Ep01: Measuring, Improving, and Sustaining Brain Health

Episode Transcript

[00:00:05] Dan Kendall: Welcome to the Brain Health News Podcast, part of Health Unmuted and created by Mission Based Media in association with the Davos Alzheimer's Collaborative. 

This episode was recorded live at The World Economic Forum, annual meeting in Davos, Switzerland in January, 2024. 

George Vradenburg, the founding chairman of the Davos Alzheimer's Collaborative, engages in a thought provoking conversation with three global leaders in the field of brain health. 

Doctors Miia Kivipelto, Ian Hickie and Harris Eyre discussed the critical importance of brain health across the lifespan. 

Dr. Kivipelto introduces the five FINGERS model, which is aimed at reducing the risk of dementia through lifestyle modifications. 

While Dr. Hickie delves into the plasticity of the brain and the potential for resilience throughout life. 

Dr. Eyre sheds light on the concept of brain capital and how it can drive economic and societal growth. 

Tune in to hear about the cutting edge research, actionable insights and transformative possibilities in the field of brain health.

[00:01:02] George Vradenburg: Good afternoon from The World Economic Forum annual meeting in Davos, Switzerland, and welcome to our brain health conversation series curated by the Davos Alzheimer's Collaborative. My name is George Vradenberg, I'm the founding chairman of the Davos Alzheimer's Collaborative, fondly known as DAC.

DAC is a partnership with the World Economic Forum and the Global CEO Initiative on Alzheimer's, and its mission is to drive brain health across the life course in order to prevent dementia. So today we have the honor of having three worldwide experts in this field talking to us about the importance of brain health.

Miia Kivipelto is a renowned expert in the field of Alzheimer's and indeed the pioneer in demonstrating that adjusting one's life course, the day to day living practices can actually reduce the risk of dementia. She is also the professor of clinical geriatrics at the Karolinska Institutet in Sweden.

We're also joined by Ian Hickie, founder of the Brain and Mind Center at the University of Sydney, Australia, and Harris Eyre on your left, my right, who is a fellow in brain health at Rice University's Baker Institute for Public Policy. I am very pleased to have these three renowned experts here to talk about the importance of brain health across the lifespan.

So I'm going to start with you, Miia. You are the sort of the instigator of this whole notion that by changing one's daily life habits, in a variety of ways, that one can actually reduce the risk of future dementia. So tell me about your research and what are the five FINGERS? 

[00:02:43] Miia Kivipelto: Thank you, George. Indeed, dementia is the big challenge in our aging societies, and luckily it's not only age and genetics.

Dementia is not part of normal aging, it's very important to remember that, and luckily we can do so much already today to reduce the risk. We know now that at least 40 percent of all dementias are linked to modifiable risk factors and what we did in the finger trial, it was the randomized control trial,

so it's the highest level of evidence, so we put together different risk factors. So, targeting several risk factors at the same time, we thought we have enough power to really reduce the risk. So it's easy to remember. It's five FINGERS. First one is healthy, balanced diet. Our brains really need nutrition during the whole life course.

Second FINGER, physical exercise. I would say it's one of the most powerful medications we have for the brain. It increases the blood flow, it affects many different transmitters and biomarkers, it's very, very important for the brain health. Third one is mental stimulation. Activating our brain. And here we have so much new knowledge about the brain plasticity, how we can increase the brain reserve and simply trying to make brain more resistant against Alzheimer's and other kinds of lesions.

Then fourth FINGER is the social activities. So important for the brain health and well-being. And part of the social activity is also the relaxation, sleep, stress management. And the fifth FINGER is taking care of all vascular risk factors. Blood pressure, cholesterol, obesity, diabetes. What is good for the heart is good for the brain

and this is more also the holistic care. We know also it's never too early to start to prevent, but luckily it's never too late either. You can always do something for the better brain health. In the FINGER trial, we had very promising results. The risk of cognitive decline was significantly reduced in the FINGER group,

and on top of that, it was not only cognition, there was better functional level, better quality of life, and even the risk for stroke was reduced by 20% and multimorbidity by 60%. So it's the brain health, general health on individual and societal level. And I'm very happy for the partnership we are having because now we are having the World-Wide FINGERS.

With 60 countries where we can adapt and further develop the FINGER model so that it can really fit to different societies. And as part of that, we are upgrading FINGER to FINGER 2.0 which is even more individualized and we can combine the lifestyle with new treatments when needed so that the right person get the right treatment at the right time.

