16d (edited) • Functional Living
Your Brain Needs Exercise Too (Alzheimers/ Dementia Prevention)
Five weeks of cognitive training produced a surprising finding 20 years later
Every morning and every evening, I play games.
Not Candy Crush.
Brain games.
I have a series of about six that I rotate through — pattern recognition, word games, memory challenges, processing games and puzzles. I use an app called Brain Games. I play several of LinkedIn's daily games. Sometimes it's Wordle, Connections, Sudoku, a crossword or another puzzle.
The New York Times has an entire collection of daily games that can keep you entertained — and occasionally humbled — for quite a while.
Todd is different.
He loves chess and strategy games that require sitting down, thinking several moves ahead and committing far more attention to one game than my attention span generally wants to give it.
And I've come to think that both approaches have value.
Because we exercise our bodies to maintain strength and mobility.
Why wouldn't we exercise our brains to maintain cognitive flexibility?
A fascinating long-term study published this year gives us another reason to think about that.
They trained the brain for five weeks — then followed people for 20 years.
Researchers went back to data from the ACTIVE study — Advanced Cognitive Training for Independent and Vital Elderly, one of the largest randomized trials of cognitive training ever conducted.
For this particular analysis, researchers linked training records for 2,021 adults with Medicare claims extending over approximately 20 years.
Participants had originally been assigned to one of several groups:
- memory training
- reasoning training
- speed-of-processing training
- or a control group
The original training wasn't years of intensive therapy.
It consisted of up to ten sessions over about five to six weeks.
Some participants who successfully completed the original training were later offered booster sessions approximately 11 and 35 months afterward.
And that's where things got interesting.
The people who did speed training PLUS reinforcement had a 25% lower risk of a dementia diagnosis.
Over the 20-year follow-up, participants in the speed-of-processing group who completed at least one booster session had a 25% lower hazard of receiving an Alzheimer's disease or related dementia diagnosis compared with controls.
Hazard ratio: 0.75.
But participants who completed the initial speed training without the booster sessions did not show a significant reduction.
Neither the memory-training nor reasoning-training groups demonstrated a significant main effect on dementia diagnosis either.
That's fascinating to me.
Because it suggests something more interesting than:
“Do crossword puzzles so you don't get Alzheimer's.”
That isn't what this study showed.
What kind of brain training worked?
The successful intervention wasn't simply memorizing lists or answering trivia questions.
The speed-of-processing training challenged participants to rapidly interpret visual information while paying attention to more than one thing at a time.
As participants improved, the program became harder.
Information appeared more quickly.
The visual demands increased.
The brain had to recognize, process, divide attention and respond.
In other words:
the task adapted to the person.
Researchers describe it as a speeded, dual-attention, adaptive task.
Think about what happens when you progressively increase weight at the gym.
If you lift the same five-pound dumbbell forever, eventually it isn't much of a stimulus.
Your muscles adapt.
The brain appears to need challenge too.
Your brain was designed to adapt.
We sometimes talk about aging as though deterioration is simply something that happens to us.
You get older.
Your memory disappears.
Your brain slows down.
Eventually dementia arrives.
Except biology is considerably more complicated than that.
Your brain remains capable of changing its connections and adapting to demands throughout life — what we commonly call neuroplasticity.
And that's why I think we need to stop treating Alzheimer's and dementia as though they are inevitable sentences handed down by age or genetics.
Risk is not destiny.
Even APOE status is a risk modifier, not a guarantee that someone will develop Alzheimer's disease.
And increasingly, dementia research is pointing toward something I've taught about chronic disease for years:
Our terrain matters.
The 2024 Lancet Commission identified 14 potentially modifiable dementia risk factors across the lifespan, including physical inactivity, diabetes, hypertension, obesity, smoking, social isolation, hearing loss, depression, high LDL cholesterol and others.
Collectively, the authors estimate that addressing these factors could potentially prevent or delay around 45% of dementia cases.
That does not mean every case is preventable.
It means we have considerably more influence over brain aging than many people have been led to believe.
Alzheimer's isn't only a memory problem.
One of the biggest mistakes we make is waiting until someone starts forgetting things before thinking about brain health.
The brain is metabolically expensive tissue.
It requires an enormous amount of energy.
It requires adequate circulation.
It requires healthy mitochondria.
It is affected by insulin resistance.
It is affected by chronic inflammation.
It is affected by sleep.
It is affected by physical activity.
