Will I age like my parent? Dr Norman Swan on the brain cliff, dementia and looking after yourself | Club Sandwich

Hi, Sarah.

So the concept is that we tend to confuse cognitive function, the cognitive function, our thinking and memory abilities during life, our general intelligence with falling off the age and cognitive decline. And one of the reasons I wrote the book is they're two entirely separate phenomena. And what we fear is exactly what you described, is that we fear at some point and many of us mistakenly believe it's inevitable, that we just fall off the edge. And I don't want to stigmatize dementia any more than it's already stigmatized. But at the bottom of that cliff we fear is dementia. So I thought there's a lot to be said. So you know, people like Henry Brodarti, quite rightly talk about diet, exercise and various other things, the 14 different things you can do to prevent dementia. But what's missing is a fundamental reconception of what happens to your brain, particularly from your 30s and 40s on, that you can actually do something about independent of your cognitive function. So no matter how bright you are, how many degrees you've got, whether you're a carpenter or a bricklayer, the brain cliff is the same phenomenon. And it's Avoidable, but you gotta think a little bit more deeply about it.

So my parents died in their early 90s, not so long ago and they lived in Glasgow and I lived in Sydney. So I was a distant Sandwich generation. And my mother particularly was quite bitter about the fact that she did didn't have children in Glasgow to look after her. So we avoided the opportunity, or didn't have the opportunity to be the Sandwich generation. They did not age well, even though they lived a long time, which is a very different phenomenon from today, is that people do tend to live to older ages in pretty good shape. And we can come back to that. So they, you know, my father was very disabled. He was bed bound, he needed a hoist to get out of bed and into a wheelchair. Complicated reasons why. My mother had mild vascular dementia which she kind of overplayed. So the psychogeniatrician looking after her, you know, things would happen and I would say, oh, it must be getting worse. And I'd consult with the psychogyriatriatrist and say it's not getting worse at all.

No, no and no, no, it was overplayed. My mother was a force of nature and, and so there was a personality issue with my mother which overplayed all that, which made it incredibly complicated. And it was very sad in the end that disabled as my father was, I always said that if my mother went first he would actually cope quite well, even though he was extraordinarily disabled. In fact, he probably didn't even need to move out of house, he just needed somebody to get him out of bed and he could move around and so on. But I predicted that if my father went first, my mother would not cope. And that's actually how it played out. And in the end she took a bread knife to a carer and then threatened the police who came around and she ended up in a locked ward. Oh no, terrible story.

And. And my brother went to visit her and she, you know, he was told not to return because she couldn't cope. Eventually she got discharged. It's a terrible story. She got discharged to an old age home or a residential aged care in Glasgow and died two weeks later watching television. So a very different story from a lot of people.

I don't know what it was.

you've got all that. People listening to our conversation are feeling guilty because they're not doing enough and so on. And here you are across the world with an incomplete story.

Yeah. You do accumulate disabilities as you get older. So it's not as if it's disability free. But, you know, the question is how you define disability. So is knee arthritis a disability? Yes. But you can get a knee replacement if you're lucky enough to have private health insurance, and then you're pretty okay. Is a stent in your coronary artery a disability probably gets defined as such, but if it gets fixed, you're okay. It's the brain that is the focus of this. That if you are falling off the cliff, that's what. That's the problem. So that's why my father would have done better. Left behind his brain. There's nothing wrong with his brain. It was his body. But with an intact brain, you do much better than if you're falling off the cliff.

I don't think there's a single person listening to what we're talking about who wouldn't agree.

There's no question about that. No question about that.

It's a really good question. So in my research for the brain cliff, my idea was that there was something separate, very separate about the brain cliff from cognitive function. And in fact, the genetics prove that. So if you look at the genetics of how bright you are, how intelligent you are, how much memory you've got, that's very strongly genetic. Could be as much as 90%, but obviously it's influenced by how much education you do and so on and so forth. However, the brain cliff, is only 26% genetic or thereabouts, according to some sophisticated research, which means it's 75% environment, how you live and how you have lived and those influences on your brain. So you actually have a lot of control over the brain cliff, Much more control than you have over how bright you are during life.