So we are moving to the precision medicine. So I'm very excited for the future, what opportunities we have. We join forces to really make a great impact on better brain health globally. 

[00:06:05] George Vradenburg: So how is it working in 60 countries, one can actually vary the study or ascertain the different variables in each of these different cultures and among men and women and among different racial groups?

How are you doing that? 

[00:06:21] Miia Kivipelto: This is, I think, the beauty in the World-Wide FINGERS. We have had lack of diversity in many of our studies. We know that a dementia is increasing even more rapidly in low and middle income countries. So we have the opportunity to have more diverse populations. we have support from Davos and DAC to have the harmonization,

so we try to harmonize the protocols that we know what the lifestyle factors are. We are collecting blood based biomarkers that we can understand and analyze the underlying mechanisms. So I think there is power in this diversity, to have really more knowledge, what are the underlying mechanisms, what is the best recipe for reducing the risk of dementia.

[00:07:07] George Vradenburg: So what's exciting about this is the ability to gather this data in a systematic way and then put it into a common database, so researchers all around the world can have access to the same data and make some judgments about it. Ian, I'm going to turn to you as an expert in neurology.

I want to have you talk about what we have learned about the plasticity of the brain. How can we make it more resilient during the course of our lives? Is it not a fixed thing, the brain? 

[00:07:35] Ian Hickie: So we've been very lucky, George, in the last 30 years to move from the situation where there was just an idea of a fixed brain.

A certain number of cells that you were born with. And when I was a medical student, you had to keep them and you lost them. And there were two big ideas. One was the genetic idea in childhood. The childhood was just determined by your genetics. The brain just grew. And then inevitably you lost capacity as you aged.

Both of these are wrong. And so what we've learned through being able to image the brain and follow the brain in life is the extent to which it changes the connections between nerve cells, the synapses in childhood are driven by socialization, by good health, by education, by activity, by physical activity, by good sleep-wake cycles to actually make the brain work and develop most effectively as great as capacity. Then you need to keep that capacity through life as Miia was just describing by being active. And I would make a big emphasis in our own research on sleep and circadian research every day. It's a 24 hour cycle. Your brain is doing different things when you're awake, it's then consolidating each evening through memory and exercise.

You must maintain that. And then as you get into the sort of age we're in, George, never retire. You must stay active. You must stay socially engaged. Miia and I were just discussing, you must keep dancing, you must stay connected. And then what we know is we can see the brain now maintain the connections.

And what's really interesting, you can see when people stop, they might stop as the French did in their mid fifties, and they start to lose their capacities. For many of our societies in the sixties, the French shouldn't be protesting about this. They should all go back to work and stay active. And then in our societies

there's a really big cultural bias against the elderly when they have so much to contribute. The transgenerational aspects for grandparents and taking care of kids and staying engaged and being included for their wisdom, for their capacity. What you see at the individual level is synaptic connections maintained.

The brain is active and responding in real life. It does not inevitably deteriorate with age. It may be slightly slower to get the right answer, but often older people get the right answer better. It just takes a little longer. They're not actually losing that capacity. Many of our tests, neuropsychological tests, which are time dependent, are very unfair to older people. Actually, the complexity of what they do, the consolidation of memory, the recall, and the problem solving capacity they have, do not inevitably deteriorate with age. And so what Miia was emphasizing is we need to know this every day.

You need to be working on it every day, to be socialized and to be physically active, maintaining your health. And if you do so, maintain that social connection being one of the most important aspects. And I would emphasize transgenerationally in our cultures, which have had such a bias against older people that we must maintain that

and now we can see in brain imaging, we can see in life, the individual benefit that derives from that and the potential to prevent cognitive decline. 

[00:10:14] George Vradenburg: What's so remarkable is you're telling me that this plasticity or this ability to create new synapses is not age dependent. We can do this in older age.

[00:10:29] Ian Hickie: There are so many myths, the wrong facts, the kind of alternative wrong ideas that were based on being able to collect the brain after death. largely in people who were sick. Now we can record the brain in life largely in older people who are healthy and they are making new connections, but it depends on interaction with the environment.

