Brain health

This event was part of the RSE’s summer events programme, Curious.
Find out more on the Curious website.

Health has been on all our minds in the past year and longer.

There are, however, many facets to staying healthy beyond the various acts of personal protection we have taken recently of ourselves and on behalf of our loved ones and others with whom we have been in contact.

Perhaps the major facet of staying healthy is the simple act of being resolved to keep active, maintain social contact, eat well though not too much – and so on. Motivation and the translation from merely trying to are key. However, beyond this are various scientific findings on “Brain Health” related to healthy aging, action to help stem the onset of dementia, and the diverse facets of the social contact most likely to help us avoid depression. Moreover, living as we are lucky to do in one of the great cities of the world, there are all manner of local activities that can bring us joy and purpose and new understanding – ranging from walking on the Pentland Hills or beside the Firth of Forth through to attending a gig or a concert together with a friend.

Watch the discussion about how these issues and facets of new research that bear on the task of keeping mind and brain in good shape!

Please note transcripts are automatically generated, so may feature errors.

Professor Richard Morris FRSE 0:00
Well, ladies and gentlemen, welcome to today’s event as part of the curious 21 series. I’m Richard Morris, and I’ve got the job of chairing today’s discussion, I’m really looking forward to it, we’ve got a terrific panel of people who plan to say, some words about brain health, and the various different dimensions of brain health. Clearly, health’s been very much on our mind in the past year and a half, and all the various steps that each of us have taken to protect ourselves, our loved ones, and on behalf of friends and other members of the family. And I think one of the things that a lot of us have found ourselves talking about is, you know, how do we keep active to make sure that that’s clearly an aspect of staying healthy, that it isn’t just a matter of the brain on its own, but brain and body working together. I think that social contact is very important. And I know one of our speakers isn’t an expert on the relevance of social contact to brain health. And I think there are lots of other aspects that we will touch on, either in our statements or indeed in response to the questions from you. And we’re going to encourage you to, to ask lots of questions. And I really, really want to stress that. Now what may be on the minds of some of you is when brain health starts to break down, and shortly, an expert on Alzheimer’s diseases will be joining us Tara Spires-Jones, but she’s been held up, but she will join us very shortly. And then we also have Mónica Muñoz López, who is working on a very interesting project to do with long COVID People who have COVID recover from the acute aspects of that condition, but then are left with this sort of brain fog and, and so on. And she’ll, she’ll say a word or two about that. And again, that might be an area which some of you may wish to ask questions about. So we have with us Alan Gow, who’s a professor of psychology at Heriot Watt. Stella Chan, who has a long association with Edinburgh, but is now the Charlie Waller Chair of psychological treatment at the University of Reading. Mónica Muñoz López, who’s an assistant professor at the University of Castilla-La Mancha in Spain, and Tara Spires-Jones, who’s the Deputy Director of the centre for discovery brain sciences, and a prominent member of the dementia research institute, here in Edinburgh. So what I’d like to do is to make clear that we are here in the Royal Society of Edinburgh. I’ve got Sir Walter Scott, behind me, adding authority to what we are going to have to say to you today. So I think the next step is for me to pass over to my team. And the first person I’m going to turn to is Alan Gow, who has been prominent in something called the Lothian birth cohort. And perhaps Alan you’d say a word or two about brain health from your perspective. Hello,

Professor Alan Gow 3:29
Thanks, Richard. Yes, so I’m Alan Gow, Professor of Psychology at Heriot Watt University. And in terms of brain health, the specific aspect that I focus on are the ways in which our thinking skills change as we age. So across the life course, are thinking skills develop and change, and people are often worried about some of those changes. But the thing that I’m particularly interested in are for the lifestyles and behaviours that might help us to stay sharp to put it simply, what are the things that we might do more of, or indeed do less of to protect our thinking skills as we age and as Richard mentioned, some of that work comes from my previous collaboration with the Lothian Birth Cohort based in Edinburgh, and also from some of my own work, at Heriot Watt, we were trying to develop some of those behaviours and lifestyles into interventions. I’ll be really happy to speak more about some of those things as we get into the discussions today. Thanks, Richard.

Professor Richard Morris FRSE 4:31
That’s great, Alan. I’ve already got 10 questions to ask you, but I’ll try not to dominate the questions as we go on. So let’s turn now to Stella. Stella, do you want to say just a minute or two about what you’re interests and relevance to brain health?

Professor Stella Chan 4:51
Yes. So I’m a clinical psychologist by background, but in the last 10-20 years I have always been in full time research and using a bit of my other time to do a bit clinical work, but my research interests mostly in depression, anxiety, it’s actually quite, it’s a subject that a lot of people not thinking about in relevance to the brain, but actually is very much a problem of the brain, if you like, traditionally, we always say the head is to think and the heart is to feel. But actually, it’s not true. It’s also the head and the brain that is guiding our emotions, you know, judging from starting from our immediate reaction, emotional responses to situation, our attention, our focus, our interpretation, the way we remember things, all these things, you know, you can imagine that if you’re constantly more attuned to negative information, or you have a tendency to avoid positive information, that in the short term, you probably just feel a bit low, a bit anxious. But in the longer term, if you’re consistently thinking in that style, then you probably be more likely more at risk to have depression anxiety. So I look forward to kind of take any question and discussion around depression anxiety, across all ages, but also in particular about young people, which is a very important topic at the moment.

Professor Richard Morris FRSE 6:12
Sure, Stella, that’s that’s great sort of styles of thinking and the impact that has on our mood. I’m delighted that Tara Spires-Jones has joined us, I mentioned, Tara that you were very busy. And I see her in a lab situation. So you’re clearly very busy with something. And I hope her joining this doesn’t distract you. We are really looking forward to hearing your expertise. So Tara, do you want to just if you’ve collected your thoughts, do you want to just say a minute or two about your thoughts about brain health?

