How To Build Cognitive Resilience


Welcome to Better Brain Fitness, hosted by doctors Josh Turknett and Tommy Wood. In this podcast, we will explore the frontiers of how to keep our brain fit and healthy so that we can perform at our best and do the things we love for as long as possible. Let’s go. Hello and welcome back to the Better Brain Fitness podcast. My name is Tommy Wood and I am joined by my loquacious cohost, Dr josh Technet say hello, Josh. Oh, hello. I might live up to that title today we’ll see.

00:41 : We have a great question from Greg in Fort McMurray, alberta. So up one of our neighbors to the north. Welcome, Greg says. If I wanted to be able to plan and execute a 5 hour driving trip to a relative’s house at Christmas when I’m 100 years old, what cognitive area should I work on now in my fifties, to ensure I have enough cognitive headroom to safely do it? After the inevitable decline of the next 50 years, are there any specific levels I should reach in those cognitive areas? This popped into my head while listening to the podcast about mental frailty and mixed in my mind with recent discussions by Peter Attier of a centenarian Olympics.

01:22 : All right, Josh, what have you got for us? Ok, well, so first of all, I’ll talk a little bit about the concept that he mentions from Peter Otia’s book Outlive, which I recently finished. Recommend it it’s good. But he frames the conversation about longevity by first identifying the things that he would still like to be able to do if he were to reach the age of 100 and then kind of work backwards from that. And he refers to this as the, I think the centenarian decathlon so choosing like 10 events that you compete in at that age.

01:58 : And so an example, one of one of which is being able to lift a 30 pound suitcase into an overhead bin on an airplane, right. So these are kind of, you know, sort of normal everyday activities, but ones that would be associated with being able to live independently and being able to do the things that you want to do and bring happiness so it’s a great framing for health and longevity because it emphasizes this idea that our capabilities in our health are kind of two sides of the same coin, and they’re also the reason we care.

02:30 : We want to continue to stay healthy so we can continue to do the things that we love most so living long just on its own isn’t the goal, but living well for as long as we can is right. And it’s kind of mission mission of this podcast as well that we say in the intro to be able to do the things we love for as long as possible so this framing kind of helps to maintain that longterm perspective. You know, it’s possible to sacrifice your longterm health for shortterm gains and performance. And if you focus on more shortterm goals, that can lead to that sort of thing happening so this longterm thinking helps to present that or prevent that.

03:12 : So here Greg’s asking about the same ideas kind of applied to our cognitive abilities and our cognitive function so if we were to set a goal of the things that we will still want to be able to do later in life and then frame our current brain fitness efforts around that. And I think it’s a great exercise to think through, you know, what that set of things will be are going to be partly individual for sure. And they should be individual because they’ll be specific to the things you care about most. And maybe there’s an episode or episode or two in here for where we might talk through what this would look like for us.

03:49 : But to try to constrain the conversation today that so that I’m not too loquacious because this one could get quite huge. I’m going to stick to the scenario of thinking through maintaining driving ability, you know, and go through kind of the thought process there. First I’ll step back and kind of present the challenge that we face so we’ve introduced this concept of demand coupling multiple times on this podcast, discussed it in the last episode and the basic concept is that the health of our tissues is driven by the demands we place on them.

04:26 : And furthermore, there’s evidence that this phenomenon becomes an increasingly more significant driver of health the older we get. So, for example, there are studies that show that muscle tissue atrophy after bed rest increases considerably with age. So there may be other factors maintaining tissue health in the absence of demands during youth in early life that dissipate as we get older. And by the same token, the older we get, the less we tend to demand of our brain and bodies.

05:01 : So in other words our tissue health becomes increasingly contingent upon the demands we place on it. At the same time as we are reducing those demands and as our capabilities diminish, our tendency is to adjust our demands accordingly and or to compensate. A couple years back I had played it singles matched in tennis with someone and in it was in is in the summertime it was hot it was like three sets we were wiped out afterwards and as we’re coming off the court, he says to me with in all seriousness, you know, I think that once you hit your forties you should only play doubles mean you like this is just too much for people our age, right.

05:44 : And that’s just a it’s a very common and pervasive kind of sentiment. So because of this phenomenon where, you know, as we get older, our tissue health becomes more contention on demands with something like driving, right when we’re young, we might be able to not drive for a few weeks and not see any significant decline, whereas when we’re older, might not drive for a few weeks and there might actually be a meaningful reduction in our abilities. So if this phenomenon becomes more and more significant as we age, then it means there’s more that we must do to maintain as we age. And you can easily see how this turns into a vicious cycle.