Every day those connections are driven by what you're doing, physical activity, social interaction, mental stimulation as you age, being engaged, being active, and I would say being socially engaged, interacting, seeing people's faces, interacting with groups. And that's where our societies, Western societies in particular, have often mitigated against older people who are more restricted, musculoskeletally or other problems,

and become isolated. That's when their brain capacity is most at risk. 

[00:11:07] George Vradenburg: Let me ask you, because we're working in India, through DAC, and there obviously is a greater emphasis there on meditation and spiritual aspects of life and whether or not that is a useful thing to reduce stressors or the consequence of stress.

[00:11:20] Ian Hickie: Yes, quite clearly, and I think we're very grateful for all those cultures. The emphasis has been put on not just meditation, but also yoga, physical movement. You see, it's in Chinese cultures, in other Asian cultures. Movement as you age, along with the relaxation, I think Miia was emphasizing. So meditation isn't always just doing nothing.

You can actually be doing physical movement or engaging in mindfulness to reduce the degree of stress. Because stress hormones, when they're overemphasized every day, one day to the next, have adverse effects, harm synaptic connection. Actually, the brain has to relax from those things, which normally increase its attention during the day.

Which is why your sleep-wake cycle is so important. Again, older people change slightly the timing of their sleep, but they need to sleep and that's driven by physical activity, sunlight exposure, being active during the day. So we have to support also things like the musculoskeletal health of older people so that they can engage,

or use new technology so they can stay engaged with their children, with their grandchildren, with their social groups in ways that we now have opportunities. It’s interesting what you said about developing countries, I've been visiting a number of developing countries on the way here. The transgenerational aspects, as just said Miia, men out dancing at any age, social groups across generations, dancing together, being physical together, not excluding older people simply because they're old, but actually making it really good.

And we have good evidence that's good for the cognitive function of older people and it's very good for the cognitive function of their grandchildren. 

[00:12:41] George Vradenburg: Well, let's go dancing tonight Ian. I'm up for it. Come on. Harris, you have emphasized in your work, the notion that it's not just the avoidance of disease, it's not just the avoidance of decline, it is actually brain health

can be important to capital formation to a world in which we have new technologies and where brain agility is needed in order for economies to thrive. So, talk a bit about your work and your thinking. 

[00:13:07] Harris Eyre: Sure, absolutely. As I went through my training in psychiatry, neurology and neuroscience, I noticed that there was a lot of discussion about deficits.

How depressed are you? How cognitively impaired are you? And that's important. We need to factor those things in but, we need to think about positive aspects of the brain as well to give a more optimistic framing of things and perhaps less stigma. So brain health brings in not just the deficits, but also the strengths, resilience, creativity, adaptability, frankly, a strength right now is, your ability to co-pilot with generative AI.

So if we start to bring in these health, these traditional sort of mental health and neurology aspects with the positive aspects as well, I think we can shed some of the old stigma and baggage of the fields of psychiatry and neurology. And I think we can also, when we start to talk about these skill aspects of creativity, resilience, green skills, etc., we're also able to get much more attention from the private sector and from governments for their employees because we want, essentially, to not just reduce the deficit, the cost of these disorders on society, we want to talk about how do we grow productivity, how do we get more entrepreneurship in societies, more economic dynamism and economic security.

So what this is called is brain capital, which means brain health plus brain skills. And basically what I do now is I go around and work in economic policy and policy entrepreneurship to say to heads of state and business leaders, brain capital is a vital asset. Brain capital is as important as GDP, is as important as road and bridge infrastructure and brain capital,

if you invest in it will drive your economic security, and also drive potentially your national security as well, which we can talk about another time. 

[00:14:48] George Vradenburg: I'm curious about how one does that and where one does that, because there are a lot of employers in the world. And as you mentioned, government is a big employer.

[00:14:55] Harris Eyre: Yes. 

[00:14:56] George Vradenburg: Exactly what should employers be doing and thinking about and measuring the capital they have within their own organizations and how to improve that capital, the brain capital of their employees?

[00:15:06] Harris Eyre: Yeah, I would say that a wonderful example is actually an initiative that you're involved in, George.

You and I together, you have a senior position, the Brain Health Business Collaborative. we need to engage in, recognize that there's been a lot of mental health in the workforce projects before, and they're great, like One Mind at Work. But when we're talking about brain health in the workplace,

this project that Kelly O'Brien is leading with Us Against Alzheimer's in the Milken Institute and Brain Health Business Collaborative is exactly on the money here. We need to engage big private companies, like Shell is engaged in this, as well as government employers as well, and we need to give them ideas and facts and knowledge.

