Rebecca Chopp: First, I got a neurologist that was not a good fit for me. She told me in three years I wouldn't be buttoning my shirt or being able to feed myself. That added more devastation. I asked for a new neurologist and I got one, and she said, "You know, some people are starting to live for years with this disease when it's caught early." And her prescription for me began with the following words, "Live with joy." Allison Sekuler: That's Rebecca Chopp. She was diagnosed with Alzheimer's disease, but she's going all out to stay healthy and delay the disease by challenging her brain. You'll hear Rebecca's inspiring story in a minute. Jay Ingram: Welcome to Defy Dementia, a podcast for anyone who has a brain. It's all about living in ways that keep your brain healthy and reduce your risk of dementia. Allison Sekuler: Because dementia is not predestined by genetics, it can play a role, but there are other risk factors like hearing or vision loss and lack of exercise, and those risks can be reduced through lifestyle changes. In fact, scientists think that lifestyle changes could reduce dementia cases worldwide by 40%. Jay Ingram: On today's show, we're talking about how we can keep our brains healthy and there's evidence we can even grow new neurons, brain cells by taking on mentally challenging activities. Experts call that cognitive engagement. Allison Sekuler: I'm Allison Sekuler, President and Chief Scientist at the Baycrest Academy for Research and Education, and the Center for Aging and Brain Health Innovation. Jay Ingram: I'm Jay Ingram. I'm a Science Author and Broadcaster. I have both a personal and professional interest in dementia. Allison Sekuler: Join us as we Defy Dementia. Jay Ingram: Because you're never too young or too old to take care of your brain. Allison Sekuler: Whether you are old or young, one of the best ways to take care of your brain is to give it a real mental workout. Jay Ingram: If you're young, consider the radical idea that school is a major workout. We know that a lack of education early in life is one of the biggest risk factors for dementia later in life.. It may increase that risk by as much as 7%. That's huge. So stay in school if you can. Allison Sekuler: Now, if you're older or didn't have the opportunity to stay in school, take heart. There's another great way to lower the odds of dementia, cognitive engagement activities that are mentally stimulating, that you enjoy. Activities like crafts, reading, socializing, or learning a language. Jay Ingram: More research still needs to be done, but scientific studies are saying cognitive engagement is a very promising way to lower your odds of developing dementia. And for people who've been diagnosed, there's evidence it can delay the disease, and that's something that caught the eye of our first guest and it changed her life. Allison Sekuler: Rebecca Chopp is 71 years old. She was an ordained minister and university administrator. She served as dean, vice president and president of several universities and rose to become the chancellor of the University of Denver, the first woman to hold that office. Jay Ingram: Then in 2019, her life took an unexpected turn. She was diagnosed with early Alzheimer's disease, one of the dementias. She retired from the University of Denver and dedicated herself to slowing down progress of the disease through lifestyle changes like cognitive enhancement. She embarked on a new career as an Alzheimer's activist and educator. She joins us now from Denver. Allison Sekuler: Rebecca, welcome to Defy Dementia. Rebecca Chopp: Thank you. It's wonderful to be here. Allison Sekuler: It's such an honor to have you here. We want to talk to you a little bit about cognitive enhancement, but before we get to that, I'm wondering if you can take us back to the diagnosis when you were first told that you had early Alzheimer's, and do you remember what that felt like? Rebecca Chopp: You know, I had not been really experiencing that many symptoms. I had been sleeping a lot. That was it. So when they first brought this up to me that I could have Alzheimer's, I couldn't believe it. And then four months of diagnoses and brain scans and all that. When they told me I had mild cognitive impairment, Alzheimer's, I was devastated and shocked and my life changed in a moment and very sad. Both my mother and both my grandmothers had Alzheimer's. I knew what was coming, I thought. Allison Sekuler: And after that shock and the sadness and mourning that followed the diagnosis, what was it that helped you take a new direction? Rebecca Chopp: I had a fabulous neurologist. Well, first I got a neurologist that was not a good fit for me. She told me in three years I wouldn't be buttoning my shirt or being able to feed myself. That added more devastation. I asked for a new neurologist and I got one, and she said, "You know, some people are starting to live for years with this disease when it's caught