Episode 579: Dr. Masud Husain: Motivation, Memory, and the Truth About Aging Brains

>> Hi, or when welcome to another episode of Habits and Hustle,

“where today I'm joined by Dr. Masood Hussein.”

Imagine waking up one day and losing the drive to do anything. Not sad, not depressed, just nothing. No urge to shower, call a friend, or even turn on music you love. Well, that's exactly what happened to one of Dr. Masood Hussein's patients after two tiny strokes.

You couldn't even see on a normal scan. Masood is one of the world's leading neurologists on memory, motivation, and cognitive decline. He co-leads the dementia research group at Oxford University and serves as editor-in-chief of Brain,

one of the most respected journals in neurology. He spent decades studying real patients, not just theories, to understand what actually drives the way we think, act and stay sharp as we age. His take is simple. The way most people think about brain health is backwards.

Memory loss isn't usually the first sign of something's changing. Motivation is, and most of what gets blamed on laziness, burn out, or just getting older, is actually your brain sending you a signal. Today, we get into why the earliest signs of decline show up in behavior, not memory.

What dopamine actually does, and why the whole dopamine detox, trend gets it all wrong. The daily habit is quietly protecting or damaging your brain without you even realizing it, and where brain health tested is headed next. If you've ever wondered whether your brain is aging the way you think it is,

this episode is going to change how you look at every off day you've ever had.

But before we get into today's episode, one thing I never get tired of

is reading where you all write in the reviews. So let me read one right now. All right, a must listen, I love this one. Thank you, a must listen. I love how Jen Cohen just says things with no filter.

She says that things most of us are thinking. Her guests come from all aspects of life, and there is always nuggets to find in all of them. The Doctor's Shaday Zahira interview so far is one of my favorites. So many lessons in insights.

All right, thank you so much.

“I appreciate that, and I think I pronounce your name, J. Bex Petit.”

I don't know if I did that right, but thank you. Keep them coming. And if you have not yet subscribed to this podcast, what are you waiting for? Please do. [MUSIC]

Dr. Missou, who's saying I am very happy to have you on this podcast. Thanks for inviting me. Absolutely. Your background is, I think impressive is pretty much the biggest understeer I can give, right?

First of all, what we do on this podcast before we start and your perfect

person giving your background is we do these performance shots that are really good for focus, mental focus, and being more alert. And I want to do it with you, especially because of your background. Okay. So there are these things by magic mind.

And so it's all like Lions, Maine, Ashwaganda, which I want to talk to you about these things actually in your opinion, do like move the needle for you. So let's take a little, we don't, we don't do alcohol. We do healthy shots, so you shake it, and we cheers, and then that's all we do. So here we go, cheers, here we go, you tell me if you're more focused and

“more alert than ever before after taking it, do you like it?”

It's definitely interesting. Okay, that's okay. This one is a caffeine free one. I like the one that's more the OG, but this one is caffeine for people like it, because if they've had too much caffeine sometimes, I could go to like it.

Yeah, good. I love that. All right. Okay, we need to get into this, and you can tell me after if it made an impact.

Where do I begin with you because I really do have a million questions for you?

One of my first questions is when the brain does start to decline, what do you say is the first thing that happens or people notice? Well, it's a, it's a really complex area, so it's not, it's not the kind of thing where you can say, this is what happens in everybody, and so it really depends on which part of the brain is being affected, and perhaps the thing that most people notice in somebody

else is memory, because when memory goes, you notice that your mother or your friend or your grandfather isn't working in the same way they used to be for it, their brains don't seem to be working and say, "Well, but what we've realized is that there are other things that can happen long before something like memory shows up as a problem for these people, and one of those things is actually motivation."

So it turns out that even in healthy older people, if you start developing what we call

then your chances of developing dementia, for example, are twice that if you didn't have apathy, and the reason for it, say that again, so if you're somebody who doesn't have, so if you're somebody who starts to lose motivation in older age, but your otherwise healthy, it turns out that your chances of developing dementia in the next 10 years is twice that, if you had normal motivation, and the reason for that, we think, is because there are

“brain systems which are important in motivation, we've identified some of those, that”

are beginning to degenerate, and that's the first signal that something is going wrong.

When one of your family members doesn't seem to be interested in doing stuff that they would have been before, that could be going out to have a walk, or being interested in the news, or being interested in the family, all of these things can be science, but of course, you know, this is a complex area because there are many reasons why people could lose motivation, so I'm interested in apathy where a brain system is slowly beginning to fade, but you

could lose motivation because you're depressed. I was just going to say that, I mean, you would think if someone changes what they want to be doing, it would be a sign of depression, not a

sign of cognitive decline. So what is the, what are the earlier signs that someone is cognitively

“declining through that, through the behavior versus someone who's just depressed?”

So one of the features of depression is that you're unhappy. You're sad. Yeah. Usually that's an important feature of depression, or you may have what we call an hedonia. You just lack pleasure in anything you do. Now, in patients with pure apathy, those things need not be a future. So you mentioned the young man that I saw who led to this whole body of research. He was a guy called David, and he was a person who's 30s, and he had been highly

motivated. He worked in finance, very productive, socially, great guy, really the center of a big network of friends. And then suddenly he loses his motivation. He becomes completely apathy. Very different to the kind of person he'd been. He's not doing anything at work. He's not making an effort to see his friends. People are getting worried and concerned. And it turns out that David had a very unusual form of stroke. He'd suffered a stroke, an area where he might lose

blood supply in the deep parts of the brain called the basil ganglia. And when we saw him, he wasn't unhappy. He was quite absolutely happy with what was going on. He just lacked motivation to do anything. So much though that he eventually got fired from his job. So much so that he couldn't be motivated to get social security benefit. So his friends said, "Okay, come and stay with us, but they regretted it almost the minute they did so because he did nothing. He just sat there

all day waiting for them to come home so that they would cook for him. He never helped out in

any way with looking after the domestic chores. And of course, they got annoyed. They couldn't understand why this man had changed. And when we actually saw him and went into this in more detail, what we found was someone who was very disheveled. He wasn't even looking after himself. He wasn't having a shower. He wasn't doing anything. And what I asked him, "Well, what would you normally do if

“you were sitting?" He said, "Well, I had listened to music. So why aren't you listening to music?”