06:25 : And this, you know, happens across the entire spectrum of our physical and cognitive capabilities. So you know, not quote aging in the sense of it either being irreversible or inevitable, but it definitely does tend to result in a decline over time and probably the biggest force driving that decline in most people’s lives. Now, the challenge with something like driving is that the things that we care about, you know, having an accident happen at the extremes, so someone slams on the brakes, you know, runs a red light, you get caught in a thunderstorm, whatever.

07:01 : And what we want to know is that we can still perform well at those extremes. With driving, though, we don’t know there’s a problem until it’s too late, right. And this is actually a really good analogy for health and for the concept of frailty and it gets kind of at the heart of what we’re trying to do you know our health is reflected in the range of conditions where we can continue to maintain homeostasis.

07:23 : Our driving ability is actually reflected in the range of conditions where we can drive and not crash, right so a decline in either of these means there’s a constriction in the range of conditions where that’s true where we can still maintain performance. Now fortunately there are other activities that share many of the cognitive demands of driving and we’re pushing ourselves to the limits, doesn’t risk major bodily harm. So specifically the functions that are most important for driving and the ones that we know that are impact impacted first as we get older are things like reaction time, processing speed, cognitive effects, flexibility, attention.

08:07 : You know how well you can stay on focusing on one thing not getting distracted by irrelevant stimuli, executive function. Those are the things that are, you know, most relevant and most likely to be affected early on. Now, the temptation might be to isolate out these specific functions and try to train those individually. And in fact, that’s what a lot of the early brain training apps we’re trying to do. The problem is that doesn’t translate very well to real world improvements and cognition. And I wrote about this a little bit in the last Brain Geo Connection newsletter is another example of the allure of reductionist thinking. But what the research has shown is that the stimulation that we get from a real world cognitive skill is likely significantly different and much more than the sum of its parts so we can’t just break it down and its pieces and train those up and assuming we’ll get benefits in the whole thing.

09:07 : So holistic real world activities like music, dance, skill, sports are going to be the things that provide the most powerful cognitive stimulation and the ones most likely then to keep the specific functions related to driving and other things that we care about in good working condition. Of course this is the approach that we strongly advocate for. So the ideal there being kind of always be developing and supporting multiple real world whole brain cognitive skills with things like music, dance, skill, sports being activities that can push the limits of our cognitive abilities.

09:46 : There’s a really great study that I talked about in a recent newsletter that’s very relevant I think here where they looked at old and young pianists, both experts and amateurs in each age group and they tested individual cognitive functions in each. Some of those functions were related to piano playing and others weren’t. And what they found was that the older expert pianists, who were significantly older than the younger cohort, performed as well on cognitive tasks that were related to piano playing as the young expert pianists and significantly better than the young amateur pianists on those cognitive tasks. So just to emphasize that again, these older individuals perform significantly better than their much younger counterparts on multiple tests of cognitive function.

10:42 : So young or old, the key driver of cognitive function was how much they challenge those particular functions through a real world, holistic cognitive skill, in this case piano playing. And so the message, you know, time and again is that training Trump’s age in both the physical and cognitive realms, also importantly, the thing that determined whether an older individual had maintained those high levels of ability with how much they practiced in the past ten years, again, the tendency is to do less as we get older, and that includes practicing less.

11:23 : And that’s typical with musicians. You know, it’s typical to practice a lot in your younger years and then priority shift and you end up, you know, doing other things which as this study shows, that’s the thing that drives a decline in those abilities and the related cognitive functions. So again, key takeaway, I think just like in the physical domain, we want to build as much headroom as possible and the issue is that everyday life rarely challenges our cognitive capabilities. We’re not operating typically anywhere near the upper limits of them, just like everyday driving doesn’t challenge our driving abilities except when we’re at the extremes.

12:05 : But there are many wonderful activities that do push us to our upper limits and that can help us to raise those upper limits and that also happen to be lots of fun. And so there are many options, which means that we can customize them to our interests, and they can evolve over time as our interests and our needs change. If we take a sport like pickleball, if we were to reduce it down to its elemental cognitive functions, we’ll find lots of overlap with driving, especially in those most critical domains.

