did a lot of other things and it may have had nothing to do with the diet, so I'm not sure diet is really the solution here. A good diet is wonderful for all sorts of reasons, but maybe the evidence isn't that strong for reduction in cognitive decline risk. All right, part four might be the most fun area, the most controversial area, and that's where the evidence is uncertain. Now you can view these as well. They're promising, maybe I should think about them. Or you can view them as not ready for prime time Since there isn't compelling evidence. Then what do you do? I tend to be skeptical until I see good evidence. So I lean towards not jumping into the ones I'm about to talk about until we have stronger evidence.

Dr Bobby Dubois: 31:22

So there's been some studies of probiotics and they did find small improvements in cognitive function and recall. But these studies were all very small, not ideally designed, and with probiotics you never know exactly what you're getting and whether, when you go to the store to get it, you're getting what was used in the study. So it's always a complicated area, and if there were improvements it was probably pretty small. So I'm not sure I would at the the moment commit myself to a life of probiotics. Here's a fun one that when I first ran across this a couple of years ago I was like oh, that's interesting.

Dr Bobby Dubois: 32:03

A number of database studies looked at the use of Viagra Obviously Viagra is primarily used for erectile dysfunction and whether the use of Viagra was associated with a reduced risk of Alzheimer's disease. And in these two studies it actually turned out that those people who use Viagra had a lower risk and that those who had more prescriptions presumably they used it more had an even lower risk. You know, 20, 30% reduction. So what do we make out of this? Is it that the Viagra, because it changes your blood vessels and brings more blood to certain parts of your body? Maybe it brings more blood to your brain. People who use Viagra may notice a flushing sensation, so you could make the argument it's bringing more blood to the brain and maybe that's helpful. But it may have had nothing to do with the Viagra and that's why we have to look at studies very carefully. Maybe it had to do with the fact that people who use Viagra have some intimate connections you know, once a month, once a week, whatever it is that they do, so having that closeness, a person in their life. As we've talked about, social connections are deeply important. Maybe it was the social connection of having romantic intimacy and not the drug itself. We don't know.

Dr Bobby Dubois: 33:27

I would put this in the not quite ready for prime time, but it's very, very interesting. There's some data. Number three, on multivitamins and cognitive function. There was an interesting randomized controlled trial. They were testing whether cocoa might reduce cognitive decline and they also looked at multivitamins and they found that the cocoa didn't do anything for us. But the multivitamins may have had some benefit on global cognitive function. Now I take a multivitamin, as I talked about in our supplements episode. It appears to have some cancer benefit. If it also has some benefit to my cognitive function, wonderful, so I'm already taking it. So we'll wait and see what the further studies come to.

Dr Bobby Dubois: 34:16

And now the third one is perhaps the most controversial area and why it has taken me so long to get this episode completed Brain training games. Now these are things that are maybe on the web. They may be a booklet you work on that, help us with memorization, thinking through complex tasks, and there's a really good rationale why brain training games might work. You've heard the saying use it or lose it and, like hearing loss, if your brain isn't stimulated, we learn that from hearing loss that that can increase your risk. We know that if you have a better education or a higher IQ, you have more to lose. Before it becomes obvious your cognition is a problem.

Dr Bobby Dubois: 35:15

What it appears is that also people would argue that specific tasks where you focus on attention or concentration or memory may create new brain synapses, what's called neuroplasticity. And again, this all sounds really really good but, as we've talked about numerous times, does it work in people? Do these brain games really help? There is a very nice summary of studies and what I would say the preponderance of evidence suggests is that if you do a lot of crossword puzzles as you get older you'll maintain your ability to do crossword puzzles. Or if you enjoy doing Sudoku then you'll maintain that skill over time.