Professor Tara Spires-Jones 6:45
Yes, certainly many apologies for being late. I’m going to just be cheeky. I know we weren’t really officially having slides. But I wanted to take the chance to just show one slides to you all and I’m sorry, I missed your introduction, Richard. Lovely to be here. So as you can see, I’m in the lab, we had a donation of brain tissue today. So we don’t control the timing, very very sorry for being late. But what I wanted to talk about very briefly is that it’s important to maintain your lifetime brain health in order to prevent dementia. We’re focusing on brain health today, but my lab works both on healthy ageing, and diseases of ageing, including dementia is like Alzheimer’s disease. So what I wanted to share before we get into questions is that when you think about your risk for dementia, I think about particularly for Alzheimer’s disease, it comes in sort of three buckets or three circles that hope you’re seeing here on your screens. This is ageing, ageing is the biggest risk factor for Alzheimer’s disease and related dementias. And of course, we all want to age that alternative is much worse, as my mother says. So we all are glad that we get to live into older age. But it comes with these risks. Then there are your genes which you inherit from your parents. And of course, we can’t do anything about that. But there’s this third bucket that I always like to share when we’re thinking about brain health, which is lifestyle factors. So there are some things that we can do to reduce our own risks of developing age related diseases like dementia is and this is not in any way to blame people who have dementia like Alzheimer’s disease, because two thirds of the risk is stuff you can’t do anything about or don’t want to do anything about. But that 1/3 it’s important to think about, there are a few things we can do. So the estimates actually, since I made this slide, it’s now up to about 40%. So more than a third of dementia is we think when you look at all the scientific literature together, could be prevented by changing some of these modifiable risk factors. So what are they things that are bad for your brain, you won’t be surprised at the list things like smoking, high blood pressure, obesity, diabetes, physical inactivity, there are a few things like social isolation, depression and hearing loss which are associated with increased dementia as you age. But it’s important to think about that association doesn’t imply causation. It could be that as we are in the early stages of disease, we have become more isolated or depressed. But what can we do on the good side, also not a hugely surprising list. But things like this are great for you, increasing your level of education and keeping your brain active. So well done for tuning in today. Exercising is excellent. And keeping active generally both your mind and your body. So I don’t want to take too much time. But that’s the kind of thing we think about is how you maintain your lifetime brain health to prevent these late life diseases like dementia.

Professor Richard Morris FRSE 9:14
Tara, thank you very much. That’s great. And I’m glad to see that the lifestyle factors is edging up from 30 to 40%. So I’m still youthful, there’s a lot I can change right to live to, to the great age that you and your mom. Hope to do. Likewise. So let’s just turn to our last person who’s been working a bit on long COVID and other projects. Mónica Muñoz López, who’s joining me here in the Royal Society of Edinburgh so I’m not completely lonely here in the Scott room. I’ve got Monica as well.

Mónica Muñoz López 9:48
Thank you, Richard. And thank you everybody for inviting me to this event that I’m delighted to be. Well, my experience in neuropsychology is to understand how brain damage can affect cognition. And I was interested initially in hypoxia, and also in understanding the neuroanatomy of the brain. And this led me to work in a project on COVID. And initially, when COVID unfolds as a very acute infection, depending on huge variability on the degree of these reactions to the infection that can occur in different people. But a small proportion of patients, it’s not big, there are different studies, and we still don’t have a clue of a specific number. But we think it’s not more than 5%. But maybe more, we don’t know. But around that number of patients continue to show and persist with the symptoms that COVID has unfolded with, for example, like physical and cognitive symptoms like fatigue, pain in the joints, pain in the muscles, but also cognitive symptoms, like memory loss, problems of attention, what attention what is called as a brain fog, and also difficulties with access to words, they can express themselves as they could in the beginning. So there are many studies trying to tease apart what is gone wrong with these smaller number of patients who continue to show these persistent symptoms. And I am trying to do research on that, and also trying to do research on once you have persistent or long COVID. What is going on in your brain? Is there any correlation that we can fight in terms of memory, attention, white matter, grey matter? So that I’m looking forward to your questions? I hope I can answer some of them because it’s not very much known.

Professor Richard Morris FRSE 11:51
And this project you’re doing in Spain, team in Spain, is that right?

Mónica Muñoz López 11:55
Yes, yes, yes, we’re doing this in the University of Castilla-La Mancha.

Professor Richard Morris FRSE 12:01
Okay, so great. So we’ve already got a few questions, which is absolutely great. But I think, and I’m looking forward to turning to these very quickly. And thanks specifically to Muhammad Malik for asking the first question well done. We’ll come to you in a moment. But beforehand, perhaps one or two of the other speakers may want to put a question to, to each person. Is there anybody who’d like to ask something? Stella, you’re nodding, yes, I see the hand. Right. So let’s have your question first. And then we’ll

Professor Stella Chan 12:35
Yeah, so looking forward to Tara joining us, you know, I have known Tara for many years in Edinburgh. And it’s very clear, your slide, only one slide, impressively clear. But what I’m wondering is about the time frame of those lifestyle factors. So is there a particular window in which you could focus on those things? For example, if you stopped smoking at a certain age, would that still help or exercise? Say some people were very active when they are younger, and then after retirement, they become very inactive. So what are the kinds of time window? Do we know anything about that?