12:39 : But there we can push those abilities super high without risk of bodily harm, right? And do so in ways that we never would in the course of our everyday life. So it provides A cognitive challenge in a cognitive stimulus many orders of magnitude greater than daily life so, for example, when someone smacks a ball at you as hard as they can from a few feet away, which is a regular occurrence in pickleball, you have to react incredibly fast in order to get it back. And I can tell you, I’ve played against people in their seventies and even eighties whose reaction times are probably, you know, 4 standard deviations ahead of their peers and way faster than people, you know, a quarter of their age who aren’t trained.

13:25 : So just like in the piano study, it’s because they’ve continued to stimulate those capabilities, which, you know, this day and age becomes increasingly uncommon the older we get and so is unusual. They’re also, you know, lots of strategic elements involved in sports, including pickleball there’s keeping score. There’s, you know, standing in the right place depending on where you are in the game, you know who keeping track of who served last. And so there’s lots of opportunities to, you know, tax working memory and executive function.

13:56 : Lots of demand being placed on cognitive flexibility as you’re always have to, having to shift your rules and schemas for whatever’s happening at the moment. So again, you know the that’s why these particular domains and these particular activities are so great for enhancing and building headroom. This podcast is brought to you by the Brain Joe Academy. The Brain Joe Academy provides brain boosting whole brain stimulation in the form of neuroscience based musical instruction designed for adult brains and with no prior musical experience required. Start your brain boosting musical journey today at Brain Joe dot Academy. One final thing I’ll say is that if you’re wanting to maximize the brain benefits of an activity and it’s translation into other areas of life, then making sure that you’re spending some time trying to improve in whatever activity that is isn’t really important.

15:02 : So, you know, being mindful to include some level of regular challenge where you’re pushing yourself to the limits of your current ability and trying to drive adaptations, which sometimes referred to as deliberate practice. You know, in Pickleball and other sports, it’s common, you know, for people not to make an active effort to continue to improve. But the way we increase capacity or build headroom is by stimulating adaptations in the more headroom we build, the more resilient our brain and cognition becomes. So, you know, in the case of pickleball that might be drilling sometimes with a coach or other players or playing against better players. It’s common it’s quite common in doubles for the strategy to be hit it to the weaker player, which is, you know, well and good if your only goal is to win, but not good at all if you’re out there to challenge yourself or to stimulate adaptations and actually improve.

15:58 : So I’m usually the oddball who doesn’t want to adopt that strategy because I’m more interested in challenging myself than I am in winning. But hopefully, you know, with this mindset, maybe there’d be more people out there. I’m thinking that way, and of course it applies to any brain fitness endeavor it would apply to music as well you know, you could sit down and play the same songs every time, which would be better than nothing. Or you can do things that continue to challenge yourself, you know, that push your push to the limits of your present ability, which of course will then have the added benefit of translating into growth as a musician.

16:33 : So like the, you know, perhaps the peak challenge here would be playing unfamiliar material with other musicians who are better than you, right? Again, all of that would require split second reaction time and decision making, really sharp attention, cognitive flexibility and so forth. So that’s my loquacious way of kind of thinking through this question. And you know, I focused here on the demand side of this equation, partly because it’s so commonly overlooked.

17:01 : But as we’ve talked about many times before, making sure your lifestyle is one that supports the brain’s ability to grow and adapt and maintain health is also critical to ensuring that those demands actually translate into increased capacity and resilience. And of course, that’s a gigantic topic all on its own. All right so that’s what I have in response to Greg’s excellent question. Anything else, Tommy, that comes to mind? Yeah, i guess a few things came to mind based on that the 1st is that there’s a possibility that some of these, well, i would think about other things that help support these processes as well so that pianist paper that you mentioned, they also had an aspect of the paper where they looked at nonspecific cognitive functions, right they actually use something called the digit symbol substitution test, where you get you have to learn a series of random symbols that are associated with numbers and then you just get like a sheet full of numbers and you have to write down the symbols associated with each number as fast as you can.

18:19 : And I actually have done some recent studies using data that include the digit symbol substitution test that come from the N Haynes data set and look to this in you know individuals in their sixties and older so hopefully you know they didn’t have anybody in the data set out who’s 100 years old but hopefully it’s still relevant to Greg’s question. And we looked at a whole bunch of things that may be associated with your performance in this test and it the performance does decrease with age, as you as you might expect and that’s what they showed in the pianist study as well.