But then, one of the things that's interesting, is a brain health score of your company. So could we assess the brain health of employees? And then start to rank order private companies, brain health scores, collective of their employees against each other. This could also help to drive dementia prevention and FINGER could be an example of something that drives up the brain health score of a company.

So, the logical progression would be, imagine if you could get an exchange traded fund where you have the shares of these big private companies, and you essentially choose the 100 highest brain health scored companies in the world and put them into an ETF to celebrate those companies and have those companies an ETF for brain health ETF traded on the exchange and people can invest in that, whether they're, Mr and Mrs Jones, consumer investors or whether they're potentially big investors like pension funds, and sovereign wealth funds could start to invest in and force company positive behavior to invest in the brain health of their employees.

So anyway, this is very exciting opportunity, I think. 

[00:16:41] George Vradenburg: Harris your mind is large and growing. I tell you, you're resilient, brain resilient. 

[00:16:46] Harris Eyre: Well, I take off to you, George. You're a good role model. 

[00:16:49] George Vradenburg: I'm not retired yet to Ian's point. So I want to figure out how it is that if one can identify the four or five or six, risk modifying behaviors,

how do we get people to do that? Behavior modification, it seems to me, is a large challenge and I would say the government policy is probably not going to be very helpful here because my guess is that Facebook knows more about me than my government and maybe what most stimulates me in terms of my socialization, my exercise, my diet.

So how do we get people to change their risk modifying behaviors at scale around the world? 

[00:17:26] Miia Kivipelto: Wow, that's a good question, but I can give a few answers. What we have learned from the FINGER. First, I really think that the brain health motivates people. When people know that this is something good for your brain health throughout the life course,

that is the motivational factor. People don't know. There are still many people who don't know that you can reduce the risk of dementia. So that increasing knowledge and awareness, I think, is number one. The second thing, I think it should be something positive. And that's why the five FINGERS, you don't need to change everything at once, but making it to be something nice, like dancing, like music.

So I think that is something exactly the answer. So that is something what motivates people as well. And the third thing, I think we can maybe learn more using new technology, we can maybe help, we can get help from the new technology to follow our behavior. And somehow the concept e-FINGERS could be something to further develop here as well.

So I think there are many things we can do. Final thing, I think, as you said, individual, we can do certain things, but the health policy should be there making the healthy choices to easy ones for everyone. 

[00:18:37] Ian Hickie: So I think George, that's a critical issue. A lot of health behavior. It's very hard to change individual behavior.

If you're trying to eat well in a family that eats poorly, if you're trying to move well in a family that doesn't do much, if you're in a family that never dances, it's hard to suddenly be dancing on your own. So one of the things I think is that we've got to think about the social groups and the cultures.

What can we do to encourage families? A lot of this happens now in childhood, early childhood development, early childhood education, the governments are investing in trying to support, and we of course classically do that. We've not done that so much around aging. We've not actually provided the social structures.

In fact, we tend to say to people, don't work, stop, retire, be isolated, and to see them as a burden rather than to capitalize on the contributions they could make in care, in education and others. So that the individual behavior change, I think your point is very hard, is really hard. It's much more likely to occur and be sustained for the FINGER things to work.

You can't just do them one day or three weeks or three months. You have to build it into your regular lifestyle that it happens for you and those around you. So I think, we need to look at what are the incentives for social groups, I think. Pleasurable things to be done, socialization things that are done, things that build on different cultures in different places to be reinforced, the social gatherings that people have.

And that may be through religious groups, through cultural groups, through other community groups. What are the things that we can capitalize on and invest in, whether they're private investors, whether they're by governments, whether by other organizations, to achieve the behavioral change at scale and then to use new technologies to enforce that. I'm associated with a number of these efforts in developing countries in the early childhood years. people are desperate for information about the right things to do with their children, the right things to do in their families.

And I don't think we've provided good information. What does work? Things that Miia was just emphasizing, what things can we do and what things could you find in your culture that allow you to do that? And to really reinforce the value of that is not just for entertainment, it's for really important health.

It's a pick up Harris's point. It's an asset for the community that we should invest in, and that will be important to the continuing economic development and social development of each of our families and communities. 

[00:20:37] George Vradenburg: One of the things that impressed me, and a couple of you have mentioned this, is the intergenerational nature of this, where you can actually have grandparents go talk to kids in the community, and socialize in that fashion.