Because it would take me a bit of time to put my music system together. How long would it take? Five minutes." So for David, the effort of putting the music systems together was not worth the reward of being able to listen to something pleasurable. And this turned out to be a really important part of what we have done in terms of trying to deconstruct motivation. Because one part of motivation seems to be how we evaluate whether something is going to be

rewarding enough in this case music. And whether the effort required, in this case, the physical effort of putting together the wires for the music system is worth it. And in David's case, very few things were worth the effort. He would just sit there. That still reminds me, or that still would make me think it's depression. Because you don't want to, you're too lazy or lethargic to put the effort in to get the reward. So your dopamine is obviously not at it.

But I think the interesting thing here is you have to talk to the person. And one of the things

that neurologists do is try to understand the person, not just through the scans, but also through the conversation. David wasn't unhappy. He couldn't see what the problem was, living in his friend's house. Right. You keep on saying that the unhappy, he seemed pretty like content. I didn't have any problems about the future. He'd just been fired. He was living in somebody else's house. They weren't very happy with him. He couldn't see what the issue was. He was quite happy doing nothing.

Okay, but that guy is young. He's like in this 30s. So what can trigger something at that young of an age to then bring on cognitive decline? So in his case, we knew that it was two tiny strokes. You know, strokes are when blood vessels be clotted. For example, or bleed, but in his case they were clotted. But the important thing is it showed us one part of the brain, which is so important for making this calculation, is the reward worth the effort. It turns out the basal ganglia are very,

very old, 360 million years old. If you go back to through evolution, they're there because they

“link motivation cues in primitive animals to action. And they're still with us. That's what they do.”

They link cues, for example, if you are feeling hungry in two hours' time, you will develop an urge to act. And you're not going to expire if you don't eat anything. But there is this urge. It's a motivational urge, knowing away you to say, you know, Jen, go and open the fridge, have something because you need it. You don't need it really, right? But you have this motivation to do this because this system is there pushing you to do that. Similarly with first, right?

You don't necessarily need to drink right now, but you can feel thirsty. And these are primitive

motivational cues that make you act. And as animals have become more sophisticated, there are other

cues. For example, it turns out many of the drugs of addiction use the same system, the basal ganglia, to the action system in the frontal lobes. They hijack that system, making you want to seek something which you find rewarding, in this case, you know, a substance of abuse or something like that. So it turns out this is really complicated. The relationship between losing motivation and becoming apathetic as in David versus having hyper motivation to seek stuff that might give you some

rewarding outcome as in addiction is using the same pathways. We're talking about the same pathways. The same pathways, but I'm really on this idea that what scary is these two strokes that David had, it didn't even come up on the scans. How did they find them? How did you even know even look for that? It didn't happen often. That's a very young age for that. It is. I mean, they did come up in scans. If you do them in high resolution, you can see them.

“You can see. Okay. That's not, but what I'm, I think coming back to your other point,”

what about, you know, these other people we're talking about as they get older. David is really unusual. It's an unusual thing. He's an unusual case, but what he's taught us is if these brain systems that weren't wrong in David also go wrong through other pathological processes, let's say the pathological process in Alzheimer's disease or Parkinson's disease, if that pathology affects this circuit, let's think of it like this. There's a circuit that

goes part through the basal ganglia to the frontal lobes. The circuit could be taken out by strokes as indigulate or it could be taken out by other processes nibbling away at this circuit, like the pathology that occurs in Alzheimer's disease. In Alzheimer's disease, proteins called amyloid and tau build up, they have toxic effects on the neurons. And if those toxic effects are occurring in this circuit, what happens is you have a problem with your motivation.

If they were occurring in the memory circuits, you have a problem with your memory. So it depends where in the brain the pathology occurs. Okay. So let me ask you a basic question.

“Is there a real, is there any difference between dementia and Alzheimer's?”

There are over 200 causes of dementia, of which Alzheimer's is the communist cause. So the definition of dementia is a change in someone, a progressive change in someone, such that the cognitive impairment leads to problems with everyday life. So it's gotta be something that's relatively new. It's gotta be progressive. It's gotta be a problem in cognition or as we now

have developed cognitive impairment, but the level is such that they haven't quite got to a problem

in everyday life. They're just about coping. So Alzheimer's is just one. It's just one, but it's the communist. It's the most common because I see here and I've already read about a lot of this myself that social isolation, chronic stress, poor sleep, in activity, in activity. These are all can be causes of, well, they're symptoms. They can be symptoms. Yes, exactly. But what I was going to ask you is if you have somebody, I'm just going to give you my own personal experience.

My mom was pretty good. She was excellent cognitively up until COVID. COVID then took her to down because of the isolation because of the loneliness. She was living alone for many, many years.

“She really cognitively took a major decline. So how can someone go from being like perfect?”

Like actually 10 to 15 years below their age, like physically and mentally? Actually physically, you could still be perfect. It's just ironic. And then because of these things dramatically change. Right. Obviously, I don't know your mom's today or the details. But if we look at the trajectories of cognitive decline, often the people who are doing really, really well, the high performers, actually when it comes to the decline, the decline gradient is much more rapid than the people

who were not high performers in the past. It's really interesting that people can go up to a certain threshold and then all that cognitive reserve and resilience that was helping them maintain their abilities. Yeah. It's no longer enough to do it. So that's a really interesting. There's been several studies which have looked at this. They've looked at people with different levels of cognitive ability before they develop dementia. Right. And seeing that trajectory is steepest. When it happens,

it's steepest in the people who are high performers. But why is that? Well, you'd have to think that up to that point, all the other things that were helping them cope, all the, we might call them strategies, but it could be actually neural mechanisms, brain mechanisms. Right. Well, you know, you might be using systems that you wouldn't normally think of when you're doing memory. I mean, the strategy might be I'm going to take notes to help me cope with this system, right?

I'm going to listen more carefully to people because actually I'm aware that there is a problem. I can easily miss information. So you can have coping strategies to help you and that's coping strategies. Obviously rely on the brain. Right. But what if you don't do those and you're

just somebody who is highly functional, who's very active. You always hear, oh, you know, if you

“want to, if you want to age well, age, you should exercise all the time. You should eat healthy.”