It is affected by nutrient status.
It communicates continuously with the gut.
And it changes according to what we ask it to do.
That is why protecting cognitive function cannot be reduced to one supplement, one medication or one puzzle.
You have to protect the terrain in which the brain lives.
Metabolic health matters enormously.
This is another reason I talk so much about insulin resistance and metabolic flexibility.
Diabetes is one of the established modifiable risk factors for dementia.
Researchers are also intensely interested in the brain's ability to utilize ketones as an alternative fuel source, particularly when glucose metabolism becomes impaired.
Small randomized trials involving ketogenic interventions and ketogenic MCT supplementation in people with mild cognitive impairment have reported improvements in brain energy metabolism and some measures of cognition. That research is promising, although it is not yet the same thing as proving that a ketogenic diet prevents Alzheimer's disease.
But it is another reason I believe maintaining the ability to efficiently switch between glucose and fat-derived fuels — metabolic flexibility — deserves attention throughout our lives.
Not just after disease appears.
Your muscles protect your brain too.
Then there is physical exercise.
We often separate “brain health” and “physical health.”
The body doesn't.
Exercise affects circulation, glucose regulation, insulin sensitivity, cardiovascular health and numerous biological pathways involved in brain health.
Physical inactivity itself is included among the major modifiable dementia risk factors identified by the Lancet Commission.
So when you walk…
lift weights…
garden…
hike…
dance…
carry groceries…
or deliberately build and maintain muscle…
you aren't just training your body.
You're supporting the environment your brain depends upon.
And then…actually USE your brain.
This is the piece I think people sometimes forget.
We spend enormous amounts of time talking about supplements.
Diet.
Exercise.
Sleep.
Blood sugar.
Inflammation.
Gut health.
All of those matter.
But your brain is also a network that responds to use.
So challenge it.
Learn something.
Solve something.
Remember something.
Create something.
Make it work a little faster.
Make it shift between tasks.
Make it notice patterns.
Make it coordinate information.
And don't necessarily do the same thing every day.
Mental gymnastics can actually be fun.
You don't need to enroll in a neuroscience laboratory.
Try:
Wordle.
Connections.
Sudoku.
Crosswords.
Chess.
Strategy games.
Pattern-recognition games.
Memory games.
Visual processing games.
Learning a language.
Learning an instrument.
Trying a completely unfamiliar skill.
And based on the ACTIVE findings, I'd especially include activities that challenge processing speed, divided attention and progressively increase in difficulty, rather than relying entirely on familiar puzzles you already perform easily.
One important caveat:
We cannot take this study and say that Wordle or Sudoku specifically reduces Alzheimer's risk by 25%.
That isn't what was tested.
What we can say is that a very specific type of adaptive cognitive training, reinforced over time, produced a remarkable long-term association with lower dementia diagnosis.
And that should make us curious.
Don't just protect your brain.
Challenge it.
This may be my favorite takeaway from this study.
The people who benefited weren't simply given ten brain-training sessions and sent on their way.
The group showing the significant long-term difference came back and trained again.
The reinforcement mattered.
And that fits beautifully with what we know about the rest of the body.
You don't exercise for five weeks when you're 40 and expect your muscles to remain strong until you're 80.
You don't eat well for six weeks and assume your metabolism is protected forever.
Biology responds to repeated signals.
So perhaps we should think about our brains the same way.
Build a brain that has options.
Eat in a way that supports metabolic health.
Maintain your ability to use different fuel sources.
Keep blood sugar and insulin under control.
Take care of your gut.
Reduce unnecessary inflammation.
Sleep.
Move your body.
Build muscle.
Maintain relationships.
Learn.
Stay curious.
Solve problems.
And occasionally do something that makes your brain say:
“Wait…what?”
Because some of the best things we can do for an aging brain may be remarkably ordinary.
A walk.
A conversation.
A nourishing meal.
A good night's sleep.
A chess board.
A crossword.
A puzzle on your phone while you're drinking your coffee.
Five minutes spent making your neurons work a little differently than they did yesterday.
You exercise your muscles because you want them to keep working.
Maybe it's time we became just as intentional about exercising our brains.
Grounded in Faith. Nourished by Nature. Supported by Bedrock.
Adaptive Brain Applications: Lumosity, BrainHQ, Elevate, Peak, Brain Games.
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Your Brain Needs Exercise Too (Alzheimers/ Dementia Prevention)
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