Professor Tara Spires-Jones 13:13
That’s a great question. So the the Lancet Commission’s article that I was citing there, there, that’s a meta analysis. So for those of you who aren’t into the scientific literature, that’s just a few authors who’ve taken an overview of all the studies that have been done on this kind of prevention and sort of dementia association risk. And they sort of put these different risk factors in different parts of the life timeframe. And I encourage you to click on that link, or just look up Lancet Commission’s and have a look. So there are things that are occurring throughout your lifetime, like your genes that you can’t change. But in terms of lifestyle factors, unfortunately, like so many things, I would say the data are still not solid to know, for sure. But the data are coming. So education, there’s a really strong association of staying in school, and reducing your risk of dementia. And that usually happens when we’re young. So we don’t really know I would say, although anyone jump in here, if anyone knows any more recent data than I do, whether going back to school for years later on in life would help I don’t know if the data are solid yet. As same for exercise, we don’t really know generally, what’s good for your heart is good for your brain. And what I like to say is your brain is so amazingly plastic, we study the synaptic connections between your neurons. And if you can boost, if you can stop damaging and sort of boost your brain’s function, you have the ability to make new connections throughout your life. So I would say anytime it’s probably not a bad idea to modify these lifestyle factors. But in terms of the solid data about when it’s best, I personally don’t know if we know enough as a field to give you really good thoughts on that, but others might have better, better data.

Professor Richard Morris FRSE 14:45
So that’s an interesting and cautious note. Clearly, we need to do more research to try to find out some of these things. But I’d like to combine my question with Mohamed Malik’s question, he raises the question of curious to understand the factors that improve brain health as well as factors that damage brain cells, and I take it, Alan, if I could put this question to you that this is precisely the kind of thing, at least from the point of view of behaviour and cognition that you’re interested in, in your new unit at Heriot Watt is that is that right? Did I get that right?

Professor Alan Gow 15:21
Absolutely. So leading off what start Tara was saying just a few moments ago, we’ve got this list of factors that we believe are among the most consistently associated with risk of dementia, now those things aren’t just about dementia as an umbrella term for the range of diseases. But those are important across the whole lifespan in terms of building capacity. And I think, you know, we want more and more to think about preventing these diseases or building better brain health, as well as also looking for better treatments for people who have a diagnosis who are living with dementia. And so to lead them to an audience question. And these are exactly the kinds of things that we want to think about doing do more of and do more of at any point in the lifespan, physical activity, being more socially connected, challenging ourselves, whether that’s educationally or occupationally. And absolutely taking what Tara has mentioned, as well, some of these factors, we maybe don’t know precisely, at what point they might be most beneficial, or indeed in what amount. But what we often see with those kinds of factors is there’s very rarely a negative consequence of doing a bit more of them. And so while the evidence is still accruing, we would certainly suggest that people try to live, you know, physically healthy, mentally challenged, and socially connected life’s in addition to trying to reduce some of those particular risk factors. So the risks of heart disease, the risks of experiencing a brain injury, but as mentioned a few times already, some of those things, we can’t control quite as much as we would like. And so it’s all about just trying to increase the amount of the positive things and reduce as many of the negative things as we can. And we’re going to, we’re probably going to mention the same things over and over again, through today. So exactly the things that Tara had on our first slide, we will definitely come back to, I think, as a discussion point, trying to move more and more towards people in earlier life, starting to plan for good brain health, I knew that that’s something that I’m really keen on. Although my work predominantly is with older adults. So people 65-70 and above. As a discussion in society, I think we need to think about improving brain health from much earlier on. And I know that’s something that obviously Stella has keen interest in, particularly from the mental health aspects through adolescence and into early adulthood.

Professor Richard Morris FRSE 17:48
Okay, that’s great. Well, it was a question from Carly Anderson, which I think links very well to what you’ve just said. Because one thing that can happen when people retire, or worse still, when when say a spouse dies, is you get social isolation. And Carly is asking the question, whether social isolation is as debilitating as, say, smoking, or indeed as debilitating as some of the other kind of risk factors. Now, what you said is, is, is that you might want to move some of these kinds of good patterns of behaviour to sort of earlier in life if, got your point, but you know, the difficulty there is, of course, that we’re busy in our jobs, or we’re busy with kids, the focus might be family. And the ability to interact with neighbours and friends is, you know, it’s time limited. And it’s hard. So we we got this huge sort of juggling act, to, to perform Alan to actually reach to precisely these kind of things that could help our brain health.

Professor Alan Gow 18:56
That’s a really good point. When we talk about brain health, there are dozens of things that might be important. And I think when we start to talk about them, people start to think, well, how can I do all of those things really, really well. And I think there’s another idea that came out of colleagues, at Edinburgh who work on the Lothian birth cohort study as well led by Janie Corley, this paper talked about this idea called marginal Brain Gains. So you may have heard of marginal gains from a business perspective or a sporting perspective, that’s where people identify all the things might be important. And rather than trying to be brilliant, all of them, you try and make these marginal improvements across lots of things. So if we think about brain health, yeah, let’s imagine that Lancet Commission that Tara was talking about there are 12 identified risk factors from the most recent in review, it’s very unlikely that any of us would be able to optimise all 12 of those risk factors. But could we all do a little bit more on each of them? Yes, we probably could. Now it’s not easy and you’re quite right. What we need better communication about is A. what are those positive and detrimental factors? And how do we best support people to make those good decisions. The example you use, particularly social isolation, social isolation is becoming more and more of a visible risk factor, you don’t have to go that far back before, people weren’t really considering that as a health risk factor at all, it was seen as something a bit intangible, you know, something like a head injury or smoking here we can we can measure those, those are bad things. But social isolation has, over the last 5 to 10 years become more seen as a tangible and measurable risk. But you’re quite right. It’s not necessarily as easily controlled as other things, particularly as we get older with our social networks naturally shrink anyway. And over the last year, our ability to be sociable, and to have social contact has changed quite dramatically for many people. And I know that again, it’s something that is not just about brain health in terms of thinking skills, but in terms of Stella’s interests, and mental health, or Monica’s interests, in the outcomes of long Covid. Again, if that’s another thing that might be reducing people’s ability to remain socially active.