You should sleep properly. If you're doing all of those things, what I find extremely ironic, I don't know if that's the right word is the people I know who've developed this horrible decline, disease, are all people who did everything right. Yeah. So why is that? Is it genetic? Okay, just. Yeah. So there are many issues here. So one of the, let's just go about to your first point, that the things you do to help your brain, all those kind of things you mentioned, those physical

things you mentioned. Exercise really, really important. Low stress. There's absolutely good evidence for all of these things. But in addition, what we now know, and sometimes people call this protecting the mind rather than the brain, but, you know, protecting the mind is protecting the brain from my 20 is that there are other things that are important. One of those, for example, when you retire, your network of friends reduces. The people who keep that net, try and keep a large network,

they do better than people who don't. So people who are curious, who actually go out to find out new things, want to develop new ways of doing things, are interested in new information. Whatever it is,

they do better than other people. And finally, it's people who have a sense of purpose. Because

all of a sudden, your sense of purpose has been taken away. You know, you're no longer working, your family are, and now have left. You've got grandchildren. You don't have to look after anybody. What's your sense of purpose? You've got to have some sense of purpose that will be important for you. And those factors, those three factors, right, sense of purpose, being curious, keeping a network of friends or contacts, turn out to be in some ways as as important as all the

“physical things you mentioned at the beginning. Right. Yeah. I think for sure, that's what it's a hundred”

percent I would say that's true. But it's not just practical, just by by observation. Right.

who are developing dementia. And this problem of that motivation is about them. Because actually

“what we've learned from, from looking at people with this sort of problem is we learned about the”

brain systems that are involved. And in Oxford, we did a study a few years ago. We took university students of different levels of motivation. We purposefully found people who are highly motivated and believe in a lot, there are students at Oxford who are also a really apathetic. Really? That's true. That's true. It's everywhere. I guess that's true. I guess it's all relative, probably apathetic in relation to the other people. Oh, no, no, no, no, no, no, no. You know,

did you go to Oxford yourself? I did, I did, yeah. You know cognitive abilities don't necessarily

map to your behavioral levels of motivation. Yes, so that is true. I have noticed that, though,

actually in life. Of course. There's a huge variation. So we took these students of different levels of motivation. And we put them into the brain scanner to look at brain activity. When they were asked to make a decision, a bit like David, is this particular activity? Would that be rewarding enough for you to make the effort? Or would you say, no, I'll pass. I wouldn't do this. Right? So we're looking at their brain activity when they're making these decisions in the MRI scanner. And what we

found is that the brain regions like the basal ganglia, which were affected in David, like the frontal lobe, which is important for action, were active when you and I when these students are

making this decision about, is this reward worth the effort? Right? This is the simple calculation.

But the thing that was really puzzling was that the students who are apathetic showed far greater activity in these areas than the students who are motivated. And we just weren't expecting that. Right? Their brain systems involved in motivation were more active than the students who are motivated. So apathy was associated with greater brain activity. And the way that we've really tried to understand this is thinking that what this means is that for people who are

“apathetic, they are using more brain energy to make that decision. Is it worth the effort or not?”

Now, they might do it for us in the scanner. Right. Right. But at home, the my god, it's just too much effort. Having to think about this is just too much. I'd rather not think about it. Let's do nothing. Right. So the default becomes inertia because the cost of working out. Is it worth the effort or not? Right. And it's constantly thinking back and forth. Right. Well, is dopamine the pleasure chemical or is it serotonin? Most people have said dopamine is the pleasure chemical. And I'd

like to debunk that because all the animal evidence plus all the human evidence suggests it isn't like that. What dopamine does is it's really important in this calculation I was talking about. Is the reward worth the effort? Okay. So what we found in apathetic people is that low rewards are not worth the effort for them. Whereas motivated people will say, okay, that reward, although it's not a lot, I will do it. I'll do this action to get it. When we have given

dopamine to patients who are apathetic, we found that they're more willing to put in the effort for low rewards. So dopamine incentivizes things such that you act. You're motivated to act. And the difference is between something that people call wanting is this thing worth it for me to want it versus just liking it, which is the pleasure that you would get from the reward. Are we though because we're living in like a dopamine, like, you know, the whole anxious

generation, everything is like a dopamine hit, dopamine hit, like constantly that are we like going to be numbing ourselves to a place where we did so much dopamine to do something because we're so used to being constantly filled with so much that your body becomes acclimated or well, or do you sensitize? There is a big dopamine myth. There is no evidence that there are any dopamine hits when you're scrolling through, you know, social media. There is absolutely no evidence

for that. That's become, that's become a myth. And of course you'll find some very popular books out there, which also perpetuate the myth. The evidence from the animal literature and humans

“is that dopamine is really important for motivation to act. It is not the thing that gives you the”

hedonic burst of pleasure. So that is actually very, very subtly different. What I'm saying is it gives you the motivation to go and find that pleasure, but it doesn't give you the buzz of the pleasure itself. So what is the chemical that gives you that buzz? So the evidence is that there are

are the things that are very important for giving you the pleasure, the liking. So this is the difference

“between the work on wanting, having the motivation to want something versus liking, obtaining the pleasure”

from whatever you've worked for. And those two systems are very different neurochemically. So it's a big deal. And of course what I haven't mentioned to you is in David, the patient I was talking about, the beginning. We used a dopamine drug. And three months later, this man who you would think is, you know, so untidy, so disabled comes back to our clinic. I didn't actually recognise him, because he had a suit, hair cut, he had a new job, and most impressively he had a new girlfriend,

which would never have happened, because he met nobody, you know, sitting,

"Wait, you meet the girlfriend?" Well, because we had treated him with this drug. What drug was that? It's a drug called Rapineral, which works on dopamine receptors in the brain.