Someone mentioned today, sort of a bench mothers, bench grandmothers. So you basically go out, just have conversations with people, greet them in the street, just say hello, it's remarkable when you see someone coming down the street at you with a scowl and you say, good morning to you,

and all of a sudden their face lights up. There's something about the interaction that we ought to be having every single day. I'm going to ask you something else. I know my H1C number. I know my blood pressure number. I don't have a brain health number. Is there a way to create a scale that might suggest all the FINGERS elements on it, maybe some of the cardiovascular elements on it, whether if we use this as a brain health scorecard for companies and their employees or with consumers directly? Is there some utility potentially in using that as a tool to get people

who scored a 10 and they could be at a 20, to say, okay, I'm at 11, how are you? I am a 12. What did you do that I'm not doing? Is that a useful thing to think about? 

[00:21:52] Miia Kivipelto: Yes!

[00:21:53] Harris Eyre: Let me go first and frame it and then these guys are more expert than me, but I think that we need to do this.

It's an absolutely critical project to work on, but let's do it at different scales because we probably need different types of brain health scores for different scales. Let's do a global brain health score where we can use data from like the World Bank and WHO and such and Gallup and whatever can help us.

So we have a global brain health score and national level brain health score, which of course, we know that the Institute for Health Metrics and Evaluation is working on with their Brain Health Atlas, but then we need to have a company level brain health score, which Kelly is working on and you and I, and then also for individuals, that's where it gets into multiomics,

I think about advanced biology, which, my two colleagues here are more well placed to talk about multiomics at the individual level. 

[00:22:42] Miia Kivipelto: I'm fully agreed. Of course, we should have a brain health score and having different type, not only one. And this is for me, the implementation gap, how we really can start implementing the research. It normally takes 15 to 20 years, which I think is too long time,

and this kind of tool and score would really help. This is also the step we can take to move to the precision medicine because we all have different risk scores that could be a motivational and educational tool. 

[00:23:07] Ian Hickie: George, I think you've hit the nail on the head. We now live in an age where you can get information all the time about what you're doing.

I now know how many steps I do each day and how many I don't do, various days, and it tells me immediately to change. And if you can do certain key things about how quickly you're doing things and brain measurement things, very simple ones, and if it changes, is that because, now we have to be careful here, it doesn't mean you're necessarily dementing, you may have slept badly, you may have not done as much exercise this week.

You can see the real time relationship between what you're doing and how your brain is functioning. Then people do make very profound changes. It's like cholesterol for heart, it's like other areas. It becomes consumer driven, not healthcare profession dependent, and you can make the changes every day. So I think in the new era of wearables, with simple neuropsychological tests that are now available, yes, that's where it's going.

And that, also in the developing world, most people now have access to those kinds of technologies in one way or another. So the sort of massive change we're talking about, scales, is no longer dependent on health professionals or high end tech, it can be done with lower end tech for really critical aspects of brain function that you can monitor.

And as long as we're really clear that it's changing, it doesn't mean you've lost it. It means you may need to look at it with you. Is it sleep? Is it exercise? Is it diet? And see how it varies, which a lot of us don't want to know, but how it varies. I drank too much last night, I was too stressed at work,

I need to relax more, I need to exercise more and see the improvement in your function. Just like with your physical fitness, just like with your heart rate, just like with your hemoglobin A1C, you can see the effect of lifestyle on your brain. In the past, we couldn't see that. Now we can.

 

 

[00:24:42] George Vradenburg: I'm enthused by this conversation, I really am. Both about what you started and continue globally around the world. The science of how it is that we now understand, different things about the plasticity or the resilience or the capacity of the brain at any point in time. And the fact that you're thinking at a global level on how to invest in this is really very impressive.

So I want to thank the three of you. I want to thank this audience, continue the efforts to think about how brain health is part and parcel of your life. Ask yourself, ask every member of your family, what is the memory that you'd least likely not forget, and just get a variety of things. And remember, maintaining your memory and maintaining your brain health is so critical to all aspects of life.

So thank you. 

[00:25:30] Dan Kendall: Thanks for tuning into the Brain Health News Podcast. 

Be sure to visit healthunmuted.com for more information about brain health.

Please also visit www.davosalzheimerscollaborative.org for more information about the work they're doing to promote brain health and end Alzheimer's globally.