The Art And Science Of Staving Off Cognitive Decline

IRA FLATOW: Hi, this is Ira Flatow, and you’re listening to Science Friday. Today on the podcast, Josh is struggling with alcoholism, so he moves back home to get sober. And then, somewhat unexpectedly, he finds that his alcoholic induced brain fog and memory loss are similar to what’s happening with his four aging grandparents. Josh reads about the idea of something called cognitive reserve, that doing brain stimulating activities can prevent or delay the onset of dementia symptoms. So he tries out some creative strategies to help both himself and his grandparents.

That’s the plot of the semi-autobiographical play The Reservoir. The play received funding from the Sloan Foundation, which also supports Science Friday. It’s currently running at the Atlantic Theater Company and co-produced by the Ensemble Studio Theater in New York. Joining me now is the playwright, Jake Brasch. He’s based in Brooklyn. Welcome to Science Friday.

JAKE BRASCH: Thank you so much for having me.

IRA FLATOW: Well, I loved it. It’s a terrific play. It’s a timely play. It’s semi-autobiographical. Tell me how you came up with the premise.

JAKE BRASCH: So I actually started with the science. I was looking for something to pitch to the Sloan Foundation, and I came across this concept of cognitive reserve and looked at all of the factors that one can try to improve in order to delay the onset of Alzheimer’s symptoms and realized that those are largely the things that one does to get sober.

So I started there and then quickly realized, oh my gosh, I’m writing about that year of my life, and I don’t think I would have otherwise, but the science was really what started it. And then ultimately, I knew I wanted to write a play about intergenerational connection and grandparents and how much I loved my grandparents, and also how my family copes with difficult things through humor.

IRA FLATOW: How did you go about weaving in the science? And by that I mean, did you really make sure the science was correct when you put it in there, or did you use a lot of literary license in this?

JAKE BRASCH: I mean, I hope the science is correct. Please, Sloan Foundation, I hope the science is correct. First and foremost, it’s a play, right? And I think it’s important when you’re trying to make art about science or sharing science, that the story itself is the most important thing and that the characters are vivid and the situations are interesting.

For me, I think that the play asks a lot of questions more than it gives answers, and that’s where art can actually specifically add to the scientific conversation. When it’s about doubt, when it’s about these two diseases, alcoholism and Alzheimer’s, so much about them are unknown in the scientific world. And I think posing a lot of the questions in this play around, maybe the science is this, maybe the science is that, maybe we don’t know, maybe we’ll learn something in the future is really what it’s all about more than getting the science right, if that makes sense.

IRA FLATOW: Yeah. And Josh comes to a surprising conclusion in the play and that’s that the higher the cognitive reserve, the sharper it falls. Did you witness that in your own life?

JAKE BRASCH: I did. So one of my grandmothers until 85 was completely with it, still working. She had her doctorate in math. She was an electrical engineer. She was the most meticulous, organized. She ate well. She did everything correct. She was totally with it. And then at age 85, she kind of just dropped off the planet.

And I had spent a lot of time thinking about, how is that possible, that she slipped so quickly? And then coming across this concept of cognitive reserve. And like you said, the higher the reserve, the sharper the fall. I was like, aha, that’s exactly what it was. She developed so many pathways to the point that she was able to pretty much present as herself until she wasn’t.

IRA FLATOW: Yeah. That character is right there in the play. You put her right in there.

JAKE BRASCH: I did, I did, which is complicated. And that character is very different from my grandmother in some ways, but also very similar. And I feel terrified and thrilled to be able to share my family with the world.

IRA FLATOW: [LAUGHS] Well, I’m laughing because the play is filled with humor. And as you say, humor brings a lot of things you’re able to discuss to the fore, doesn’t it?

JAKE BRASCH: It does. I mean, I firmly believe that you have to laugh, to cry, and you have to cry to laugh. And for me, that roller coaster of things being both funny and terrifying at the same time is what it feels like to be alive right now. And I think also it was acutely how I felt when I was in crisis, trying to get sober. And so I think the play tries to capture that energy and asks you questions like, am I allowed to laugh at this? Am I allowed to cry at this? And mixes up the audience and off puts them in a way that I’m super proud of but also is sometimes difficult in the audience to figure out how to metabolize this story.

IRA FLATOW: Were you channeling Mel Brooks at any point here?