early." And her prescription for me began with the following words, "Live with joy." She gave me some guidelines about what I should do, diet, exercise, et cetera. And that got me started on a journey to find out were there ways I could slow down the progress of my symptoms. Jay Ingram: Can you give us some examples, Rebecca, of the changes that you were persuaded to undertake at that point? Rebecca Chopp: Yes. The first one was creativity. I like to think I was a creative person as an administrator and minister, but I didn't do anything artistic. I didn't draw up on the so-called right side of my brain. But it turns out that any art, painting, gardening, music, knitting, woodworking, whatever, activates different neurological networks in your brain and stretches them and helps keep your brain plastic as maybe the ones about memory and reading are starting to get weaker. These are lay person's terms, of course. And a friend convinced me to take up painting. Another one was exercise. I had always worked out a little bit just to keep the stress at bay, but my doctor said at least two hours a day. She said cardio, choreography, which would be like dancing, kickboxing, yoga and strength. So again, I had done maybe 45 minutes, an hour a day, but I retired. So I pushed myself to two hours a day. One was, I got a very active dog so I could run and hike and walk with my dog, and then I do strength or choreography or something. So, you know those are just two. And then there's diet and intellectual engagement and a number of other things. Jay Ingram: I'm really interested in the fact that you were advised to take up painting. Had you been a painter before? Rebecca Chopp: Never. In fact, I was one of those kids who, you know, the art teacher looked at my little stick figures and said, "Not artistic." And I might not have taken it up except for the friend who intervened after I told her I needed to do something creative and what was I going to do, and she was an artist. And I just discovered it was fun and I started taking lessons and I took a class called something like drawing for those who think they can't. And at the beginning I drew another stick figure. By the end of the class, 12 weeks later I drew a pretty accurate self-portrait. So this creativity thing, like learning to read or write, it's a learning process. Allison Sekuler: So you're talking about learning to read and write and comparing that with learning to paint or draw, in this case. There's a creative element for sure. Do you now view the painting and these other creative pursuits as cognitive enhancement in some ways, sort of cognitive training? Rebecca Chopp: Correct. Very much so. I think there's all different types of learning, all different types of knowing. We know that, science teaches that there's not just one type of knowledge. And so the art, or again, music or gardening is a matter of stretching your brain. It's a matter of learning techniques. You don't just sit down and paint a portrait. You have to learn, and I'm actually constantly pushing myself to learn new techniques. Jay Ingram: Is that difficult to push yourself? Rebecca Chopp: Well, yes, but I think when you give up the notion that you have to do it for a living or for grades or for people's approval, it makes it a lot easier. And I think the key is finding something you really enjoy. For me, it's art. For others it might be woodworking or gardening or something like that. I think it's to continue to learn to make your mind stretch. Allison Sekuler: And how do you think that that stretching of your mind, that cognitive enhancement as we're calling it, is helping you, is helping your brain? Rebecca Chopp: I'm not a technical scientist, but as I understand it, it really does three things. It helps keep your brain plastic. I mean, it's the plasticity of the brain. It helps keep your brain flexible. It makes new pathways. In my reading, I have learned that the combination of the cognitive enhancement through painting or gardening or whatever combined with exercise also creates those good chemicals that help wash the toxins out of your brain. And that many writers find, and you see this throughout history, they take walks or they run or they do something physical before they write. I just often find, if I go out and run or walk with my dog or something like that, I have two or three hours that are really good for painting or writing. So my own experiences, yes, the brain gets somehow more focused, less scattered. Jay Ingram: Rebecca, is it important that you really like the cognitive enhancement things that you're doing? Rebecca Chopp: Yes, Jay, I think it's really important. I mean, again, living with joy means that for me, everything I try to do is about trying to choose to find ways I feel or experience joy. And I don't mean happy happy. I mean a kind of blissfulness, a kind of abiding, a kind of feeling connected. So we know that many people who get diagnosed