No. No, it doesn't quite work like that. So, for example, it depends what kind of dementia you've got, what age your parent got it. So, for example, what they used to call pre senile dementia, which is you're getting Alzheimer's disease at a young age, that is strongly genetic. That's a 50% heritability. It's called autosomal dominant. Later on in life, if you've got a parent with Alzheimer's disease, you are at increased risk, but not as much increased risk as you, as you might think.

Yeah. And Henry Berdotti is an interesting. Professor. Henry Berdotti is an interesting example. He has got a family history of Alzheimer's disease, but he's doing very well and he's working very hard to. To prevent it. So it's not. And the vascular dementia is more environmental. It's how healthy your arteries are. And then there are other forms of dementia, such as frontotemporal Lewy body disease, which are much less understood, but they are not as common.

It is. But I also think if you look at the evidence in the brain Cliff, self care for the sandwich generation is incredibly important. Some of the things you subject yourself to. Sorry, it's wrong to say subject. That sounds like I'm blaming people. But some things that you are subjected to or experience as a sandwich generation could accelerate brain aging.

So I'm not, you know, unfortunately, I. I cannot settle people's minds on this because I think it's true. But there is. The good news is you can do something about it. And I think it's probably worth just talking about you. You alluded to it earlier about brain aging. And I don't talk about brain aging very much. In the brain Cliff, I talk about brain, brain change. And one of the researchers I spoke to, Maureen Irish at Sydney University at the Brain and Mind center, is very angry about similar things that you're angry too. In Club Sandwich, she says that you, what we do in neuroscience is compare Everybody to a 20 year old or a 25 year old and you know, we're not as good as a 25 year old. And it's all declined from there. And she said, and that's because we've really only researched in detail 20 year old adolescents, 20 year olds and the elderly define that as whatever you like. But it's people who are 60, 70, 80 years old. What hasn't been well researched is the sandwich generation age group, which is 40 to 50. What some researchers do is they realize that they haven't researched that, so they fiddle the books and they claim that being 60 is midlife. Well, I don't know, many hundred and twenty year olds midlife is 40, 50, 55 or thereabouts. And what Maureen Irish talks about is that we don't understand that group as well. And what is happening is not brain aging is brain change. And another researcher at Ann Arbor in Michigan, Patricia Groter Lawrence and a colleague has described what's happening as a scaffolding in the brain as we get older. So it's not that our brains function less well, it's that when you look at how the brain does the tasks of life, it actually changes the way they do that. And when you understand that, you understand what gets in the way. Let's say you trained as a teacher and you learned how to do a lesson plan, and you're doing your first lesson plans in your 20s, in your first class. Well, you're probably only using a little bit of one side of your brain to do that. Ten or 15 years later, you're doing lesson plans probably better than you've ever done them before. But if you were to do a functional brain scan on you, it's spread to the other side of the brain. You're using more of your brain to do the same job. Now, you could look at that negatively, or in my view, you should look at that neutrally. It's just your brain's changing and it changes the way it works. And this scaffolding goes across the brain to do the same job and at least as well, if not better, come back 10 or 15 years later, it's actually moved around to the front of the brain. So your whole of the brain is involved, but particularly the part in front of your brain called the prefrontal cortex, which is an incredibly important part of the brain. So the point here for the sandwich generation is what is that doing to your scaffolding? And what Patricia Roger Lawrence talks about is you, you want to be encouraging the scaffolding and not allowing stuff to get in the way of it. So what I did in the book was talk to seven cognitive superagers of very different backgrounds.

Well, no, some one was 110.

They were certainly over their mid-90s. You know, from a female mathematician who taught Mick Jagger statistics at LSE to an illiterate shoemaker, to, as I say, this 110 year old minister in Melbourne who still conducts services and sometimes teaches kids at Scotch College. So very different people with very different

And it tracks right back to the scaffolding story that really hasn't been talked about. And it's this prefrontal cortex. So your brain is busier as you get older, doing the same job. It's working harder, it's working harder, so you don't want to distract it.

In theory, it could be good for it. You've heard the phrase use it or lose it. It's actually not a sufficient description of what you need to do to keep cognitively healthy as you get older. And the analogy I use is muscle training. So if you want to build muscles and you've never done it before, you might start with a two kilogram weight. Two weeks later you need to be on four kilograms. Three or four weeks after that you need to be on six. You constantly need to be putting your muscles under more demand than you feel able to deliver. And your brain is the same. So your cognitive demand has got to be high. So you're constantly exercising the brain. So this multiple demand on the brain that you describe could actually be quite good for your scaffolding.