“And he, it wasn't that the Rapineral was giving him more pleasure. It was motivating him to do things”

that he wasn't doing before. It was motivating him to put his music system together to listen to music. It was motivating him to, you know, have a shout. It was motivating him to go out and get a job. It was motivating him to go and find a girlfriend. So why is it, so is this also used now for anti-depressants, like for as an anti-depressant? It's a really, really interesting question. Dopamineurgic drugs have not classically been used as anti-depressants. They're usually anti-depressants

work on the serotonin system. Why? Well, I'm just explaining that. So it turns out that there are

about a third of people who have depression do not respond to the serotonin-nergic drugs.

And those people with treatment-resistant depression, it seems, are now responding in certain clinical trials to the exactly the kind of medication I just mentioned that we used in David, which might mean that even in people who are depressed, there are nuances between the type of depression you have. You might be sad, but in addition, there may be also some degree of apathy in people who show depression. So, you know, you can have an overlap. You could have pure depression. You can have pure

apathy or you might have depression and apathy. So the question is, is it the case that people who have treatment-resistant depression might respond to drugs, which we are beginning to use for apathy?

Wow, that's really fascinating to me, because I would think that if David can change,

what is the role, I guess I keep on coming back to dopamine versus serotonin. How does someone respond differently to serotonin than they would to dopamine? So there's different neurochemical systems. There are different circuits in the brain, which use dopamine or serotonin. But is it manifest similarly or? I don't think so, yeah, so serotonin. No, I think serotonin is the effects of serotonin. For example, I'm not necessarily in terms of reward, but in terms

of what we call a "versive" responses. So something that you learnt is actually not very rewarding,

“unpleasant, costly in some way, and serotonin has an impact on behaviours where you need to have”

an "versive" response. Is truly complicated in terms of how we map these neurochemical systems on two different components of motivation. So one thing we've tried to do is to deconstruct motivation. Say, okay, if motivation isn't simply about willpower, what are the potential components of motivation? One of those things I mentioned to you is this thing about working out whether the reward is worth the effort. It turns out that's really important. But you could imagine

that someone would look inert. They wouldn't do anything. If they had a problem, for example, in deciding, thinking about the potential choices for behaviour. You know, it's a sunny day outside. What could you do, Jen? I mean, you could probably come up with 20 potential alternatives, right? No, about, yeah. But imagine if you couldn't, if you couldn't even think of one, if you're the brain system that would generate those choices, just was not able to do this.

How much of this is genetic? Oh, I don't think we know about that at all. But the, like if your mom has it, do you get it? There's no evidence for that in this way. But yeah, they can be biases. But things like, for example, Alzheimer's disease is just a very common disease as we get older. There are unusual genetic causes of Alzheimer's disease, which run in families. Well, there are mutations in what we call prescencyline 1 or prescencyline 2.

So it's like the thing that actually affects the chemical is what then affects, that meets

“you get the Alzheimer's. Early, not the genetic, so right. Well, the gene mutation means you're”

going to get it early. But I'm just explaining that actually that genetic component is quite rare. We also know there's a gene called apoe, and the, having the apoe 4 genotype put you at a higher risk of developing Alzheimer's. So in that way, there could be familiar with familiar risks. But in general, the vast majority of patients who develop late on Alzheimer's disease, we have not been able to pin down a genetic cause. Do most people as they, like,

what's the, what's the, I guess, the percentage of elderly people that eventually get Alzheimer's or dementia? Well, it depends on the age. Yeah, it depends on the age. Yeah, it depends on the age.

Yeah, it depends on the age. If you're going to 80, you're getting towards 20 percent, 25 percent,

and if you're going older and older, those percentages keep going to get older. Yeah, and of course, there are other causes of dementia, you know, like vascular dementia. I can occur with if you have high blood pressure or smoke or diabetes, those things affect the blood vessels in the brain and slowly you begin to accrue enough pathology, vascular pathology that you will develop vascular dementia. Sometimes unfortunately, people can get both Alzheimer's and vascular

changes in the brain and have a mixed dementia. That that's just the increased risk as we get older because, you know, our brains weren't designed to live this long. We're living a huge. Oh,

“that's the matter of time. So that's why there's a 20 percent around approximately 20 percent of”

people after age of 80 get it. Yeah, and the numbers increase enough, yeah. Can you reverse cognitive decline? We're Alzheimer's dementia. Is it true? So if we just stick to Alzheimer's, the, you know, the latest clinical trials show that there are drugs which mop up amyloid in the brain and they can make a small difference to the trajectory of decline. But it is a very, very small difference. Right. And therefore, it's been very controversial because the FDA

approved it. People have been saying that the that approval was based on level of evidence which was not really sufficient to do this because it has huge implications. The treatment. It's intravenous, this drug. Well, one of them is something called Lacanamab, for example. So it's a monoclonal antibody, which mop up the amyloid. But I mean, on the positive side, here is proof of principle

that it could make a small difference. When you say small 2 percent, 5 percent? Yeah, it's probably

of the order of 1 percent that I love very little though. Yeah. So would you, would it change someone's quality of life though if it's only one or 2 percent? And that's exactly what people are saying that that probably isn't going to make any huge difference. Yeah. So why are you putting somebody through this? But on the other hand, you know, 30 years ago, I can remember being a junior doctor seeing people doing deep brain stimulation surgery in Parkinson's disease, putting in electrodes into the

brain to try and help Parkinson's disease patients who were not necessarily responding so well to medication. And I used to think at that point, why are these doctors doing this to these poor patients because there were complications of surgery? But now, now, you know, things have improved so much in

“the techniques. They can make a huge difference to some people with Parkinson's disease. So I think”

we have to be open-minded to the possibility that even if something looks a bit odd and maybe making small changes, differences at the moment. In the future, this kind of investigation could open up whole new other ways of treating. So my, I guess my question is, it's hard. You can't, you can't reverse Alzheimer's. We haven't got any evidence that we can reverse Alzheimer's. You know, there are people out there who say it is reversible. Yeah. I've yet to understand how and how this

happens. I'd called this guy a couple weeks ago, this man, who is a gerontologist and neuroscientist. And he's fairly known. And I was telling him about my mom. He's like, oh, have you tried red light? Have you tried giving her a triple dose of creatine? Like all these things, right? Like all these things. And I went to my mom's doctor. And he's like, you have got to be kidding me. Like this is nonsense. You really think that you know, like maybe it can be for help you prevent it,

like maybe a percentage, you know, years behind, like years before. But to think that putting a red light on someone's head and giving them some creatine is going to reverse it is is wishful thinking. I think it is. Yeah. And we don't have the clinical trial evidence for that.

where they getting this from. I didn't say it. I know you didn't. I'm not blaming you.