Professor Richard Morris FRSE 21:19
Sure. Okay, that’s great. Now we’ve got a question about sleep. And that jumps off the page for me, because I’ve actually been trying to read quite a bit about the impact of good sleep on health. And within scientific circles, there’s growing interest in something called the glymphatic hypothesis, the idea that there are mechanisms in the brain that that clear bad stuff out of the brain and some very prominent Danish group working on on that and providing a lot of evidence, both from human studies and animal studies, that something like that maybe going on, and that if it gets disrupted, it can contribute to aspects of neurological disease. So Jennifer Waymond, raises the point that sleep quality may not have been highlighted in the Lancet Commission Report. Is that an oversight on the part of that report? And does anybody on the panel have thoughts about the relationship between sleep and brain health and what triggers what any of you want to come in on that?

Professor Tara Spires-Jones 22:27
I can talk a little bit about that sleep. Sleep is an amazingly fascinating thing. As you’re well aware, Richard, good sleep is important for learning, it’s important for your memory consolidation. We know throughout our lives, good sleep is important. We know that disrupted sleep is associated like some of the things we’ve been talking about with early disease with with brain diseases like Parkinson’s disease and dementia with Lewy bodies and Alzheimer’s disease. I think, I don’t know if it was an oversight of the Lancet Commission, it’s probably more that the evidence just wasn’t strong enough, right. So there weren’t enough papers to support that being in this latest paper. But what I think is fascinating is we’re just starting, like you mentioned, to get to these links, these what’s going on in the brain that’s linking what you do with your lifestyle, and what’s happening inside your brain to either damage or maintain your health. And sleep is one of those fascinating ones, where there’s really good evidence that good sleeps, important for thinking and important for learning and memory. It’s associated with disease, but it’s one of the ones that’s a bit iffy about whether it’s a cause or a consequence of that. Are you in the early stages of a disease? So you have bad sleep? Or is disrupted sleep leading to the disease? On that question, I would probably fall on the side of your brain disease is causing your sleep to be messed up. But that’s not to say I couldn’t be wrong, because it’s not the end all settled. And unfortunately, you’ll see, as a neuroscientist, a lot of the questions when you ask me are that the honest answer is? I don’t know. We don’t know. But it’s a really good question.

Professor Richard Morris FRSE 23:50
Yeah, chicken and egg is really hard in all of this, isn’t it? Because you want to get as much evidence as possible from the diverse ways in which people live. And I think one of the challenges Alan and his team have faced through their LBC work and in other ways is indeed that, that juggling of causality is really really tough stuff. But, you know, I think the scientists to try and try to do that. Now, I’d like to bring in Stella a bit because we’ve had one or two questions related to mental health issues. And Melissa is asking about schizophrenia, anti psychotic medicine and, you know, opportunities that might have to help maintain brain health but she goes on to say, well, you know, are there other lifestyle factors that could help contribute to you know, that kind of thing. It’s not quite depression, but it’s another mental health issue. So Stella, do you want to say a word or two about that? That’d be really great.

Professor Stella Chan 24:49
Yeah, so I think that actually thank you for the question. And I was about to chip into Tara’s answer about sleep anyway. Which is kind of the same point I want to make. Is about stress. So one thing we do know is that people who have long standing depression, for example, then we will see kind of some structural changes in the brain. But again, similar to what Tara said, it’s very difficult for us to know what is causing what, because it could well be that maybe to start with people have a kind of that kind of structural changes early on, and then lead to kind of worsening or mental health. But it is, you know, it’s not completely uncontroversial, but the general consensus is that stress it is very likely to, to damage your brain to a certain extent, I’m not talking about everyday stress, which we all have. So don’t worry, if you have it, we all have it, we’re all in the same boat, you can’t, you can’t really get rid of stress completely. But I’m talking about really, really long term stress that kind of go in, and people have mental health problem, we tend to struggle with that, both because of the consequence of the disease or the mental health problem, and also the indirectly around that. So in particular, for schizophrenia, you know, it’s not only about all the disturbances, perceptual disturbances, and some other kind of thought intrusions not only those, but also above the kind of how we impact on social life. So stress, I will say that the best bet is actually thinking about stress coping. So there are quite a lot of existing evidence base around what would be more healthy way of coping with stress. One example is that there are two kinds of coping when you have a stressful situation. One is emotional coping, so you you, you respond emotionally. And the other kind of coping is problem solving. You identify what, what he really doesn’t matter, you’re trying to solve the problem. And research has shown very clearly that problem solving is a more healthy type of managing stress. And I think apart from that all the thing Tara say about the other lifestyle will apply to people with and without mental health or the thing about not smoking, healthy lifestyle, exercise, eat well sleep, well, fresh air, all those things. But I think particularly for mental health, in the context of that, I will say, think really about stress coping, social connection, maybe Alan would want to tap in, because social isolation is another big risk factor for mental health. And it’s not good for your brain is not good for your well being. So thinking about where to get support, both socially, informally, and formally when when you have access to that. So I will say stress, trying to think about how to cope with stress would be the best bet.