with dementia have trouble with the discipline and they get overwhelmed with despair. And I think the real key to the discipline and to fighting despair is to choosing to find things that give you joy. So I wish that... I mean, I love music. I love to listen to music, but I just am not a great singer. Painting I really love, so I can do that and do it consistently. So I think it's key to find things that you love to do. Allison Sekuler: In addition to the advice of finding something that brings you joy that you really love, do you have any other tips for people, whether they have a diagnosis or not on how to increase cognitive enhancement? Rebecca Chopp: Yes. Well, we've talked about creativity and we've talked about exercise and I think a brain healthy diet is extremely important. In fact, my wonderful neurologist, the love with joy lady, told me to make sure that I planned and cooked several meals a week in this new diet as a way to help my cognitive enhancement. So it is. I had never really known much about food from India. Well, food from India is fabulous for your brain. I mean, turmeric is a spice that is known to chase away those nasty toxins. And then all the legumes and other good spices and vegetables is fabulous. Allison Sekuler: One last question, whether it's cooking or any other kind of cognitive enhancement, is this something that you would recommend people wait until they have a dementia diagnosis to start, or is it something that's worthwhile people thinking about even before they have a diagnosis? Rebecca Chopp: Well, I think everyone should start. I think it's a healthy lifestyle, trying to avoid stress. Now, while you're working, you are going to have stress and raising kids is stressful and we all have stress, but trying to minimize the stress and to have as much joy as possible, adopt a brain healthy diet. Two other things I'd want to mention that have been important for me. One is the social and community engagement. I thought that was just to fight depression, although then I learned depression itself is a cognitive issue, but it also increases your cognitive enhancement to converse with friends or be a part of a community. I've gotten very involved in Alzheimer's advocacy. Again, constantly learning, constantly meeting new people, but that itself is a cognitive enhancement. And I also, and I know this is a little more not everyone's taste, believe that some kind of spirituality. There's lots of interesting research done on things like meditation and prayer and spirituality as a way to also keep your brain healthy. Allison Sekuler: Rebecca, you've made so many different lifestyle modifications since your diagnosis, and I'm wondering what's the math on your health after all of those changes? Rebecca Chopp: Well, I mean the math is a little unpredictable, but again, the first neurologist I saw said three years and I wouldn't be buttoning my clothes. It's been four and I just finished writing a book. I'm still driving. I'm hoping to be one of those people who continue with, again, all these lifestyle modifications that I don't show symptoms for another good seven to ten years. I just had one friend who just really stopped driving and is now having a little more trouble speaking, and she's had this disease for 12 years. She was a nurse and she knew intuitively how to modify her lifestyle. So the longest that I know of is that people can live up to about 20 years. So my hope, my desire, my belief is that I can go again seven to 10 years without any serious huge cognitive impairment. Allison Sekuler: And you clearly believe that the changes that you've made in your lifestyle, including these additional cognitive enhancement approaches, that's bought you time. Is that right? Rebecca Chopp: Oh, yes. And I think there's lots of research that shows that, that can happen not for everyone. Again, because people are unique and maybe some it's five or six years, maybe some it's 10 years. But I think these lifestyle enhancements can prolong the cognitive wellbeing and also give you wonderful years to be engaged, to have joy to live well. Jay Ingram: Rebecca, you've obviously given this a lot of thought, and there are many people in the world who are either in a position similar to yours or at least thinking about it. What do you think is the most important thing that the rest of us can understand about Alzheimer's and other dementias? Rebecca Chopp: Well, I think the most important thing we all need to understand is that everyone is different in this range of dementias, but everyone has to get educated. They have to be their own advocate. They have to do their own research. Thankfully, there's lots and lots of materials out there on the web and Alzheimer's associations around the world, Alzheimer's groups, books. You've got to research and you've got to choose to live with joy. You've got to refuse to surrender to the despair because it is a tragic disease. But by