“I'm not blaming you. I'm not going to be saying that I can promise you. Yeah. On the other hand,”

we've got to realize that, you know, people are very different. So these clinical trials just take any evidence of this. Not for the things you've mentioned here. What is their evidence of that has been able to move the needle one or two percent in habits. Forget about medication,

but in habits is there anything that people can do habitually to help them first. Partying

my question to prevent it, prevent Alzheimer's, and be to stop from getting worse. So now we're going back to the thing that we were talking about before. Yes. What are the physical things you can do? Yeah. And what are the other kind of social things you can do? Right. To help purpose isolate purpose curiosity. Keeping a close big connection with people as well as all those physical risk factors. Making sure your blood pressure is under control. You're doing physical

exercise. You're eating well. If if and not drinking too much alcohol, other things are important

too, like deafness. You know, when you're beginning to lose hearing, you become socially isolated.

So there's a whole raft of these things and the evidence is that they might actually make a difference in prevention. So if you put all those things together, it could make a big difference in prevention if you are currently healthy. I want to take a quick break from this episode to think our sponsor TheraSosh. Their tri-light panel has become my favorite biohacking thing for healing my body. It's a portable red light panel that I simply cannot live without. I literally bring

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So similar to read your book, that you wrote trying to get the, I want to make sure that I properly are brains ourselves. We're not at the top three themes that people will learn about. The book is really about how people with brain disorders reveal something about how our brains work, how our brains create our identities, our personal identities. So who we are as a person is really the product of our brain functions. We've talked about motivation today, but there are many different

brain functions, perception, attention, how we build concepts, how we behave in terms of whether we're impulsive or not, for example, those control mechanisms that we have to stop us being impulsive. So there are many different brain systems that produce us our personal identities, but the other

“important thing here is our social identities, because we're also defined by our connections”

to other people, our affiliations to different groups, our religion, place we grew up, where we went to school or university, the kind of job we did, but I also arguing the book that even our social identities really are a product of our brain's abilities to make those social identities. Imagine if you had to go off and live in a different country with a different language, in order to integrate into that society, your brain has to be curious and able and to start

learning this language to understand the customs, the humour, the way things work in this to be accepted, so to be socially accepted, we do a lot of stuff with our brain. And so the argument in the book is personal identity and social identity is created by our brains, it's an emergent property of the brain. The self is something that's created by the brain, and it's something we take for granted. It's only when things go wrong that we begin to realize,

my goodness, the way I see the world, the way I perceive the world, the way I attend to things,

if any of those, if one of those goes wrong, it's revealing how my self has changed,

“how my identity has changed, so that's what the book is about.”

But once this starts to happen, of course everything's going to start changing, right? Like you're, but are you even aware of it to know that it's changing? Some people are, but there are brain, some brain disorders like something we call front-to-temple dementia, where people lose insight, they don't actually understand that they're behaving abnormally, they can't see what's wrong with behaving the way they did. You know, there's a patient in the book called Sue,

who's walking down the street and seeing a woman in a short dress thinking that's inappropriate and shouting out, that's not going to be good for you, love, because you look terrible in it.

Now we might think that, but we never say that, right? Our control systems are making sure

that we don't blurt out something we're thinking, but in someone like Sue, those systems which would normally inhibit you and me from doing that are no longer functioning. So she's a change person in that way. I find it interesting because you're talking a lot about how, you know, it's not people just perceived that when you get, when you get dementia or all timers that it's just people just assume it's like your memories the one to go. But a lot of times it's actually

not even the memory. You know, it's all these behaviors that you're saying. I'm like, I'm learning it with my own, with my own mother. Like it's all this other stuff, the confusion, there's no logic behind anything you're doing, but they still know who you are. That's very common. Can that, can it stay like that or does it eventually? It's one of the most, you know, it's the thing that can last for a long time, also knowing who they are is also something that

can last for a very long time. But obviously we get to a point where there is so much neural damage that it's not really viable in terms of them being able to represent who you are. What made you study this so thoroughly and really specialize in this? I mean, it's, it's the bit of medicine that we know least about, right? We know about the heart. We know about the lungs.

We know about your big toe. The brain is just an amazing organ that we we've just barely

touching the surface of. You're asking me these questions. I'm trying to give you the state of the art. But I'm also completely, you know, open, explaining that we don't know much of this stuff.

“Right. So that's what's really attractive about it. And obviously these are, if there are”

diseases that affect the brain, they have enormous influence not only on the people who suffer from them, but on the families, they have a huge impact on the families. So this is where we can make the biggest inroads. What are some of the most surprising things that you've kind of turned, like you've kind of learned about or or at least that you've found in your research that would surprise most people? Well, I think this area of motivation is probably the biggest area that I've

got into thinking that you could try and deconstruct motivation into components. We talked about a couple of them. One, can you come up with the potentials for things you could do today? Right. And if you can't, you could be very important. Yeah, the motivation part. But, but it's really important because, you know, although we're talking about people with brain diseases, these are taken, there are important takeaways for how we live our lives

in people who don't have brain diseases. Right. So one thing we've learned is people think, for example, this too, it's too much effort to do this. So I won't do it. So how do you make it easier? How do you make the activation energy to start? Right. In people, our kids, our friends, where our colleagues, how do you do it? Well, one way to think about it is try and break down the problem into smaller parts. Try and make it so that it's not one big thing to do. Try and reduce it.