18:54 : But some of the general health stuff seemed to support some of these like nonspecific cognitive functions which may still be relevant, you know, as you start to plan a complex journey, you know, in your tenth you know ninth or tenth decade. So things that popped up in our analysis that were really important were like vascular health, so blood pressure was really important, blood sugar regulation, HB A1C was important. We’ve talked previously about homocysteine and inflammation so if those were elevated that was associated with lower scores. And then multiple aspects of physical activity were all independently associated with better performance so that’s more aerobic activity, more resistance training, more vigorous like sort of high intensity training because all of those variables were kind of in the data set so these general lifestyle factors seem to support your nonspecific cognitive function as well, which I think is relevant here.

19:50 : So that’s worth thinking about as well and then of course, right, if you take a pickle ball, you’re probably doing a few of those things because the exercise helps to decrease inflammation it’s both, you know, vigorous and aerobic physical activity And so you can probably tick many of those boxes that’s why we like these very human activities, because you do multiple good things at the same time. One thing that’s. Maybe we’re thinking about is ensuring some kind of resistance training in particular.

20:20 : The reason why I say that is because if you know you need to maintain your reaction time, but you also need to maintain the musculature that supports rapid movements to say if you suddenly need to slam on the brakes, that’s going to take a type of muscle fiber called a Type 2 muscle fiber and those are the muscle fibers that you seem to lose preferentially as you get older. And those the ones that respond best or can be maintained best with some kind of strength or resistance training so like that’s maybe going to be important as well.

20:49 : And then finally, I did think about some other things that support these multiple cognitive processes required for driving. And one of the ways that you might do that in a safe environment is with a driving video game. And we, you know there’s some nice data on the ways that video games can support various aspects of cognitive function we’ve actually talked about that before. But I kind of thought that if you know, in addition to some of these other activities, if you are particularly interested in driving or you know any, a cognitive function that you wish to have for decades to come into the future if there is some kind of gamified or automated computerized version that you can incorporate in addition to all these other things, that then that may be worth considering so for driving is probably going to be better if it’s more of a realistic simulator rather than Maricart maricart, of course is a lot of fun you can do with your friends and family get a social aspect.

21:49 : But there’s no, you know, there’s no punishment for driving off the track really you just kind of get like plunked back on and you can keep on going whereas if you maybe did a more realistic simulator, then you know that your time to get around the track and when you’ve like sort of crash into the side, it’s a real pain to kind of get going again so maybe some maybe some of that is worth thinking about as well particularly if you if you really enjoy driving that’s something that could go into the list as well.

22:20 : Yeah, that’s, those are great points. I think that if your goal was just the driving piece, then yeah, doing a driving simulator, perfect way to do it. If you’re wanting to ensure that your efforts are translating into other things and sort of you know, doing maybe more general types of activities. And I guess that’s that was one of the motivations behind the Decathlon concept was trying to choose 10 things so that you don’t over index on any one thing, right.

22:48 : But of course, like if something really matters to you a lot like piano playing, do that thing. You know what I mean? Like that’s step one right. Making sure you continue to do that thing the support side is interesting that there are likely factors that at least in our current world matter that impact these processes that we care about the most commonly like you’ve identified some of the you know blood pressure and metabolic health and so forth. And so if you were going to flesh out the support side, talk about areas if you were going to prioritize where you wanted to focus your energies and ensure that you are, you know, paying adequate attention to and that’s a whole, that’s a really interesting topic as well.

23:40 : And yeah video games are great for this too i almost included that in my in my answer but I am they’re great because they can provide a challenge that in some ways it can be hard to replicate in the real world right. Like in you’re playing a sport you’re limited by what the other player can do, right whereas like you can set the parameters to be as hard as you want in a video game and you can push you conceivably push yourself further, you know building further capabilities then you might not be able to do in another setting.

24:10 : And there are some I think some great games that are really great for that i think that just video games in general that are designed to sort of optimize for fun tend to work better than specific training games that are optimized to train a function. You know, again it’s back to holistic versus reductionist kind of approach to things so and there are plenty of games that are fun and would be great for the brain fitness. Ok, Anything else to add Tommy? I would actually say one thing because Greg’s question includes the, you know, what level should I try and achieve in a in a specific function, you know, now assuming some decline in the future.

24:54 : We talked a little bit about that idea on a previous episode we talked about like how much is enough skill so maybe pair this one with that one to help you know, answer that part of the question as well great nice call back. All right. Well, thank you, Greg, for that excellent question. I’m sure we’ll come back to these topics many different times and something I’ll continue to think about, including the idea of the centenarian decathlon for cognition. Well, if you have any questions that relate to this podcast or any others about brain health and fitness, please feel free to send them our way you go to