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

Is a lack of motivation a personality flaw, or a signal from your brain that something needs attention? We tend to think brain decline begins with memory loss, but changes in motivation, behavior, attention, and decision-making can show up much earlier. Apathy can look like laziness. Poor sleep can feel like memory loss. Doom scrolling gets blamed on dopamine, even though the science does not support many of the claims people repeat online. And the habits we rely on for brain health are often based more on trends than evidence. This matters because your brain is constantly deciding whether a reward is worth the effort. When that calculation becomes harder, doing even simple things can feel overwhelming. Understanding how motivation works can help you reduce friction, take action before you feel ready, build routines that support your brain, and pay closer attention to changes in yourself or someone you love. Purpose matters. Curiosity matters. Relationships matter. And movement may be one of the most effective tools we have for protecting cognitive health. Dr. Masud Husain is one of the world's leading neurologists studying memory, motivation, attention, and cognitive decline. He is a professor of neurology at Oxford University, co-leads Dementia Research at Oxford University, and serves as editor-in-chief of Brain, one of the most respected journals in neurology. He is also the author of Our Brains, Ourselves, which explores how the brain shapes our behavior, identity, relationships, and sense of self. What's Discussed: (06:01) Why losing motivation can appear before memory problems and signal early cognitive decline. (08:07) How apathy differs from depression, even when the behavior looks almost identical. (12:14) What two tiny strokes revealed about the brain circuit responsible for motivation. (20:55) How purpose, curiosity, and strong relationships help protect the aging brain. (22:23) Why unmotivated people may use more brain energy deciding whether something is worth the effort. (24:54) What dopamine actually does and why it is not the brain's pleasure chemical. (26:31) Why the idea that social media gives you constant dopamine hits is not supported by evidence. (34:50) Whether Alzheimer's can be reversed and what current treatments can realistically accomplish. (45:17) How breaking tasks into smaller steps, starting before you feel ready, and building routines can create motivation. (57:12) Whether relying on AI is making our brains lazier and changing how we think. (01:01:36) How loneliness and isolation affect cognitive performance and long-term brain health. (01:07:22) How poor sleep, anxiety, and low mood can create memory problems that feel like dementia. Thank You to Our Sponsors! Magic Mind: Head over to magicmind.com/jen http://www.magicmind.com/jen and use code JEN at checkout. Momentous: Ready to try supplements that actually do what they claim? Head to livemomentous.com http://livemomentous.com and use code JEN for 35% off your first subscription. Therasage: Visit therasage.com http://therasage.com and use code JEN to get 15% off your order. Your skin Prolon: Prolon is offering listeners 30% off sitewide plus a $40 bonus gift when you subscribe to their 5-Day Program! Just visit prolonlife.com/JENNIFERCOHEN https://prolonlife.com/JENNIFERCOHEN and use code JENNIFERCOHEN to claim your discount and your bonus gift. Kion: Visit getkion.com/habits http://getkion.com/habits for 20% off. Tru Niagen®: For supplements that are rigorously tested, third-party verified, and actually deliver what's on the label, head to truniagen.com http://truniagen.com Find more from Jen Cohen: Website: jennifercohen.com https://jennifercohen.com Instagram: @therealjencohen http://instagram.com/therealjencohen Books: jennifercohen.com/books https://jennifercohen.com/books Speaking: jennifercohen.com/speaking-engagements https://jennifercohen.com/speaking-engagements Find more from Dr. Masud Husain: Website: masudhusain.org https://www.masudhusain.org/ X: @MasudHusain https://x.com/MasudHusain Instagram: @masudhusainoxford https://www.instagram.com/masudhusainoxford/ Book: Our Brains, Our Selves https://canongate.co.uk/books/4975-our-brains-our-selves-what-a-neurologists-patients-taught-him-about-the-brain/ LinkedIn: Masud Husain https://www.linkedin.com/in/masud-husain-3874708b/

• 0:01Speaker 00

  Hi guys, it's Tony Robbins. You're listening to Habits and Hustle. Crush it.