“The other thing that I found useful is start. Don't think you have to do a perfect job right”

from the beginning. If you start, you can become more motivated. Right. Even action can lead to more motivation. And, you know, I'm also a big believer in routines because, you know, if you have those routines, it means when I'm having like coffee, I will do this or nine o'clock in the morning, I will do this. Raging the book, it was really difficult because I'm a full-time neurologist, I'm a researcher, I'm an editor of this journal. Don't have a lot of time. But I would say you have

to turn up to the screen. Six a.m. It could be rubbish you're writing for an hour, but you're going to write it because, you know, this is the way to make sure it happens. And of course, sometimes it is rubbish that we write. Right. But just starting, just starting means you get it off on the page.

high performers, when they get some issues with their cognitive abilities, they had the biggest

crash, right, because they have all these systems in place versus people who are more like type B for their abilities. So then like maybe it is actually not good to be so tightly wound. Seriously, with all these systems and routines and mechanisms in place to performance at a high level, because once those are gone, it's actually you have a bigger chance of having, you know, the opposite, the bigger swing happens. Like the pendulum will swing even further. It's kind of like

I'm going to give you an answer to that, and I'm going to say something after. Yeah. Well, um, I mean, depends on how long you're planning to live, Jen, you know. I don't know. I would probably a much longer, you know. I would rather be, you know, really productive,

very good at what I do when I'm able to, rather than think about what I'm going to be like

“at the age of 80. No, but what I, yes, 100%, but what I think is interesting is we're doing all these”

hacks, you know, to like live longer and be like, you know, to have our brains be at like at such a peak state forever. Yeah. Meanwhile, like at the end of the day, from what I get is like, if we, if the high performers can crash, are the one to crash the most severely, I'd rather just maybe not, what am I doing to myself? Well, it's a choice, but you know, our forefathers, generations before us, they wouldn't even, this is a luxury to be talking about this. It was

survival for them, you know, making enough money to work through all these things. Okay. So we are in a luxury position where we're thinking contemplating, how am I going to do this? How much hack

am I going to use? True. Okay. So I have a few other bunch of questions. I'm going to, I haven't even

asked any of my question questions, but like, what would say, I'm going to ask them to you and then you can just answer them as quickly as you can. Like, it's concisely as you can, because I, there's so much information. Yeah. And I, I know we're kind of, we're tied on time, kind of, so here we go.

“Okay. Was the biggest misconception people have about how the brain actually works?”

Hmm. Well, probably it's to do with things like these don't mean bursts and detoxes that people are doing. I think in the current generation, that's probably the biggest misconception. Tell, talk about that again in a way that, so when you said that earlier, that like, people think that if you're on your social media, people gain these bursts of dopamine, that's actually not in the literature or research doesn't back that up. Yeah. There's no real evidence for that.

I'm not saying it's a bad thing to do. It's a bad habit. It just keeps scrolling. Yeah. But there's no evidence that we can link that to dopamine. So what, what can we, what does that do to our brain? And then if it's not about the, about that, people just scrolling, doom scrolling forever, it's developing a habit. It's developing a habit. And that habit, once you develop habits, it's very difficult to get out of them. We've been talking about trying to develop good habits

“like routines, right? Right. Start. Then by the way, out of big routine, first and obviously,”

so don't don't get me wrong. I'm still going to do it because it makes me feel good. So I'm talking about doom scrolling is probably a bad habit that for most people, they realize it's a bad habit that they shouldn't be doing as much as they can. But they, they're brought back to it. But there's no evidence that it's dopamine that's bringing you back, that you're thinking I'm lasting after dopamine when it's bringing us back. Well, we don't necessarily know what that,

that is, but no one's measured something that says this thing is the thing that's bringing you back. Okay. And it's definitely no evidence that it's dopamine. Don't know. You know what I like about you is that like, there's no nonsense. Like, so a lot of times people will be like, they'll say, oh, well, it means it's this. But you're just saying, plainly, I don't know. There's no research. We don't know what it's called. We don't know why people

are doing it. It's not the dopamine. It's like kind of unknown. But it's okay. I don't have the answer. You're just being honest. Yeah. Exactly. I love that. If you could teach everyone one thing about their brain, what would it be? It has much bigger capacity than you think. I wish when I was a kid, someone had told me whether it was teachers or parents or whatever, that actually you can do much more. And we are sometimes just limit ourselves because we constrained by the fact that we think

we can only do this much. And usually it's in one area. I've learned that brains are capable of multitasking in a way that we most of us wouldn't even think about things. Well, there's a lot of conversation around that, right? Some people say multitasking is really not great. Some people think it's excellent. So you think multitasking in the way they mean it's not good. It means switching from one thing to another very quickly. Because there is a cost, there's something we call a switch

problem. And then you're having to translate something in French if you're at high school or something.

There is a cost because it takes time to switch from doing one kind of problem solving to another. I'm not talking about switching very quickly. I'm talking about the ability to take on different types of problem. And I had no idea that I could be capable of doing that when I was younger. Well, does multitasking make your brain sharper or less sharp? Because you're constantly have to do the switcher route back and forth. And then neither task that's done well.

Oh, well, I'd like to think I'm doing them perfectly. Yeah. Yeah. But no, I have a very demanding life where, you know, one moment I'm seeing a patient and doing a clinic for three hours. I'm not talking about switching straight away. And the afternoon I'm doing a research study or I'm reading

papers about something that have been submitted to the journal that I had it break. Right. Or I'm

having to deal with some university problem that's a reason. And I quite like it. I quite like the fact that these are different types of problems. What about ADD, then? Would you say that

“people who have ADD? Do you think ADD is a myth? Do you think it's actually something true in the brain?”

I don't think it's a myth. I think it is something that some people have. Okay. Whether it's being over diagnosed is something we could argue about. I'm not a specialist in that area. So, you know, I'm not, I don't think I can be qualified to stay whether the levels of diagnosis have risen because it's a genuine thing or not. The evidence from good studies, research studies, is, yeah, there are differences in the brains of people who have developed ADD compared to people who

don't. We can also measure those differences, particularly in the ability to sustain attention.

