Brain Health & Dementia Prevention: Barbara Sahakian's Insights

[00:00:04]so our second speaker this morning is Professor barara sakim from Department Psychiatry bar completed her PhD at Cambridge as well as being a basic scientist is also an honorary C psychologist at aten Hospital bar is a co-inventor of canab and oton which are neuropsychological tests used globally and today bar will talk about achieving better brain health and wellbeing of older age and early detection of memory problems well the aims of the talk today really are to promote good brain health so brain health as every bit as important as physical health and I think we're only beginning to realize that um through the fact that so many people are off work due to mental health disorders and they are are certainly a blight on individuals who have them also to emphasize the importance of cognition resilience and well-being throughout our whole life course and to old age as well and probably importantly for this audience is to discuss evidence-based ways to improve cognition well-being and mental health and reduce the risk of cognitive decline and dementia with aging and finally to consider the use of technology to improve learning memory and motivation in patients with mild cognitive impairment and stroke I first got very interested in uh the lifespan approach to good cognition and and good well-being when I worked on the um UK government Foreside project on mental capital and well-being I was a neuroscience lead on that project and it was really to the government wanted to enhance cognition resilience and well-being over the life course um it found that obviously we have a large aging population and of course age is a big risk factor for dementia and also they realize that uh Depression was very high so they wanted to ensure that people had good wellbeing so we took this life course approach and we tried to identify factors that would improve cognition and well-being such things as a good education and a good social support system and those are in blue pointing upward and then we also wanted to identify the detractors from good cognition and good wellbeing and those are in red pointing downward such things as stress and also substance abuse so today I'm going to talk about southern evidence-based ways to boost cognition and well-being and the reason these are so important is because with everything including physical health it's much better to try to prevent than to try to treat after the damage is done so uh this is the importance of this so I'm going to talk about uh getting optimal sleep uh having exercise having healthy nutritional eating social connection um giving to other people the sort of volunteering work mindfulness and uh also learning throughout your life course so we did this very large sleep study um and we looked at middle-aged to older adults and of course we used to think of sleep as a rather passive process but now we know it's an incredibly active process it's an important component of maintaining normal brain functioning and the Brain actually reorganizes itself and recharges itself during sleep it removes toxic waste byproducts and it boosts our immune system and we just heard about the importance of that and sleep is also very important because we consolidate our memories during our sleep and in our recent study in nature aging uh with almost uh you know we had these 500,000 participants we showed that seven hours of sleep was actually optimal for cognition mental health and well-being in middleaged to older adults and you can see that here that for cognition if you have seven hours of sleep you have better performance uh but so you have reduced symptoms of anxiety and reduced symptoms of depression and then we also had a subset of participants who under what neur Imaging and that showed that insufficient or excessive sleep was associated with smaller brain volume areas and thickness and exercise is incredibly important it boosts your cognition it's kind of allrounder because it improves your move it boosts your cognition it's good for your brain and it's good for your physical health so it's one of the best things that you can do and exercise is associated with improving cognition including both executive function and memory across the lifespan and this study looked at people from 18 to 79 years of age and you can see that as the exercise increases you get better executive function better memory and also other Studies have shown that you have uh lower mortality if you exercise so it's it's not only good for your cognition and you move but it's also uh means that you live longer and one reason for this is that exercise may lead to Greater plasticity of the brain healthy and nutritional eating so nut nutrition can substantially influence the development and health of the brain structure and function it actually provides the proper building blocks for the brain to create and maintain connections which are critical for improved cognition and academic performance and evidence has shown that if you have long-term lack of nutrients it can lead to structural and functional damage to the brain and so a good quality diet is related to larger brain volumes therefore whatever your age in the lifespan you should eat a well balanced diet including fruits vegetables and cereals and two of the key ones are the Mediterranean diet and the M diet and they've both been evidence-based so in our study of uh 19,000 pet pants from the UK biobank we showed that if you have higher intakes of cereal and lower caffeine diets that's associated with increased volumes of bra brain gray matter and improved cognition and we looked at cognition across a whole range of tests and you can see that if you have increased serial you get um better performance across a whole range of tasks and if you have reduced caffeine you get better performance across the whole range of tasks but diets that are rich and sugar saturated fats or calories can damage neurofunction and they can also reduce the brain ability to make new neuro connections which of course will negatively affect cognition now obesity is associated with an increased risk of cognitive decline with aging coronary heart disease stroke cancer and type two diabetes and of course type 2 diabetes is a risk for dementia and it used to be that you'd only see typee 2 diabetes in older adults but of course now we're seeing much more uh type 2 diabetes in in Children and adolescents so it really is a substantial problem and importantly our study that we just uh just talked about with the high seral uh and low caffeine diets that were associated with increased brain volumes and better cognition it also uh that was associated with optimal BMI so uh you had the body mass index was optimal with those diets so you know we're social animals and we have a social brain you just saw at the beginning in the