Professor Richard Morris FRSE 27:35
Right? Okay, that’s, that’s very useful. And it does indeed link also into the sleep issue, doesn’t it? Because it can be very stressful if one is suffering from sleep loss. Now, let’s just touch briefly on COVID, at least or maybe longer length, we may get more questions we already had had one. Now, we’ve already mentioned the social isolations problem. And clearly that may have been exacerbated during, you know, the height of the pandemic during the first and second and even the third wave of what’s happened. So that will be a contributing factor to people’s mental health as they deal with a pandemic. But as they come out of this, I guess, you know, some parents will be just delighted that kids can go off and play with other kids and others might be cautious, you know, is that such a wise thing to do? You know, we’re perhaps guilty of thinking that COVID is gone away, and it hasn’t. So we have an interesting question here about, I’ve sort of lost it because sort of moved around. But the question of whether COVID symptoms, and particularly long COVID symptoms, are they only in mature adults? Or could they affect younger people, too? And maybe Monica might want to say a word or two about that?

Mónica Muñoz López 29:00
Yeah. Well, as I said earlier, the number of patients that go into develop a long COVID is relatively small, even though it might be that because you see it in newspapers it seems that 50% of them do is not that big as one. And the number of children with COVID is much slower than the number of patients adults with COVID. So the proportion in terms of absolute number is going to be small. But this evidence an increasing number of articles published on children showing on young adults teenagers, so in showing the long Covid, so it is there. It is a risk. It can happen. It can happen to anybody.

Professor Richard Morris FRSE 29:44
How much Monica is known about what’s happening in the brain, either in COVID, or indeed in long COVID. Do we know much yet? Have there been any studies or is it far too early?

Mónica Muñoz López 29:56
It is far too early to draw conclusions but it is time to see and open our eyes to the consequences of COVID in the brain. And during the acute phase, apparently, there are different numbers in different reports and in different countries. So the number of patients who have COVID that show neurological problems vary between 30 and 80%, depending on the study, but the truth is that many of these patients, not all of the patients who have neurological symptoms show brain issues that are detectable with a conventional techniques like MRI, or CSF lumbar puncture, to analyse the fluid inside the brain. But there are many, many, many different manifestations and they are central. So in the brain, or they can be peripheral, in the nerves that draw or sensations into the brain, or the motor into the limbs. So there are many symptoms that can happen. Neuropathic white matter problems, grey matter problems.

Professor Richard Morris FRSE 31:13
Okay, anybody want to add anything there? Or should we go on to another question? Okay, so one was related to dementia. And maybe Tara might have some thoughts about this is that we’ve talked about different patterns of behaviour that might promote brain health. But of course, we might also go to a doctor and our doctor might prescribe various kinds of medicine that they think might be helpful, so particularly in relation to depression or stress. But somebody has asked question about amitriptyline and dementia. And Julie Johnson is concerned about this medicine and the possibility that it may promote the development of dementia. And she wonders of the some kind of age cutoff. And at some point, she should, if she’s already taking it to cut it off. Tara, do you want to say a little bit about either amitriptyline specifically or indeed more generally about medicines and dementia?

Professor Tara Spires-Jones 32:17
So thank you for the question. The first thing to say is I am not that kind of doctor. So I’m a neuroscientist. So you should definitely talked to a proper medical doctor about any prescriptions. The broader question of are antidepressants linked with dementia? I would say I don’t I’m not aware of any data. Alan, are you aware of any data linking antidepressants with dementia risk, I would say managing depression is probably a good thing in terms of keeping your brain healthy. So keeping on top of, of whatever medication is helping you is probably the best bet. But again, I wouldn’t give individual advice, I would just say, in general, depression is associated with dementia risk. I don’t know the chicken and egg of that yet, whether it’s early stages of brain changes, or of course, you’re not going to feel great about losing some of your memory. So I don’t know whether that it would be causative, but it would certainly be a better thing to keep your depression in check. I would say. Sorry, not to be more help.

Professor Richard Morris FRSE 33:11
That’s all right. Anything to add Alan? there on that? No. Okay. All right. Well, nobody’s mentioned mindfulness yet. But it may be on Stella’s mind. I don’t know. But there is a question about it. So Padma says, do practices like mindfulness, yoga, tai chi, and some of the sort of creative therapists do they. Is there any evidence that these can affect brain health and stave off dementia? Any thoughts on that?

Professor Stella Chan 33:44
This had been quite a lot of research on mindfulness. So leading to mindfulness now being kind of recommended for kind of maintenance of certain kinds of depression, particularly what we call treatment resistant type. So the kind of depression that is quite long term, quite chronic. And that seems to be mindfulness seem to particularly help. But at the same time, it’s important to know that kind of mindfulness also have taken that public imagination. So some of them self help is not necessarily the same as those that can deliver professionally, under a certain standard or protocol. But in general, I would be very surprised if, there will be a lot of research on, you know, tai chi and yoga. Beyond that being actually quite good exercise. So tai chi and yoga, they’re actually quite quite, quite good exercise and often sort of suggested for people especially pregnant women, you know, and so, it’s generally quite good for kind of as a relaxation technique. So I would say meditation, mindfulness, yoga, tai chi, what share in common is that? It may not work for everyone, but if it’s something that worked for you to unwind and relax and come back to the point of stress that it helped you cope with stress, then if your stress coping is better, then definitely it helped with your mood. But also help with your your brain, because they kind of cause less damage and tear and wear if you like. Another thing around these is that, we also find that actually our own research as well as far as others, is that things like mindfulness, it also creates a mental resources for you. So when you’re very stressed, you imagine yourself as a whole person and you’re bringing is a bit like a sponge that really scrunched up, and then you can’t really do anything yet, when you’re stressed. You know, you can’t be creative, you can’t do problem solving, you’re very diminished your way to cope with everyday life. But if you can relax a bit, even temporarily, to allow your mind to, to use your usual ability to cope, that actually helped, then going back to Alan’s point about taking small steps, so it doesn’t need to be doing one session at tai chi to completely change your life but it’s about everyday to lead to something, they all add up together to increase the best chance for health.