choosing to live, you can prolong your wellbeing, your years of wellbeing, you can enjoy your family and you can remain productive. That is, I think that we used to, again, think that the moment you got Alzheimer's, you stopped being productive, you became dependent. It was kind of a binary. You were healthy then you were terribly unhealthy. But that's not true. It's a long spectrum. You can remain productive and remain engaged for many, many years. Jay Ingram: Rebecca, it's been a great pleasure to talk to you. Thank you very much. Rebecca Chopp: Thank you. Jay Ingram: Rebecca Chopp is an Alzheimer's disease educator and advocate. She has a book coming out in 2024, entitled Not Your Grandmother's Alzheimer's. She joined us from Denver. Allison Sekuler: Our next guest, my colleague Dr. Nicole Anderson, has been listening to Rebecca. Nicole studies memory, aging brain health and how lifestyle interventions like cognitive engagement can reduce the risk and progress of dementia. Jay Ingram: Nicole is a Senior Scientist at the Rotman Research Institute and Associate Scientific Director of their Kimel Family Centre for Brain Health and Wellness, both of which are at Baycrest. She's also a Professor of Psychology and Psychiatry at the University of Toronto. Nicole, welcome to Defy Dementia. Nicole Anderson: Happy to be here. Allison Sekuler: Nicole, when you were listening to Rebecca, what caught your ear in particular? Nicole Anderson: What impressed me most about what Rebecca was saying is that she addressed many different risk factors for dementia. So she started eating more healthfully. She became more cognitively engaged through her painting. She focused on stress reduction through, in her case, spirituality. And so she was tackling not only one risk factor, but doing as much as she could across the board. She's very ambitious, though, a high functioning woman, and I think for most of us, this might be too much to take on all at once. So people should feel comfortable in tackling one thing at a time, and then once they have that mastered, moving on to the next domain. Jay Ingram: So Nicole, even given that array of things that Rebecca is doing, is there anything you'd like to add to that selection, to her description of cognitive engagement? Nicole Anderson: She focused somewhat on social engagement. That's another very important domain. So if people are faced with the situation and they're addressing their nutrition, they're addressing their physical activity, they're addressing their cognitive engagement, I hope that they're not doing that alone. I hope that they're joining a painting class with others, joining a book club or something for cognitive engagement, exercising with other people, just to help also get that social engagement as part of the recipe. Jay Ingram: Yeah, good point. I'd also like to know if you think her impressive selection of activities is a good representation of all the activities that constitute cognitive engagement? Nicole Anderson: Well, she's focusing, for cognitive engagement primarily on painting. And that's great. People can pick whatever they want to pick that engages them cognitively, as long as it's something that challenges them and that they're constantly learning from. So somebody else might say, "Does that mean I have to start painting?" And the answer is no. If you're more into studying Ancient Greece, then go study Ancient Greece. So whatever inspires you and keeps you motivated, go after that because people won't keep it up if they don't enjoy it, right? Everything counts as long as you're challenged, you're having to think hard and you're learning new things. So painting would fall in place there, because when you're painting, as long as it's not completely abstract painting, you're having to think about perspective and contour, all these things that you have to plan out in advance. Allison Sekuler: Colors. Nicole Anderson: Yes, and colors. So think Sudoku and crosswords, yes, those are cognitive engagement. Again, as long as you're challenging yourself with them and not just doing the super simple puzzles that you can do in your sleep, but it really would encompass anything where you're having to learn constantly and pushing your limits. Allison Sekuler: And are there differences though? People have heard about different kind of brain training games and crosswords and so on. Is there a difference between engaging yourself in a way that helps you get better at that one thing versus engaging yourself in a way that's going to help you be better at lots of different things? Nicole Anderson: Absolutely. I think this is a message that's very important for people to hear that if you just do one thing over and over again, whether that be crossword puzzles, sudoku, or these brain training games, you're going to get better at that one thing. But in general, that's not going to generalize to your everyday functioning necessarily. So my personal