People with ADD are far more variable in their, their ability to sustain attention. That's one of the key markers. There's just variable in their response times. Let's do something very simple like pressing a button if you see a flash of light. You are very consistent. If you don't have ADD, if you do have ADD, you're far more variable. I don't think there's any data. Well, the multitasking piece that you were just talking about, right? Like I feel when you have ADD,

you're much easier. It's kind of like part for the course, like multitasking and jumping from one thing to another. Like I've noticed a lot of entrepreneurs have a lot of, that's an ADD is a very big piece of fat. Right. You know, you could argue that some people who are very creative have that ability to jump from this problem and suddenly think, actually, I can sometimes also use principles in one area to apply them to another area. That's another important ability

to be able to do. Seeing something you've learned in this particular area might actually be helpful

“for you to solve a problem in a completely different area. So, I think there are people who have ADD,”

who are very creative, who are very able and also do this thing about having lots of problems to solve. So, I guess my question was more, you're kind of touching upon it. Like since everyone's now being diagnosed, self-diagnosed or clinically diagnosed as someone who has it. Do you see that the research that is there anything to back that the brains are chemically different than people who don't have ADD? Yeah, there are research studies which show that, either in

terms of brain activation. Yeah. And it turns out it's the areas of the brain include the basal gangly we were talking about as well as the frontal and parietal regions of the brain, which seem to work differently in people with ADD. And that maps on to our ideas also of the attention networks in human brains. We were talking about circuits for motivation, there were also circuits for attention. Those are affected in ADD. There are also some people with ADD who are apathetic. And we assume

that that's because the brain circuit for motivation can also be affected in these people. So, I hope I'm getting this concept across that we have circuits in the brain, each two different things. They can be affected by different disorders whether it's ADD or we were talking about stroke or neurodegenerative illnesses like Alzheimer's disease. It's what affects those circuits and how the affected leads to the manifestation of the cognitive deficit or the behavioral deficit.

Okay, now with AI, right? Because everyone now is relying on AI to do like basic tasks that they would otherwise not have been able to do, writing emails, print together sales strategies, decks, building websites are our brains actually getting lazier. Is that actually a thing that can happen? I think if you know, like what happens to our

“brains, if we're just like not using them, that's what he said when you're getting older,”

it's important to do crossword puzzles and stimulate your brain. I agree. And in general, I think that's what the evidence might suggest, but I'm going to be, you know, boring and say to you,

used to do very well. I mean, you remember using maps? That's something. I don't even need to

“be a neuroscientist to figure this one out. That's what I'm saying. Like, I don't know. I can't”

remember my own phone number and let alone any other phone numbers at this point because I haven't had to. Yeah, but that's whether you'd be bad at it if we started all over, right? Whether you now had to use the physical map to navigate. Yeah, I wouldn't have it. I have no clue. Well, you can give it a try. It's because it's atrophied. I think, again, I'm no, I'm no neuroscientist from Oxford, but I would imagine that if you don't use it,

you lose it. In general, my muscles, if I'm not working out, even for a week, I feel it. I'm not as strong. I'm not as strong. I'm not as strong. But the question would be,

my brain is getting, could you regain it? Chunky, could you regain it? Those skills.

Muscle memory. Yeah, could you regain it, you know, relatively do it. So what I'm concerned about, like, what I think is interesting is, like, when we were kids, we had to memorize our friend's phone number, we just wouldn't be able to call them. We had to read a map. We had to do all these things, and like, we trained our brain constantly. Like, does that mean that the generation that's like, my children right now, who don't need to remember our phone number, who don't have to do all these

basic things, are they going to have like a lazy brain? No, I don't think so. I mean, or they start learning new things. Okay, what do you tell them? Well, the new technology, like, how do you, how do you snapchat? Wonderful. They can use that. How take talk? Great. They're going to be brilliant. They're going to be professors at Oxford because of it, partly. No, I mean, I don't think there's any reason to fear that human ability,

cognitive abilities are going to be killed. Because this is what everybody said when any new technology came along, right? Hmm. Yeah, I mean, listen, you can learn how to prompt better.

Like, basically, it's like, now it's about, oh, do you know how to prompt AI to get the

answer and the information you need? Like, okay, so, but so there's different things to be learning, so to speak in technology that will keep our brains activated. But in the end, we're trying to solve problems. And if you don't solve problems well, you'll screw up, and people will notice. And you're, you know, so we have to learn new techniques to solve the problems of the modern world. And your kids are going to be able to do that. That's, that's going to happen.

Okay, I understand that. Cultures have changed in technology, right? Human culture has just gone in

“leaps and bounds. I still think it's really important. Like, that's why we're just becoming a lazy”

culture, right? Like, we don't even go to the grocery store, we order our food, we don't cook, we just, you post me, it's like, everything's become so easy. I agree with you. Like, it's like, what are we going to, we could just all sit at home all day, 24 hours a day, watch TV, order our food, like, like, our society is becoming a very lazy, unless you, unless you make a very concerted effort to not be, which is why these habits and routines and creating structures where,

you know, you do things or it, like, put out there or else it's very easy to become, like, literally a plate of mush. I'm, I'm remembering the recommendation you quoted right at the beginning of the show, but you have no filter. Yeah, I will, though it's true. I will listen, I haven't even started yet. I don't have any filter. That's 100% true. But I just feel like this is, like, obvious stuff. But, like, the, okay, so let me just move on from there, because I got to,

“I have a question that I think, or what you kind of touched upon to, which were, which I think”

is very important, and which is people who are lonely, who feel isolated, who have no purpose. This is when your brain really starts to decline. So, I really want to talk about that, because I think that's become so prevalent, and, you know, what I see, because of social media, because of what we just talked about, is our society's been it so easy, not to socialize, not to deal with people, that, like, including the tech. Yeah, I'm saying, tech has actually made

it easier. Like, in some ways, yes, they've taken the burden off of repetitive tasks, taking the burden off of, you know, sending an email with thinking about what to say, because if I use chatGPT, I sound smarter. I mean, one more stupid, because I use chatGPT, and I wouldn't have thought of it, but the alternate side of that whole thing is with that technology comes a lot of isolation and loneliness. So, my question really is this, what actually happens

to the brain when it feels lonely, and why do relationships have such a profound impact on our health and longevity? Right. So, I think that the evidence for that comes from psychology, rather than from neuroscience, because we don't have enough evidence to do in this, but the psychology suggests that it's really important in terms of, even simple things,

conversation in this way. Right. From everything simple from turn taking, in this conversation,

to being curious enough to take that conversation beyond the simple, "Hello, how are you?" Right. How are you doing? To take it to something where you're actually discussing a current event, or something that you both read, or something like, you know, that's a really important part of this. And it seems that that makes people feel well, that the ability to have those kind of interactions with other individuals gives you a boost in terms of your feeling

of being, well, exactly what is happening in the brain when that happens. We don't know. We don't know. Okay. So, can loneliness actually impair your decision-making then,

“and your cognitive performance? I think that's completely possible. Yeah. And the cognitive”

performance for sure. Yeah. In terms of everyday decision-making, I'm not sure about the evidence for that. Okay. Is there a best, now these are going to be very rapid fear, such as best exercise for the brain? Yeah. I think I would say aerobic exercise. You'd be better. If you can do 30 minute exercise, two or three times a week, where you're actually sweating,

and you're getting your heart rate up, that's probably the most important thing to do.