introduction that um there's a whole Now new section for Cambridge Neuroscience on the social brain and so it's very important that you know we interact with other people and of course it's been a a great disadvantage during Co 19 because people have been deprived of a face-to-face contact in many cases and social isolation and loneliness prevalent across all ages genders and cultures and both were made worse by the co 19 pandemic lockdowns our recent studies showed that there were negative effects of Co 19 on isol of isolation on emotional cognition but this effect was smaller it was reduced in people who stayed socially connected during the co 19 lockdown either through you know social media or some of means zooms and whatnot um they actually had a better outcome so developing social connections and alleviating loneliness is also associated with decreased risk of mortal ity as well as uh a decreased risk of a range of illnesses and social interaction is associated with positive feelings and increased activation in the brain's reward system so it's important to keep up with family and friends but also to expand Horizons and make new Connections in our recent study uh in children in E life um and Adolescent showed that five close friends was for brain structure cognition and mental health and this this was actually the experimental data that we found and we we don't really understand exactly why that is but what we suspect is that if you have five close friends if one of them or two of them are unavailable or leave you still have some friends to interact with but if you have if you say you have more than five close friends they're probably not that close or that you're spending all your time time interacting with your friends and not doing school work so it's not as good for other things so our recent study in neurology indicated that social isolation is associated with brain changes um poor memory and other forms of cognition and importantly an increased risk of dementia and older adults a study also showed that the negative impact of loneliness was mainly due to depression increased depression and we actually found that social isolation was was uh linked to a 26% increase risk of dementia and older adults so that's a big increase just in those people that were socially isolated and here you can see that social isolation is related to uh decreases in Gray matter volumes and poorer cognitive performance so giving a volunteering can also give a sense of meaning in life it promotes happiness health and well-being and older adults who volunteer regularly also have Greater Life satisfaction and reduce depression and anxiety so making other people happy is actually a great way to make yourself happy kindness altruism and ly can affect the brain one study showed that making a charitable donation activated the brain's reward system in a similar way to actually receiving money yourself so donating to societal causes recruited the VTA ventral Statum Network and also involved which is also involved in monetary rewards and it also activated a subgenual area which is involved in Social attachment and social affiliation and reward mechanisms so mindfulness taking notice um being in the moment uh really sort of reducing stress through um focusing on uh important things in the environment or beauty in the environment very important to do so structured meditation and mindfulness training have been shown to improve emotional regulation reduce stress anxiety and depression and help prevent substance abuse and these uh types of symptoms of stress and anxiety and depression have all increased during the co 19 pandemic and in addition to these short-term psychological benefits recent reviews also indicated both both structural and functional brain changes and regular practitioners of mindfulness and meditation training in our own study on mindfulness practice during Co 19 pandemic showed that the training was associated with lower schores of depression and anxiety so learning new things and this is what I love the most because uh you know we're in education and here you all are learning new things and it's important to keep your brain active throughout the whole life course and keep learning so the brain changes during critical periods of development but it is also a lifelong process learning new skills can modify both brain function and the underlying brain structure for example juggling has been shown to increase white matter um structures in the brain associated with visual Motor Performance and similarly musicians have been shown to have increased gray matter and parts the brain that process auditory information learning a new language can also change the structure of the human brain so large reviews of the literature suggest that mentally stimulating leisure activities increase brain Reserve which can instill resilience and help protect against cognitive decline in older adults be it chess of cognitive uh games so the idea is that you can build up cognitive Reserve through all this learning that you do through your life and then when you have an event uh such as depression or Alzheimer's disease your outcome will be better than other people who have not built up cognitive reserve and this has been shown for depression Alzheimer's disease and traumatic brain injury and of course learning generates new brain cells that's been shown in animals so many years ago uh I wrote this paper for the bmj with mon Orel on use it or lose it and basically that's the idea that you have to keep those neural networks in your brain activated in order to keep them working well and Toco cinberg um at this in in Sweden has shown that 14 hours of training on a working memory task over five weeks was associated with increased brain activity and also changes in dopamine recept D1 binding potential in those areas that were activated and many of you will know the uh famous uh study by Ellen M Maguire and colleagues where she looked at taxi drivers in London and as you will know taxi drivers who have the black CS have to learn What's called the knowledge so they have to learn the location of places and space and take an exam on that in order to um be uh allowed to be these black uh cab drivers and what she found very interestingly was that size of the posterior hippoc campus increases with time spent as a taxi driver so as they have the spatial learning increasing uh through the time that they were a taxi driver they actually had increases in the hippocampus and of course the hippocampus is very important for remembering the locations of places and space so as you heard I'm inventor with Trevor Robins they can t tests and they run on a iPad or touch sensitive screens and they can go run over the Internet which was very helpful during the co 19 pandemic and they're they're widely used now in over uh 80 countries and 800 universities and