JAKE BRASCH: Oh, definitely. I mean, there is a grandparent, I would say, that leans on the Borscht Belt of it all. Hopefully in a way that’s a little bit off center, but yes. I mean, I knew if I was going to write a play about my family, I had to land the jokes. Humor is the currency in my Jewish family. If you’re not funny, what are you doing?

IRA FLATOW: I get it. I get it. Did working on this play make you think about aging or memory in a different way now that it’s all over?

JAKE BRASCH: It did. I mean, I think the two things that I think about the most are, firstly, the good part and the bad part of aging is that the only thing one can do is lead a curious, open, full life. And the good part about that is that we all know how to do that. That’s the best thing you can do to protect yourself from the onset of dementia or Alzheimer’s, or even just normal aging, is just to do all the things that we already how to do.

The other thing that it made me realize is how non-linear memory loss can be. That sometimes folks hold on to some things while other folks hold on to different things. The path of it is so mysterious. And we can only really conceptualize of memory loss as knowing what we don’t know. The problem is that we only have our brains to figure out how much memory we have lost. And of course, it’s the things that we don’t know that we don’t know are most haunting, and that’s what I’ve been thinking a lot about, not only around Alzheimer’s but also around alcoholism and blackouts and addiction related memory loss.

IRA FLATOW: Have you heard from anybody who’s seen the play and said, that’s me or that’s my grandparents?

JAKE BRASCH: Deeply.

IRA FLATOW: You captured them perfectly.

JAKE BRASCH: Deeply. I mean, so many folks. I go out into the lobby after this show, and there are folks sobbing and calling their grandmas right there and then, which I feel thrilled about sort of facilitating more of that intergenerational connection. And I think it also makes me feel less alone. There’s not that much art out there that is specifically about grandparent grandchild relationships. There’s a lot of parent child plays. There’s a lot of plays in which the one grandparent is rolled on in their wheelchair for their bit part. But this is a play that centers for older, hilarious, horny, wild senior citizens. And I’m super proud of that, and I think a lot of audience members see their families up there on stage.

IRA FLATOW: Well, Jake, congratulations, because it’s a great play, and I hope a lot of people go to see it.

JAKE BRASCH: Oh, thank you so much, Ira.

IRA FLATOW: Jake Brasch, Brooklyn based writer of the reservoir, a play the Ensemble Studio Theater is co-producing with the Atlantic Theater Company and the Alfred P. Sloan Foundation. It’s now running at the Atlantic Theater Company in New York. And a reminder that the Sloan Foundation is a contributor to Science Friday.

After the break, a new study that finds that a special computer brain exercise reduced dementia risk by 25%. We’ll tell you where to find it.

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Since the coining of the term cognitive reserve roughly three decades ago, researchers have been working to figure out what exactly might protect the aging brain against cognitive decline and dementia. A new study followed a diverse group of older adults for 20 years, and they found that a modest amount of specialized cognitive training reduced dementia risk by 25%. Boy, that is a big number. Joining me now to discuss the significance is Dr. Marilyn Albert, Professor of Neurology and Director of Alzheimer’s Disease Research Center at Johns Hopkins Medicine, based in Baltimore, Maryland. Welcome to Science Friday.

MARILYN ALBERT: Thanks so much. It’s wonderful to talk with you.

IRA FLATOW: Nice to have you. For you, what is your biggest takeaway from this study?

MARILYN ALBERT: So I think the most important thing is that this was a gold standard study in the sense that people were randomized to different interventions. And we found that this particular kind of training that’s called speed of processing training lowered risk for a diagnosis of dementia by 25% over the course of 20 years.

IRA FLATOW: Wow. So they were doing this for how long?

MARILYN ALBERT: That’s what’s so interesting about the findings. So the people in the study did this cognitive training for a relatively modest amount of time. In the beginning, they did it twice a week for an hour at a time for six weeks. And then a year later, they did it a few more times. And then three years later, they did it more times. And what the study found was that if you did the training not only in the beginning, but also in those follow up sessions, which were called booster sessions, then you had this reduced risk of dementia over the course of 20 years.

IRA FLATOW: You sound like you were very surprised by these results.

MARILYN ALBERT: I think everybody was surprised by the magnitude of the results. 25% lower risk is really quite a lot. You probably know that the cost of dementia every year is about $400 billion. And if we could reduce that by 25%, it would be wonderful.