But give me some specific. Would you say, "What's better? Weight training or walking for your brain?" If you had to, if you had to decide, I'd go walking or running. Running because it actually elevates your heart rate. Yeah. Okay. Would you say Pilates or Stairmaster? Stairmaster here. Could you again? So, you like the things that are a much more rigorous for your brain to be activated. I could have told you that, but I'm glad that a

professional thing, best food for cognition. I'm not sure there is much evidence apart from the fact

“that you shouldn't, you need to keep that cholesterol level at a reasonable amount because cholesterol”

is one of these important factors which affects the vascular risk factors of the brain. So, it's interesting to say that because if you're a biohacker, they say, "Oh, that's nonsense," and that cholesterol is actually good for you. Oh, cholesterol is important in the sense that lipids, fats are important in terms of making the neurons. You're like, but like, you know, like, it used to be one again when I was younger, right? But butter was like the antichrist, right?

Butter in like eating too much saturated fat, like bread meat. Now, it's like, talked about to be the panacea for health and wellness. Well, you know, in all of these things, you have to have a, you know, you got to be reasonable about the stuff like that. But butter I read me, but I'm just saying people who have a raised cholesterol level have a higher risk of developing vascular changes in the brain and therefore a higher risk of developing

“vascular dementia. So people who say, "Oh, you need to eat blueberries and a lot of omega-3s”

salmon," I guess, does it do anything? Well, I actually don't know the evidence that it doesn't do anything. You really, because like for 30 plus years that I know, people are like, "Oh, you need to eat your wild salmon and you need to eat your blueberries and you need to eat it." It might make a difference, but I don't know the evidence, but I didn't know what you haven't seen the evidence. Oh, wow. Okay, most-- I'm not sure anyone's seen the evidence. Well, where does all come from?

It's interesting. It's rhetoric that's just out there. Yeah, things take fashion, as you said. Okay, so one brain myth you wish would disappear. Well, I don't want to go back to the dopamine one for you, but I would say that one myth is that you have a limited capacity to do things. I think, as I said, you have far bigger capacity than you think. One most underrated brain habit. Sleeping well. That's a brain habit. Yeah. So if you don't sleep well, I mean, people know

this already. Does that actually create over time, like a sleepy brain, excuse the pun, but like does it actually like we can your brain function over time in a real way? Not just like, oh yeah, I didn't sleep well, so I'll be like groggy and annoyed tomorrow. Yeah. So the extremes are people who do shift work and those people have a higher risk of developing all sorts of diseases, diabetes, obesity and also cognitive impairment to some extent, right? But even less, less extreme,

when we don't sleep well, we have impaired cognitive performance the next day. Well, yeah, that's, I meant it more chronic, like not just because everyone's wearing, of course, I'm wearing my

aura ring. It just gives me more stress than anything else because I'm always like, did I sleep okay?

Did I not sleep okay? And a third of the people who come to see me in my clinic with memory problems,

they're really worried about their memory or other abilities and they're coming to seek advice,

“but we can actually reassure them that it's not something like dementia that they're developing.”

It's these things, if they could improve those things, sleep, sleep better, become less anxious, perhaps improve their mood. A lot of these things, though, I find, like, that's a lot of times, it's like life that's happening, right? Like if someone is anxious and not sleeping well, because it's not that full. And it's like, okay, it's very easy for a professional, like, well, just don't lower your stress and sleep better. Well, yeah, that's great for you to say,

but if you have like, and, you know, a sick child or sick parent and you're financially struggling, and you have all these problems, it's very hard to get those things in chat. I completely understand, but we don't put it like that. I don't, I'm not going to say, oh, I know you're not. I'm just saying,

“it's funny how that's, of course these things will make it easier. That's why. Right,”

but it's also reassuring for someone to think, oh, my goodness, it's not because I'm developing dementia. It's like, it's something that I might be able to do or a doctor may be able to help me, right? Well, what I was going to say is, after if you're, if you're experienced these things for a long enough period of time, does it become an actual chronic problem or can they reverse it? So if that was like the odd, the bottom line. Yeah, sometimes it becomes so chronic that it's very

difficult to reverse naturally unless some environmentally change happened, you know,

the other things that were making you really, make $10 million and you're like, well, that isn't always

it's charming or whatever, you know, anything like, yes, that would be great. But for most people, like, as you age and life becomes hard, it's very easy to be like, oh yeah, just like sleep better when it's really kind of not an easy thing for most people. Well, there are ways in which you could do it, right? But first of all, identify that it's a problem. Ambient? I'm joking.

Identify it's a problem, first of all. I know. So, all right, well, listen, I appreciate your time.

I mean, you're obviously a fountain and a wealth of information given where you are and what you're doing. Can you tell people where to find you and if they want to know more about you that they can, what you can do? Sure, we have a website. If you go to mysudewhosane.org, MSUD, HUSAIN.org, you'll find the kinds of research we do. The books are published, the papers we published, and other resources. Yeah. Well, I really appreciate you coming on here. Thank you for

“very much. You guys grab a copy of this book if you want to know anything or more about your”

brain and wait, you don't even have a copy here. It's going to show it for the camera, but that's

okay. I'll just, we can just basically are, it's called our brain ourselves. And that's it. Thank you so

much for being on the show. Thanks for doing much. Don't forget to subscribe. Thank you. Bye. [BLANK_AUDIO]