It is. But the things that you're describing are complex in their own right.

So you've got multiple things in your diary, you've got your own kids to manage. And if you're a woman, unfortunately you're often managing your partner as well.

That's right. Sister Angela Mary, who learned Mandarin in her 70s.

She's an incredible person.

So those are complex tasks. You're holding lots of different concepts in your mind. You're thinking about the implications, how am I going to get there? These are not simple tasks. So you're exercising your brain fully. The problem is how you respond to those tasks. That's what I want to talk about. So for example, the people that I spoke to, it's not as if they've had stress free lives. They've had quite stressful lives even since Sister Angela Mary of the Sisters of Mercy in Brisbane who ran the Martyr hospital group. She had a very stressful life. But it's how you respond to stress. So all these people that I spoke to, they get over it. They don't ruminate.

Rumination is brain toxic.

They're very different.

No, stress is not necessarily bad for.

It's how you respond to the stress.

So here's the toxic form of the stress which is where you feel you're losing control of your life where other people are making decisions for you or other factors are involved in your life. And psychologists call this locus of control. So the question to ask yourself is, and this is what you're alluding to, and this is what you talk about every week, without necessarily putting a name to it, is where do I feel my life is controlled? Is it here within me that I've got agency over my own decisions? Or is it over here? So if you live in disadvantage, it's not within yourself, it's over there because you're just living in poverty and that poverty dominates. If you, you know, job with a lousy boss and that boss is micromanaging, it's with your boss. And if it's the life of your parents driving those decisions, that's the kind of stress that is actually quite toxic.

The answer is yes, you can, but you want to be aware of the risk of it and try and minimise it, which is that you should not feel guilty about unloading, you should not feel guilty about other people taking this on, even though you might have an elderly parent who doesn't want somebody new coming into the house.

But also, if you're lucky enough to be able to build in systems which help you out, and sometimes that costs money and you don't have the money to pay for it, I understand that. But if you can build in systems that you are not taking the total load and that's being shared and, you know, the awful situation which really disrupts families is you've got three kids, you know, girl and two boys, they're now adults, but it's only the daughter who's the sandwich generation. The boys just sail through. But it's unloading and unloading is not a bad thing and you've got to actually be quite ruthless about that.

Yes.

Better at ruminating or.

your brain and where do you ruminate? You ruminate in your prefrontal cortex, that part of your brain that's really important to the scaffolding and you've really. So it can be hard to shift or it can be. So it's really not good for your brain. So what we're talking about here is unproductive thinking. That doesn't get you anywhere, doesn't solve problems, it just keeps you up at night and bothers you and bothers some people more than others. So there are tricks that you can use. If it's not deeply held, you can have a band around your wrist. And when you notice just doing it, flicking it so that you fly.

Yeah. Or, you know, some people might need cognitive behavioral therapy. And, you know, going to an experienced clinical psychologist that can help you through all that so that you recognize it, you're aware of it. And what Maureen Irish studies is something that's really fascinating, which is called mental time travel. And I think people are going to hear much more about this as the years go by. This is the idea that you center yourself in the present, you think about the past, and then you project yourself to the future. And when you do that to somebody in their 20s, they're crap at it because they haven't got a past. So you can't bring your past to this. And so when you project the future, it's all about me, where I'm at, and not contextualize when somebody is in advanced years. In life, it's all about the past, because you don't like thinking about the future. But people who do think about the future later in life do well, but it's contextualized in terms of the present. You do pretty well. The people who do best at it are actually midlife because it's kind of balanced there between past, present, and future. And that process can help you snap out of rumination, but it's also pretty good for your scaffolding.

about things you've done, this is more about mind wandering.

Letting your mind wander is good. And what's going on in your brain when your mind wanders is that new neural networks are being activated in your brain. So 30 years ago, when they started looking at the brain in action, doing brain scans, which part of your brain lights up when you do addition or multiplication or what have you? They started doing that. They realized they had to be able to scan the brain at rest. So that when they said, what's one and one? They knew which part of your brain lit up because it was compared to your brain at rest. So what they would do is they put you in a scanner and they'd say, they have a little cross painted above you. And they'd say, all we want you to do in the next few minutes, just look at that cross. Don't think about anything in particular, just look at that cross. In theory was putting the brain to rest. When people did that, the brain went nuts. They saw networks light up that they'd never seen before. So the brain didn't go dark, it went light. And you had parts of the brain talking to each other that didn't normally talk to each other. And it's called the default mode network, which means that it's what your brain defaults to when you're at rest. And it's actually not sleep rest.