Professor Richard Morris FRSE 36:02
Okay, great. Somebody is asked the question about traumatic brain injury as a potential risk factor for brain health. This attendee who, whose, understandably chosen to remain anonymous, had some TBI, traumatic brain injury a few years ago and recovered well. But you know, this has been on people’s minds a bit to do with headingh the ball in football and the impact on on sportsman of head injuries, and whether there should be action taken on what should be allowed in schools for kids. I mean, you’re saying, Alan about, you know, things at a younger age, how much is known about TBI and brain health and maybe even dementia too.

Professor Alan Gow 36:58
So Tara will definitely be able to come in with some of the more specifics on the what’s happening under the hood, in terms of you know, what’s actually happening in the brain when you’re experiencing a specific head injury. But when we talk about traumatic brain injury being a risk factor, it’s really, really important for folks to remember, we’re talking about a risk factor across the population. So if someone has already experienced a head injury, and then they’re worried, you know, how will that affect them later, going back to one of Tara’s points, we often can’t say to that individual exactly what the impact of that will have for them, if they have had a head injury. And they’re concerned, obviously, as Tara mentioned earlier, as well, their first port of call would be their own health care professional, supporters around them. But equally thinking, one risk factor among many, one risk factor alone may not be particularly problematic for them, if it’s in the context of them doing the other things that may be beneficial. And it’s all about that balancing risk. And I see it would be great if we were in a position to be able to help people to see right, you did a bit of this, therefore, you’re this much more of a risk. When we talk about risk we’re talking about on a societal level, and it’s really difficult to see. But on that question specifically, because it does relate to to that person’s own experience and their own worry about that increasing the risk. On average, if you’ve had a traumatic brain injury, it is associated with a bit more risk of dementia later. But remember, it’s one risk factor among the 12 in that Lancet report, but many, many dozens more broadly, I don’t know if Tara maybe wants to speak about more of the, you know, when someone’s experienced a head injury, and how that’s different from the more you know, the day to day, you know, bumps that everyone probably has experienced versus that more serious and severe thing.

Professor Tara Spires-Jones 38:56
Yeah, sure. I mean, if you’ve had a serious traumatic brain injury, there are some brain changes that occur in many people, you get this clumping of an abnormal protein called tau inside your brain cells, and that can eventually lead to problems and increase your risk for dementias. But like Alan mentioned, of course, this is only one of the risk factors. And more broadly, if you’re thinking about things like football and rugby, and kids, the evidence for exercise being good is so much stronger than for small TBI being bad. So I would say, it’s, you’ve got to balance your risk leaving the door you know, going outside your door every day is a risk. So maybe we want to encourage football and rugby but we want to say yeah, if we’re if you might not want to be encouraging too much banging of the head if you can get away from that right, especially little kids. The evidence, I think is that repeated traumatic brain injuries are probably more of a risk than a single incident unless it was hugely bad incident.

Professor Richard Morris FRSE 39:47
Okay. Thanks, Tara. Now we’ve got a question on a topic which I’m slightly nervous about bringing up because once Dr. Muñoz López, starts talking about healthy diet None of us will get a word in edgewise. I’m afraid. However, the question has been raised. And as chair I must faithfully ask the questions put before us. So the question from one attendee is that perhaps a healthy diet can help brain health? And they want to know whether that’s the case? And if so, how to do it. Now the word that always comes up when we think about healthy diet is the role of the supermarket’s. And I think to be fair to the supermarkets, they try to do their best in terms of making sure that there’s fresh vegetables available for us all. And I always sort of think as I walked down the vegetable aisle, what what a miracle it is that we’re looking at that fruit that perhaps in front of us now might have been growing in the ground 500 miles away, just the day before, so all credit to the supermarket for that, but they do have a few other practices, which one might want to question, but anybody want to take on the question of healthy diet. I feel fear Monica is gonna charge in here.

Mónica Muñoz López 41:18
Just two words, one being the Mediterranean. What can I say, of course, with the mediterranean diet is the critical and beneficial way of living your your life. And it’s not just about food, social connections are coming out in these discussion a lot. So in the Mediterranean diet, not only you eat a balanced diet, you everything nuts, fruit, vegetables, butter, and all kinds of things, but in moderate fashion, so even wine, but everything is moderate. And you enjoy every bit of it. But social connections are very important. So we gather together for lunch when possible. But at least we’ll get it together once a day, to just talk family or even be friends. But you you gather, even if it’s just for a little snack in the middle of the morning, you just gather. It’s super, that is that is really an important factor. And the other important factor is that we are human beings are animals of customs. So the Mediterranean diet works in the Mediterranean countries, but not everywhere. Because we grow up, we grow with it. So it’s very important to introduce healthy habits. And I don’t think we should impose Mediterranean diet everywhere. But a healthy diet in the early years in education, to understand why and to be reasonable when you know, and use our prefrontal cortex and our reasoning very early in age to decide what is and to make healthy choices. That’s more than two words, sorry,

Professor Richard Morris FRSE 43:01
That’s fine. It’s okay. I didn’t expect just two words from Monica on, on diet, but Stella?