Dr Bobby Dubois: 35:59

But for a lot of people that are doing the crossword puzzles not just to maintain their ability to do crossword puzzles, they're hoping that that effort of your brain will generalize and help us with our memory and with other tasks that we might do. The problem is most of these, the studies on them, don't generalize. They show improvement in that skill but they don't seem to prevent general decline, decline. Now there have been a few studies which are again one of our multi-modality studies, where they did bring training but they also did exercise and they also might have done vitamin D and they did show some benefits. But again, it's always hard to disentangle things and if there was benefits just from that cognitive training it might have been modest. There was a summary of studies in 2019, and they felt that, again, there was no generalized benefit, although there might have been benefit for a specific task, like the games I talked about. So another word of caution One of the big players in this space over the many, many years is Lumosity.

Dr Bobby Dubois: 37:15

I have no connection to the company one way or another, and they have an online program that has 40 games to four times per week. And here's the problem In 2016, lumosity was fined by the Federal Trade Commission $2 million to settle a lawsuit for what the FTC said was deceptive advertising. They were arguing it was changing the brain, it was reducing and delaying cognitive impairment. So that might suggest that for at least Lumosity, there was some sense that they were saying more than what the evidence supported. Now, why this is such a tricky area is people could argue well, maybe the previous brain games weren't all that helpful, but the new ones are much, much better and they really show benefit. Well, there is one that's being talked about now more generally. It's called Brain HQ Similar. It's like $100 a year. It's got a suite of brain games and they do have a study that showed some benefit. Now, some of the data I saw was also multimodality, meaning it was brain games plus other things, but I think they did have some that were just brain games.

Dr Bobby Dubois: 38:48

So where do I net out? I don't know, we just don't know. They may help, and if you enjoy doing them, wonderful, do them. But if you think it will solve the problem, I don't think we really know yet. While I was getting ready to record, yesterday, I noticed an article that suggested that people who got the shingles vaccine which is a herpes-related vaccine to prevent shingles, which is the same virus that causes chickenpox, but it comes back at an older age that people who got the shingles vaccine had a lower risk of dementia. Now again, I put this in the early category. There was a really interesting natural experiment in Wales that on an arbitrary date, certain people were going to get the shingles vaccine and certain other people would not presumably very similar people, and they found after seven years, those that had the shingles vaccine had a 20% reduction in dementia. Now, I don't know if this will ultimately turn out to be true, but the shingles vaccine had a 20% reduction in dementia. Now, I don't know if this will ultimately turn out to be true, but the shingles vaccine is a good idea for other reasons and, just like the multivitamin story, if there are benefits related to it. I got my shingles vaccine and maybe it'll help me too. Okay time to wrap up. Okay time to wrap up.

Dr Bobby Dubois: 40:12

Some of us will have cognitive decline, others will not. There are, as we've talked about, definitely things that we can do where the evidence shows it will reduce our risk, and 40% of the risk of cognitive decline is at least somewhat in our control, based upon what I've learned from the studies and what I've shared with you. Here's where I net out. I know I'll continue to follow the six pillars and the other elements that I've discussed. So I'm gonna do the six pillars. So I am gonna focus on sleep and exercise and all those other kinds of things. I don't smoke, so I'm gonna pay attention to not smoking. As I've said, I've tried to reduce alcohol intake. My blood pressure is under control. Of course, I'm going to continue to exercise. If I have hearing problems and I was checked recently, it was okay, but if they do deteriorate, I will more quickly get a hearing aid now because I understand the benefits of it. I'm going to try to remain at a good weight and I, as always, will continue to work on my social contacts.

Dr Bobby Dubois: 41:21

It is my sincerest hope that you can be like Henry Kissinger or Barbara Walters and live long and well into your 90s and beyond. We don't need to just wait and worry. Let's act to reduce our risk and, as always, I am honored to be your guide on this longevity journey. Until next time. Thanks so much for listening to Live Long and Well with Dr Bobby. If you liked this episode, please provide a review on Apple or Spotify or wherever you listen. If you want to continue this journey or want to receive my newsletter on practical and scientific ways to improve your health and longevity, please visit me at drbobblivelongandwellcom. That's, doctor, as in D-R Bobby. Live long and wellcom.