Qualy #16 - How much does cognitive activity ward off cognitive decline?

**Peter Attia** (0:05)
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How much does mental activity ward this off? You know, we hear so often the anecdote of, Bernie was working his little tail away, beavering away it, and then when he retired to play golf, it all went to hell in a hand basket. And then the other one you often hear anecdotally is, once so-and-so's spouse passed away, oh my God, the remaining spouse just regressed completely and seemed to have this accelerated case of Alzheimer's dementia. So the idea here being, once that person retired and they weren't cognitively engaged, not to say golf is cognitively bankrupt, but presumably it's less cognitively engaging than whatever that person was doing before, or once the sense of purpose, the social support vanishes, again, anecdotally, this seems overwhelmingly the case. Is there any data to support that?

**Richard Isaacson** (1:54)
So, yes, but it's complicated. The cognitive reserve...

**Peter Attia** (1:59)
Can't one thing just be freaking simple here?

**Richard Isaacson** (2:01)
No, Alzheimer's prevention? No, man, this is...

**Peter Attia** (2:04)
You sound like me, man. Everything's complicated.

**Richard Isaacson** (2:07)
Everything's complicated. I wish I could give you a concise bullet point statement.

**Peter Attia** (2:10)
I want a bumper sticker.

**Richard Isaacson** (2:12)
Yeah, live TV. You gotta give them a quick snapshot. Not on this topic. So, early life risk factors for Alzheimer's are different than midlife and late life, and early life risk can be mitigated, most so by long-term educational attainment.
That's the best evidence we have. We also have evidence.

**Peter Attia** (2:31)
To be clear, has that been normalized for socioeconomic status? It strikes me as almost impossible to normalize that for socioeconomic status.

**Richard Isaacson** (2:38)
Above my pay grade, don't know the literature as well as I need.

**Peter Attia** (2:41)
The point here being, like, people who go on to get secondary and tertiary education are gonna have lower risk. Is it because of the things that enable them to do that, perhaps having more resources, lead to them doing other healthy lifestyle things that go beyond the education?

**Richard Isaacson** (2:59)
I hope the studies have controlled for that, but I know it's impossible to control for everything. But that being said, I think early life educational attainment, for example, musical experience, midlife musical experience as well as early life absolutely can build up greater cognitive reserves so that when you get Alzheimer's, you're more resilient, you have this resiliency.
The other aspect is...

**Peter Attia** (3:17)
And I don't know enough about music, but when you were the cello playing, two bass guitar playing guy, what part of the brain is getting exercised when you do that?

**Richard Isaacson** (3:26)
Well, it's very multimodal. It's the parietal lobe is the music side, maybe on the right side. The reading music notes is kind of like language. So it would be the left side of the brain, and that's visual. It's basically an association, courtesies basically. The whole brain is talking to each other.
So I think music is a great way to recruit different parts of the brain to work together, and the stronger those pathways get, the better the person does.

**Peter Attia** (3:48)
And again, teleologically, that makes so much sense. I guess it begs the question.
I would argue we will never know the answer to this question, because if we're going to have to rely on very loose epidemiology, which can never be fully controlled and suffers from all of the usual problems that epidemiology suffers from, the question ought to be, is there any harm in believing that the epidemiology is right, attaining a higher level of education, staying more mentally engaged, sustaining more loving, social supporting relationships, having a greater sense of purpose, learning to play a musical instrument? I mean, is there a chance that doing those things increases your risk?