Professor Stella Chan 43:10
Yeah, quite some of my colleagues and here at Reading, working on nutrition, pondering about diet and food intake and cognitive functioning. So how good we are in thinking. So that’s very closely linked to the brain. And then also its knock on effect on depression and mental health. I’ve been talking to colleagues recently about that, because we have a new project thinking to give young people a free rucksack that contains all the things that we know have evidence base for good health and bring health and mental health. So I’ve been thinking to put in some recipe there. So my own copy. So I’ve been talking to colleagues who have expertise in that. And they say that it’s actually results quite mixed about like, what kind of food stuff is good for you. Generally, as Monica say, if it’s a good healthy diet, improve your general health, then of course, it will help everything. But more specifically, I know that a lot of research teams are now looking very closely into berries, blueberries, in particular, we’ve done in Reading, we’ve done a trial to look at giving young people blueberries to see where they improve their cognitive thinking and executive functioning and whether it will have a knock on effect on mood. So those have been quite small scale works that I’m involved in. So it’s not a lot that I can comment on. But I will say watched a space of berries if I think at the moment that’s what I’m looking at. Apparently good chocolate like dark chocolate in moderation is also supposed to be quite good. And I know that it’s a trial for pregnant women to reduce the risk for hypertension as well. So things that we suddenly you know, we thought snacks like chocolate but actually have good health value in moderation just echoing what Monica say.

Professor Richard Morris FRSE 45:00
So I can I can eat my chocolate tonight and not feel I’m sinning. That’s good Stella. Alan, you put your hand up and delighted to hear a contribution from you on this.

Professor Alan Gow 45:13
Yeah. So just on what Stellar was mentioning. There are often different approaches to exploring diet, sometimes people look at one thing, almost in isolation. And sometimes they look at what Monica was mentioned that more dietary pattern type approach. So you know, the Mediterranean diet is what we describe as a pattern. It’s a range of foods and foodstuffs that generally come together. The problem was the single factor approach is we get enormously long lists of things that might be good, and they’re always good, you know, those berries, they’re, they’re going to be good, that bit of chocolate? Yeah, that’s going be good. But they’re impossible for people to actually use that advice. And so I think we’ve got to be really careful looking at individual factors on their own, because no foodstuff exists in isolation. And so taking the dietary advice, I think we need to be moving more towards the pattern, which has been happening for the last 5 to 10 years. Thinking about that, equally, it’s another one of those chicken and egg type factors. So if you’re from Southern Europe, the Mediterranean, it’s not the Mediterranean diet, it’s just, that’s just the food. That’s just the expectation. When you’re in the UK, we can call it the Mediterranean diet for because for us, it’s a pattern we might choose to do more or less of. So there’s a definite cultural variation there. But what we found, or what colleagues I should say, are found in some of the studies based in Edinburgh, were the people who adhered more closely to Mediterranean diet. So this is a group of people born and raised in Scotland, and through their 30s 40s 50s, as children and then to the 2000s. As older adults, the people who adhered more closely to those generally healthy diets were the ones who were more able to begin with had better jobs had a more an affluent social background. So we do sometimes have this overlapping issue, as if you were born and raised in an environment where the Mediterranean diet was the norm, it’d be a different set of predictors that would influence you did more or less. And just to pick up on Monica’s other point, you know, that when we think when we get asked a question about diet, it’s often the case some things that we will focus in on the physiology of different factors but Monica’s point is that as well, diet isn’t just about the food, it’s about the other lifestyle factors that that creates and supports. And I think that’s a really key thing and a message that I would be really keen, you know, that has come through this whole session. All lifestyle factors that we’ve talked about are important, and they’re seen to be important individually, but they’re probably much, much more powerful. When we think about them as part of that, how do they all go together, whether that’s diet, social interaction, being physically active, trying to avoid a head injury, looking after your health, controlling your weight, etc, etc, are all potentially important, but much more important, when we look at them together, because they all overlap and interact, and someone making a change on one of those things, is probably more likely to then also think, okay, I’m reducing my smoking or controlling alcohol a bit more, that might also lead on to controlling bits of diet more, or then being able to take a bit more exercise. So I think you’re quite right Monica, to highlight, not just the diet part, but the fact that it happens in a social context, particularly as you say, from the background that you you’re used to, you know, the social coming together the eating as the whole experience.

Professor Richard Morris FRSE 48:38
Great, thanks. Thank you, Alan. So, we’re gonna get back to Stella but prompted by a question from somebody who’s British, but living abroad. And this, I think raises the interesting question about whether the some of the various therapies that have been developed in the United States and in Britain are translated into other languages and into other kind of cultures. And my one time colleague on the MQ charity, Chris Fairburn, I know was heavily involved in trying to have digital training in other cultures of some of the kind of aspects of psycho therapies or CBD and things of this sort. And I wonder where do we stand on that now, Stella? Because the question from somebody in in Spain, who’s British raises the point of that he doesn’t have access to certain therapy, but he’s probably not alone. There may be others in that situation. Any comments from you?

Professor Stella Chan 49:42
Yeah, so a lot of the major kind of psychological therapies like CBT has been translated and used across many cultures and Spain definitely would be one of them, that will have access to it. But I what I don’t know is the local context of how health services are organised maybe Monica know much more than me because I have a collaborator in Barcelona. But that’s about it. So I don’t know how the health service organise themselves. But in terms of the treatment, yes, it definitely had been developed and a evaluated in many places in the world. CBT is one, not the most prominent one. But another thing to watch out would be now that with Covid because of Covid, that a lot of there has been quite a lot new development about digital digitalizing intervention. So in two ways, one is that all of the traditional talking therapies or the traditional psychological therapies have to take place online. So that have actually really changed the whole format. But another thing is actually fully kind of digitalized self help intervention. And so and there are apps available, depending what, what help you need. But if you’re English speaking, if you’re kind of from this audience, maybe it’s English speaking, then there should be quite a lot available. That is kind of online intervention, especially in Australia, Australia developed a lot of a digitalized intervention, because the country is so big and that people so you know, that’s so kind of distributed. So that would be another to look for is kind of Australia have quite a few good versions,

Professor Richard Morris FRSE 51:24
Right. Yes, yes. Okay. Well, look, we were drawing, almost to the end, we’ve got perhaps time for one or two questions. But there’s such a range. I mean, I can still see 20 questions down there. I’m not going to be able to get through everything. But one jumps off the page to me from Helen, who’s a soprano working in Edinburgh, who raises the question of brain health and gut health. I’m not quite sure why a soprano should be interested in gut health, but maybe I don’t really understand. Anybody want to comment on that. We also have another question about microbiome as well.