Yes. Maybe activated during sleep, but it's unclear. It's when you're in a wakeful state. And why it's good for scaffolding is parts of your brain are talking to each other that don't normally talk to each other. So creative people have quite active default mode networks because they can solve problems, think about solutions and so on. People who are depressed are very low activity of default mode networks. And when you take psychedelics, it gets very high, which is why there's a risk involved as well.

Yeah, so it turns out that you should not feel guilty doing nothing. Doing nothing and mind wandering. So how I've responded to that is when I go to the gym, my EarPods are out.

And of course, where the tension is, and there's no easy solution to all this is that you think, well, I've got a few hours to myself or a couple of days to myself. I'm going to listen to all those podcasts I haven't listened to, I'm going to read all those books. It might actually be good to have a couple of hours of leaving your

The Sabbath.

Sabbath for the brain.

Controversial. If work done by Paraminda Sashdev, who co runs the Healthy Brain. I forgot exactly the name of it. At University of New South Wales has looked at this and he disagrees that women are more prone to dementia than men. He thinks probably the gender split is equal. It may change according to age. But if you look at women and men over 80, it may not actually be a higher risk.

That's right. So it's distorted by those figures.

It's not at all clear.

But, I mean, Preminda read a few of my chapters and that was one of the things he pulled me up on. He said, here's the data, here's the paper. So I went soft on that one.

So here's the story. With dementia, you can get panicked by it or you can be realistic about it. So, for example, Paramindo's story with women is exactly as you say, women live longer than men. Age is a risk factor for dementia and therefore you get this distorted view that it's more common in women. Well, in fact, it is more common in women, but their risk is not higher. It's just simply that there's more women living longer. The risk of dementia at any age is falling in Australia and falling quite quickly. So if you're 80 years old today, your risk of dementia is probably 20% less than it was 10 or 15 years ago. And it continues to fall because it's

That's correct, yeah. We're not smoking as much. We're doing the stuff that prevents dementia without even thinking about it. And yet, and you're right, it's a population bulb. So there are more people who are older. Age is a risk factor. So you see more people about dementia. But the doom and gloom about dementia is probably relatively unmerited. I'd say relatively okay.

We've missed out something that affects your prefrontal Cortex that was common to all my cognitive superagers. And not a single person listening to Club Sandwich is going to like. What I say is that none of the cognitive superagers drank.

So you've had a bad day, you know, your parents have screamed at you because you want to bring in a carer to help them out, and you don't know what you're going to do and you pour yourself a glass of red wine. So, like anything, there's a limit to this. People over 55 are drinking too much in Australia.

So where. What part of your brain does alcohol act upon? Your prefrontal cortex. So it's distracting your prefrontal cortex from that very important role it's playing in maintaining your brain scaffolding as you get older. So. And again, that's another thing that I've changed since writing the book is I've never drunk very much. I now drink much less. I don't not drink at all.

Yeah, but I just don't drink that much and I sleep much better, I have to tell you.

It is.

And that's what people are saying to you all the time. You're going to be no good for your parents if you don't look after yourself.

But in fact, this is. You've got to be selfish. You've got to protect yourself. And there are some simple things that you can do. So when I say they're simple, they're not that simple. You know, putting structures in place which take the load off you so that you're not having to plan every outing and what have you. And you're not necessarily the first port of call. Easy to say, hard to do. But as much as possible, doing that, it's going to be better for your parents, it's going to be better for you. And it's not genetic, it's environmental. And you've got to remove those environmental

And it's more than respite. Respite's good. But if you're going to go back to the same situation, respite gives you

And often parents want that locus of control, too. So when your elderly parents throw you out of the house, when you say you need a care, that's their locus of control in action. They want to control their lives. They don't want to be pushed around. So you can call them out on it saying, well, that's fine, let's see how. Let's try helping you make your own decisions here and not feeling that the world's necessarily going to fall apart if they do.

I'm glad to see you're taking up the easy issues.

Of course they do.

You're welcome, Sarah. Thanks for having me.