research institutes and hospitals around the world and uh they're extremely helpful because basically you can assess objectively uh attention and concentration or different forms of executive function incling including cognitive control and you can also uh assess learning a memory or episodic memory which is of course very important for things like mild cognitive impairment the early stage of Alzheimer's disease because uh this is the first type of memory to go episodic memory in patients with the mild cognitive impairment and um Alzheimer disease so some of you may be unfamiliar with what episodic memory is and it's a very important kind of memory because it's our everyday memory it's what we use all the time all the time every day so it's you know when you go in park your car in a multi-story car park and you go away to shop or you go go to work or whatever and you have to come back and remember where you put your car that's uh episodic memory or if you're just about to leave the house and uh you suddenly think oh where is my my keys in my mobile phone and you have to remember where you left them that's episodic memory so you can just imagine how debilitating it would be if that kind of memory is impaired because all the things that you want to learn and remember you can't you can't do so here's a Canad test the visual spatial memory the objective test that you can use in a laboratory and what happens is uh these boxes come on the screen and the example I'm going to show you is some there's something in each of these six boxes but it starts off at a easier stage than this and it also builds up to a more difficult stage where there's eight and 12 boxes on the screen and basically you have to uh remember where these patterns go in the box so I would say to to you try to remember where that pattern is and if you can't remember it on the first go I'll I'll give you other chances but try to remember where that pattern is try to remember where that is try to remember where that is that one that one and that one and then they come up in the center of the screen and you only have to touch where it was so um most of you will remember it was in the sort of top left box and if they can't get all six in a single go then you get another try so it's a learning and remembering type of test and it's very sensitive to uh amnestic MCI and also to alzheim mild Alzheimer's disease and you can see here this was uh done with Paul Fletcher and others when you put people in the scanner you can actually see that healthy controls don't even need to activate when there's only four items in the six boxes and they start to activate AC at the hippocampus when there's uh six items so performance on this test activates the hippocampus and kab pal is sensitive to the early detection of amnestic mild cognitive impairment you can see the MCI patients are having to optimally um you know at the highest level activate when there's only four things in the six boxes and then they start to have problems remembering where things are and the activation goes down so I've always said that if we could only find a a drug treatment that would change the activation in the mild cognitive impairment patients to look like the healthy controls that would be a great treatment for the episodic memory problems and allheim disease and my cognitive impairment and poor performance on canab power is associated with the higher uh cerebral spinal fluid tow in patients with amnestic mild cognitive impairment that's worked by pic Nathan and colleagues and also uh with the severity of dementia so K have pal the worst performers are the ones with most severe dementia so I've been very interested in cognitive training because cognitive training does work it's been used in schizophrenia and other areas and uh memory problems and aging but one problem with cognitive training um is that uh you usually sit in front of a computer and it's a rather boring thing that people have to do so often people drop out of studies and trials with cognitive training because they they don't want to do it it's too boring and um so I decided to get a games developer Tom piery into the lab to gamify the cognitive training so I actually um developed with uh Tom some episodic memory and learning Gams uh based on our neuros psychological and neuroimaging evidence and Tom made sure they were fun attention grabbing motivating and easy to understand and I made sure that they were uh adhered to the um evidence that we had so that we would know that they were improving uh the uh hip cample um memory circuit and the we had we used one in MCI but this one has been technology transferred to a games company called Peak so this is called wizard this one's based on a daytime TV show uh type thing it's called game show and this one called wizard is based on a kind of Harry Potter thing where you have to remember where wounds go in a box so I'll just show you this briefly [Music] so if you can remember where the rooms go you get spells to cast at the other wizard so that you can win and move [Music] ahead [Music] so um this is the data from game show and you can see that there improvements in learning memory and patience with amnestic mild cognitive impairment so it we had them play it for eight hours over one month and uh we got these very good improvements and they also rated that they really enjoy doing it it improves their confidence and so forth so we've been able to Tech transfer that Wizard game to Peak so it's available to put on your phones and Things download from from the Apple App Store or um the Google Play store so uh that's that's worked out very well from that point of view and so finally because there's a lot of young people in the audience I'd say please try to um make sure that the uh public care about your important findings that you get from your research try to communicate with the public and one way you can do that is through the conversation which is a great way to do it and I'm sure Dera has many ideas too of other ways to do it so um these are the inclusions while many people monitor improve their physical health um using mobile and wearable technology they rarely improve and monitor their brain health and it's important we've shown in our recent study that having a favorable lifestyle including factors of sleep diet social con connection it's all associated with the reduced risk of depression so it's important to keep our minds active throughout life and work on our cognition and well-being and we can do this perhaps using technology such as apps and importantly we should start with education in school and make sure that people are all doing that so I just want to thank uh my colleagues as you can see here and um Christal Langley has a poster she's in the audience here and that's on um neuroscience and artificial intelligence so I hope you go see her post thank you very much