Professor Tara Spires-Jones 52:04
Yeah, I could, I could take a little bit of that. So it’s really coming back to Monica and Alan’s point about the holistic experience of your brain and your body being in the same you know, as a neuroscientist, I usually think about the neck up. But really, it’s important to think about the rest of the body as well. And your gut health and your microbiome relate directly to your diet and to activity and there is some evidence in some brain diseases that the microbiome has significantly changed. Again, I’m going to come back to chicken and egg. So for example, in Parkinson’s disease, a serious brain disease, you’ve probably all heard of, there are changes in your gut microbiome. So in the bacteria that live in your gut that helps you digest your food. But is that because your brain has changed and your eating patterns are different? Or is it a cause of the disease? We don’t know. One thing that is fascinating, though, is that you’re in terms of Parkinson’s as well, your gut is in a way almost directly connected to your brain, because you have a nervous system, you have nerves in your gut, and they project up through your body and eventually through a couple of connections end up in your brain. And one of the things that we think is happening in Parkinson’s disease, is one of the proteins that abnormally clumps in your brain is starting out in your gut, and then it’s actually travelling up. So you really do have to think about your whole body, I think, more applicable more broadly for brain health, and not just Parkinson’s disease. If you think about things like your gut and your brain, and your microbiome, if you think about healthy lifestyle, and healthy exercise and healthy diet, like we’ve been talking about, all of those things will be good for your gut be good for your microbiome. And they’ll also be good for your brain your vasculature. So somebody asked the questions, how does this actually work in your brain, I could talk to you another hour about that. But anything that’s good for your blood vessels is getting the oxygen to your brain, anything that’s good for your diet and good for your balanced diet, you’re going to be able to keep the fatty myelin around, you know, maintain your brain’s actual cells and membrane. So I’ll stop because I could talk forever about what’s changing in your brain in response to anything

Professor Richard Morris FRSE 53:58
Well Tara you could talk forever in a very interesting way, because there are so many dimensions of all of this, aren’t there? So, as a young lecturer, I was advised that when when giving a lecture, I should first tell them what I’m going to tell them, and then tell then end by telling them what I’ve told him. So I’m going to follow that advice on behalf of our three speakers here. And give them each a moment to tell them what you’ve told us, or whatever concluding remarks you might like to make. So in no particular order. I mean, let’s let’s go anti clockwise on my screen. So Stella, what’s your big take home message then?

Professor Stella Chan 54:43
My big take home message would be stress coping. Don’t worry about a bad day or a bad week or a bad month. But generally just you know, do your best and look after yourself and be kind to yourself. Self compassion is a very, very big resilience factor. against mental health, anything good for mental health good for your brain.

Professor Richard Morris FRSE 55:04
Okay, great. Thank you, Tara, how are we going to avoid dementia? Or what is your take home message,

Professor Tara Spires-Jones 55:11
My take home would be your brain is absolutely amazing. And if you take care of it, it will take care of you. And you’ll be able to think and learn and remember throughout your entire life, don’t beat yourself up if you do end up with dementia, of course, but in the meantime, for all of us, take good care of your body. And that will be good for your brain.

Professor Richard Morris FRSE 55:26
Right. Okay. Alan, your next on my on my hit list here.

Professor Alan Gow 55:32
Absolutely. Linking off from from Tara’s point, you know, we know our thinking skills are likely to change as we get older. But we know so much more about how we can build those up across the lifespan, and potentially maintain them into old age. So be physically active, be socially connected, do as many of the good things in a small manageable way. If you’re not doing them do a bit more, if you’re already doing them do a bit more again, that you know, it’s really simplistic advice, I get that. But I think that’s really where we need to be moving lots of small, manageable changes.

Professor Richard Morris FRSE 56:08
Well, Alan, we’re gonna have to get you onto a panel to do with the climate crisis, I can see because it’s the same message, isn’t it? We can’t stop coal fired power stations being built in various countries of the world. But what we can each do is a little bit ourselves, whether it’s in plastics, or whatever else is, it’s, that’s a great message. So I’m going to turn to Monica last, but not quite sure whether to disallow her from using the word Mediterranean diet or not. But let’s see what she has to say.

Mónica Muñoz López 56:37
Well, no, I’m not going to talk about Mediterranean diet. But it’s good for your bone as well. What I like to say is one last word about COVID. And he says that was a question I saw from the public and is it mild COVID or is it severe COVID that is more likely to produce long COVID or to be followed by long COVID? And the answer is more severe COVID. There’s some evidence this is still unclear, because I have seen cases of mild COVID And they continue to be long COVID. But it seems that is statistically when you put a huge number of cases like 3000, almost of one study that I am thinking and that the more symptoms if you have more than five symptoms in your acute phase of COVID is more likely that you might develop long COVID. So as one thing, and just to finish this, even though I said there is a small portion of people who go into long COVID is really a bombshell in a lifetime. So COVID is still here. We have to be cautious. So take care of yourself, but don’t isolate yourself. Go to the bakery and talk to the baker.

Professor Richard Morris FRSE 57:53
Okay, that’s great. Well, thank you all. So much Stella, Tara, Alan and Monica, thank you very much for joining in.

Professor Richard Morris FRSE 58:03
Cheers.

Mónica Muñoz López 58:03
Thank you.

Professor Alan Gow 58:06
Thanks

Professor Tara Spires-Jones 58:07
Bye