perspective is that it's better to be engaged in real life activities because by definition, that's going to generalize to real life. So if you're out there in discussion groups, you're going to get better at being able to think on your feet and have conversations with people compared to just doing the same thing over and over again. Jay Ingram: I do have a question about activities that maybe most people don't count, and they may not when I ask you this question, but consider not just the average baseball fan who might go to the Rogers Center, watch the Blue Jays play, have a beer, cheer a home run, go home. But there are baseball fans who take an incredibly deep interest in the game, chart every pitch, know every player's stats, know the league stats, can tell you amazing detail. And obviously during the baseball season at least, they're keeping up day to day. Does that count as cognitive engagement? Nicole Anderson: I would say it does count as cognitive engagement because they're so involved throughout the season and probably off season they're talking about it with their buddies. But being a wife of a British man who knows his soccer team very, very well and can remember games from 20, 30 years ago, I can tell you from firsthand experience that his memory for his soccer team is brilliant, but it doesn't, again, generalize to everyday life. So I would suspect that these people who are baseball experts might not be better in other areas of cognition than you or I. Allison Sekuler: But it's still worthwhile going to the baseball games, is what I'm hearing. Nicole Anderson: It is. I went last night. Jay Ingram: Yeah. Well, hopefully one doesn't hate it. That's an important point actually, in terms of sticking to these things, but specifically with respect to the risk of dementia, what are you and what are other scientists finding out about the effectiveness, the role of cognitive engagement in limiting or reducing the risk of dementia? Nicole Anderson: I would say that this is really a growing area of research. There's not a ton of evidence out there, but what is out there is promising. So what's out there is studies showing that healthy, older adults with mild cognitive impairments and even older adults with the early stages of Alzheimer's disease can benefit from a variety of different cognitively engaging programs. So these could be music classes, language learning, like learning Spanish or some other language, theater and improv kinds of activities. So there's a variety of studies that have found cognitive benefits from these kinds of activities and some studies showing a reduced risk of developing dementia when they followed people over time. So the evidence is promising, but I do think we need more research into this area. Jay Ingram: Do we know, or do you know, do scientists know what might actually be happening in the brain when this emphasis on cognitive engagement, when people are doing those things, what's actually happening to perhaps slow down the progression of dementia? Nicole Anderson: Yeah, we do. So thinking is literally a workout for the brain. So whatever area that you're currently using, you're increasing blood flow to that area of the brain. And there is evidence that it also creates new neurons, the act of thinking contributes to the growth of new neurons and better connections between different brain areas. So what we call a richer neural network by thinking and engaging in these kinds of activities. Allison Sekuler: When you mentioned it's a workout for the brain, it made me think about going to the gym. And if you go to the gym and you just lift the same weights and do the same exercises over and over, you might have some gains initially, but after a while, if you keep doing the exact same thing over and over, that workout does not do as much for you. Nicole Anderson: Absolutely. So I use that example when I give public talks. I say that if I were to go to the gym and only lift a dumbbell with my right arm over and over again for six months, my right arm would get really strong, but it's not going to do much for the rest of my body. And so when it comes to cognitive engagement, what I encourage people to do is to get a whole brain workout. So to do some verbal activities like joining book clubs or discussion groups, which is going to engage more of your left hemisphere and doing some visual spatial activities like doing puzzles or exploring the city, which is going to engage more of your right hemisphere and doing planning and organizing activities like cleaning out that closet you've been meaning to organize forever, or planning charity events, for example, that's going to work out more of your frontal lobes. So I encourage people to try to mix up some verbal visual spatial and planning and organization activities across the kinds of activities that they do. Allison Sekuler: In addition to mixing up the different kinds of activities that will engage different