• 0:07Speaker 01

  Hi, everyone. Welcome to another episode of Habits and Hustle, where today I'm joined by Dr. Masood Hussain. 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 Hussain'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

• 0:47Speaker 01

  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, burnout, 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 habits

• 1:28Speaker 01

  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 what 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 the things most of us are thinking. Her guests come from all aspects of life, and there's always nuggets to find in all of them. The Dr. Shadé Zahira

• 2:13Speaker 01

  interview so far is one of my favorites. So many lessons and insights. All right. Thank you so much. I appreciate that. And I think I pronounced your name, Jay 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.

• 2:37Speaker 01

  Dr. Masood Hussain, I am very happy to have you on this podcast.

• 2:43Speaker 00

  Thanks for inviting me.

• 2:44Speaker 01

  Absolutely. You, your background is, is, I think impressive is pretty much the biggest understatement I can give, right? First of all, what we do on this podcast before we start, and you're a perfect person, given your background, is we do these performance shots that are really good for focus, mental focus, and being more alert. And I wanted to do it with you, especially because of your background.

• 3:09Speaker 00

  Okay.

• 3:09Speaker 01

  So there are these things by Magic Mind. And so it's all like lion's mane, ashwagandha, which I want to talk to you about. If 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.

• 3:34Speaker 01

  You tell me if you're more focused and more alert than ever before after taking it. Do you like it?

• 3:40Speaker 00

  It's definitely interesting.

• 3:42Speaker 01

  Okay, that's, okay. This one is a caffeine-free one. I like the one that's more the OG, but

• 3:49Speaker 00

  Okay.

• 3:50Speaker 01

  This one's caffeine-free. People like it because if they've had too much caffeine sometimes.

• 3:55Speaker 00

  I could grow to like it.

• 3:56Speaker 01

  Yeah? Good. I love that. All right. Okay, we need to get into this. And you could tell me after if it ever, 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 that happens or people notice?

• 4:18Speaker 00

  Well, it's a, it's a really complex area. So it's not, it's, 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, they used to before. Their brains don't seem to be working as they were. 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

• 5:00Speaker 00

  turns out that even in healthy, older people, if you start developing what we call apathy, lack of motivation, lack of goal-directed attention, a lack of goal-directed behavior, then your chances of developing dementia, for example, are twice that if you didn't have apathy. And the reason

• 5:20Speaker 01

  Wait, say that again. So if you're somebody who doesn't have

• 5:23Speaker 00

  So if you're somebody who starts to lose motivation

• 5:27Speaker 01

  Right.

• 5:28Speaker 00

  in older age, but you're otherwise healthy, it turns out that your chances of developing dementia in the next 10 years is twice that if you, if you had normal motivation. And that, 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, you know, going out to have a walk, or, or being interested in the news, or being interested in the family. All of these things can be signs. But of course, you know, this is a

• 6:12Speaker 00

  complex area, because there are many reasons why people could lose motivation. So I'm interested in apathy, where the brain system is slowly beginning to fade. But you could lose motivation because you're depressed.

• 6:26Speaker 01

  I was just gonna 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 diff, like, what, what are the earlier signs that someone is cognitively declining through that, through the behavior versus someone who's just depressed?

• 6:48Speaker 00

  So one of the features of depression is that you're unhappy. You're sad.

• 6:53Speaker 01

  Yeah.

• 6:54Speaker 00

  Usually, that's an important feature of depression. Or you may have what we call anhedonia. You just lack pleasure in anything you do. Now, in patients with pure apathy, those things need not be a feature. So you mentioned the, the young man that I saw who led to this, this whole body of research. He was a guy called David. And he was a person in his 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 apathetic, very different to the kind of person he'd

• 7:38Speaker 00

  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 basal ganglia. And when we saw him, he wasn't unhappy. He was quite, 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 friend said, okay,

• 8:21Speaker 00

  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. You know, 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. You know, he wasn't even looking after himself. He wasn't having a shower. He wasn't doing anything. And when I asked him, well, what would you normally do if you were sitting? He said, well, I'd listen to music. So why aren't you listening to music? Because it would take me a bit of time to put my music

• 9:05Speaker 00

  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 listened, 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. Uh, 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.

• 9:50Speaker 00

  He would, he would just sit there.

• 9:51Speaker 01

  That's still, that's still reminds me, or that still would make me think it's depression.

• 9:58Speaker 00

  Right.

• 9:58Speaker 01

  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 its

• 10:08Speaker 00

  Well, we can, we can, we can, we can. We can come back to dopamine.