I would say that I wasn’t surprised that of the three different kinds of cognitive training that were examined, the speed of training was the one that turned out to be the most important, because there had been other studies from this group showing that the speed of training was more beneficial.

IRA FLATOW: Well, now you have to describe for us what the speed of training is all about.

MARILYN ALBERT: Yeah, so it’s relatively simple. People sat at a computer. They saw two objects in the center of a screen and were asked to say which of the two they were. For example, is this a car or a truck? And then around the outside, there was a sign that they had to identify in space. And you had to switch your attention between what was happening in the center and what was happening around the outside.

And if you did that, it got harder. So then there were distractors around the outside that made it harder for you to locate the sign in space. So it’s what we call a task of divided attention, because you’re switching your attention back and forth. And also, it adapts to your ability. So if you did it well, it got harder. If you had trouble, it got easier.

IRA FLATOW: Do we know why it’s working, what the training does to the brain?

MARILYN ALBERT: I wish we did know what the training does to the brain. These studies were started over 20 years ago, when we didn’t have the kind of imaging that we have now that might enable us to answer that question. My guess is that the training is increasing brain connectivity, and that with the booster sessions, that sort of reinforces that brain connectivity. And for reasons we don’t completely understand, that had a long lasting benefit of protection. But that’s just a guess. There’s a lot more we need to learn about how this training affects the brain and how it’s effective.

IRA FLATOW: How does it compare to other things we know that they say to do for brain health, like eating healthy, doing crossword puzzles, playing chess, socializing, exercising, things like that?

MARILYN ALBERT: Well, that’s a really good question. We know that from this particular study that this training was beneficial above and beyond what people were doing in their daily lives. We can assume that the people in this study were doing crossword puzzles. They were being physically active. They were trying to eat a healthy diet, many of them, but that this training benefited them over and above that. But of course, this particular study didn’t compare this brain training to those kinds of daily activities.

IRA FLATOW: Can you put this in context for us, a broader context of our understanding of dementia and Alzheimer’s? Does this upend or does it confirm previous research in the field?

MARILYN ALBERT: What this is telling us is that there are lifestyle factors that are modifiable that might reduce your risk for dementia. It doesn’t in any way upend and what we know. But the study suggests that there might be things that you could do in your daily life that could, if not directly affect that pathology, provide some sort of buffer or brain reserve. That’s, I think, the major suggestion that we would come away with.

IRA FLATOW: Is there any way for people to get this at home, to do it at home?

MARILYN ALBERT: Yes. In fact, there is a way for people to do this at home. There is a company that I have no association with called Posit Science. And they have a suite of cognitive training tasks on their website. And one of them is called double decision. And double decision is almost identical to what was used in this study.

IRA FLATOW: And what age do people need to do this? What age were they in your study?

MARILYN ALBERT: The people in the study were 65 and older. The age range was quite large. The average age was about 74. And we did, in this analysis, look to see whether or not the age of the people made a difference, and it didn’t. So what that suggests is that as a group, everybody over the age of 65 might benefit.

IRA FLATOW: This is just fascinating. Let’s talk about the future. You say you don’t what goes on in the brain that makes this work. Is there a way of finding out?

MARILYN ALBERT: Well, I’m hoping that this finding will stimulate a lot of research in this area, because we’ve had ideas that this kind of lifestyle intervention would be beneficial for the diagnosis of dementia, but this is the first finding of this sort. I think we can do a lot of studies that are maybe more short term to see what’s happening in the brain when this kind of training is done. And I’m hoping that that’s what will happen in the future. Because if we have a better idea of the mechanisms, then we might even be able to develop even better interventions.

IRA FLATOW: This is just fascinating. Thank you for taking time to be with us today, Dr. Albert.

MARILYN ALBERT: It’s my pleasure. I think this is an important finding, and I’m hoping that people hear about it and will try to take it into their daily lives.

IRA FLATOW: Yeah, well, a lot of people will now that you’ve joined us. Dr. Marilyn Albert, Professor of Neurology, Director of the Alzheimer’s Disease Research Center at Johns Hopkins Medicine. That’s, of course, in Baltimore, Maryland.

By the way, if you want to find that special computer exercise that reduced dementia risk by 25%, we’ve got it on our website, a link to it at sciencefriday.com. This episode was produced by Shoshannah Buxbaum. I’m Ira Flatow. We’ll catch you next time.

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