parts of your brain for cognitive engagement, you had alluded previously to other types of lifestyle modifications, like actually exercise and social engagement, and I think people, including myself are wondering what you think about the extent to which cognitive engagement is really part of that same mixed bag of positive lifestyle modifications, or is it something distinct? Nicole Anderson: I think it's part of the mixed bag. What research has tended to do in the past is that they would run an exercise trial, say, and look at the benefits of exercise or a nutrition trial, and look at the benefits of eating well or a cognitive trial. So getting people, I've done this before too, teaching people Spanish and looking at the benefits of that. But our brains don't work just like that. It's not one specific thing. So what we know is that combined, the set of modifiable risk factors can account for at least 40% of dementia cases. And these span the mix of physical activity, cognitive activities, social engagement, stress reduction, and so we really need to tackle them all together. Allison Sekuler: That's great advice. Jay Ingram: Nicole, this has been fantastic actually. You've given people, I think, a lot of opportunity to think about what they should do. If we could capsulize your message, what would it be? What would you say to somebody who's been listening to this and is maybe a bit hesitant about what the first steps should be? Nicole Anderson: I'd say if somebody's hesitant, think about what is the one area where you feel most confident that you can make some kind of change and find what is it that you would like to do in that area? So the same message that I'm trying to make about cognitive engagement, choose something that you're passionate about, that's true for exercise as well. If you hate running, don't go for runs. Join a pickleball group or what have you, and then try to get active in that area, whether that be cognitive engagement or physical activity or improving your diet. And then once you feel confident in that, pick another area and again, focus in on what interests you and what would really drive you. Jay Ingram: Thank you very much for this, Nicole. Allison Sekuler: Thanks, Nicole. Nicole Anderson: You're very welcome. It's been fun. Allison Sekuler: Dr. Nicole Anderson is a Senior Scientist at the Rotman Research Institute and Associate Scientific Director of the Kimel Family Centre for Brain Health and Wellness, both here at Baycrest. She's also a Professor of Psychology and Psychiatry at the University of Toronto. Jay Ingram: So Alison, this is really a fascinating area, and I guess a relatively new area that you can do so much by keeping your brain active. And one of the things that struck me was that it's not enough just to do one activity over and over again, even if it's a mental challenge, like say a crossword puzzle, that once you get good at it, you may not be deriving the same benefit that you did at the beginning. And so do things that really continue to challenge you. I think that's one point. Allison Sekuler: Yeah, and I think another point is not just to do one thing, but to do lots of different things. Variety is the spice of life, as they say. And to make sure that you're doing things that really float your boat, if you will, things that you're really going to be engaged in, things that you'll follow up on because it's not just are you doing it and is it challenging, but are you committed to it? Are you really going all in? And I think that that's really what takes areas like painting, that we heard Rebecca talk about, and turn them from a merely a creative outlet to a cognitive engagement outlet because she got so into it. She wanted to learn about different kinds of art, and she wanted to learn different sorts of styles. And the more deeply you go into one of these sorts of activities, the more you will be engaging your brain and really be expanding your horizons in different ways. Jay Ingram: To learn more about the Defy Dementia podcast, videos and infographics, please visit us at defydementia.org. Allison Sekuler: Our podcast production team is Rosanne Aleong, Monique Cheng, Sylvain Dubroqua. Our chase producer is Ben Schaub. Production is by Pod Text, music by Steve Dodd and Cover Art by Amanda Forbis and Wendy Tilby. Jay Ingram: We'd like to give a big thank you to the Public Health Agency of Canada who fund this podcast. Note that the views expressed here do not necessarily represent the views of the Public Health Agency of Canada. Allison Sekuler: We'd also appreciate your support for our podcast. So click that subscribe button on Spotify, Apple Podcast, Google podcast, or wherever you get your pods. I'm Allison Sekuler. Jay Ingram: And I'm Jay Ingram. Join us for the next episode of Defy Dementia. We'll talk about exercise, how a workout for your body is also a workout for your brain that can help prevent or even slow down dementia.