• 10:11Speaker 01

  Or is it serotonin?

• 10:13Speaker 00

  No, we can come back to dopamine in a minute. But um, 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.

• 10:33Speaker 01

  You keep on saying that, the unhappy, the, he seemed pretty like content.

• 10:37Speaker 00

  Uh, he 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.

• 10:48Speaker 01

  Okay, but what, that guy is young, he's like in his thirties. So what can trigger something at that young of an age to then bring on cognitive decline?

• 10:57Speaker 00

  So in his case, we knew that it was two tiny strokes, you know? Strokes are when blood vessels become clotted, for example, or bleed, but in any case, they, 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, three hundred and sixty million years old. If you go back

• 11:23Speaker 01

  Right.

• 11:23Speaker 00

  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, right? And you're not going to expire if you don't eat anything, but there is this urge. It's a motivational urge gnawing away at 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, is there pushing you to do that. Similarly with thirst, right?

• 12:06Speaker 00

  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,

• 12:47Speaker 00

  versus having hypermotivation 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.

• 12:59Speaker 01

  The same pathways, but I, I'm really on this idea that like what's scary is these two strokes that David had, it didn't even come up on the scans. How did they find them? Like, how did you even, how do you even know to even like look for that? It doesn't happen often, like, that's a very young age for that to happen.

• 13:17Speaker 00

  It is, it is. I mean, they did come up in scans. If you do them in high resolution, you can see them.

• 13:20Speaker 01

  You can see, okay.

• 13:21Speaker 00

  So 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.

• 13:30Speaker 01

  It's an unusual thing.

• 13:31Speaker 00

  He's, he's an unusual case. But what he's taught us is if these brain systems that went 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, part through the basal ganglia to the frontal lobes. The circuit could be taken out by strokes, as in David.

• 14:01Speaker 01

  Mm hmm.

• 14:02Speaker 00

  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.

• 14:35Speaker 01

  Okay, so let me ask you a basic question. Is there a real, is there any difference between dementia and Alzheimer's?

• 14:43Speaker 00

  There are over two hundred causes of dementia, of which Alzheimer's is the commonest cause. So the, the definition of dementia is a change in someone, a progressive change in someone, such that their cognitive impairment leads to problems with everyday life. So it's got to be something that's relatively new. It's got to be progressive. It's got to be a problem in cognition, or as we now know, behavior, that is having an impact in their everyday life. Because there are people who might 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.

• 15:23Speaker 01

  So Alzheimer's is just one.

• 15:25Speaker 00

  It's just one, but it's the commonest.

• 15:27Speaker 01

  It's the most common. Because I see here, and we've, I've, I've already read about a lot of this myself, that social isolation, chronic stress, poor sleep, inactivity, inactivity, these are all can be causes of.

• 15:42Speaker 00

  Well, they're, they're.

• 15:43Speaker 01

  They're symptoms.

• 15:44Speaker 00

  They can be symptoms, yes, exactly.

• 15:46Speaker 01

  But, 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, like she was excellent cognitively, up until COVID. COVID then took her down because of the isolation, because of the loneliness. She was living alone for many, many years. She really cognitively like took a, like, like a major decline. So how can someone go from being like fa- perfect, like actually ten to fifteen 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.

• 16:30Speaker 00

  Right, and obviously I don't know your mom, so I don't know the details. But, but if we look at the trajectories of cognitive decline.

• 16:37Speaker 01

  Yeah.

• 16:38Speaker 00

  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.

• 17:00Speaker 01

  Yeah.

• 17:00Speaker 00

  Is 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 developed dementia, right? And seen that trajectory is steepest, when it happens, it's steepest in the people who are high performers.

• 17:19Speaker 01

  But why is that?

• 17:21Speaker 00

  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.

• 17:31Speaker 01

  Like what?

• 17:32Speaker 00

  Well, you know, you may be using systems that you, 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?

• 17:44Speaker 01

  Mm hmm.

• 17:44Speaker 00

  I'm going to listen more carefully to people because actually I'm aware that there is a problem. I could easily misinformation. So you can have coping strategies to help you. And those coping strategies obviously rely on the brain, right?

• 18:00Speaker 01

  But what if you don't do those and you're just somebody who is highly functional, who is 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.

• 18:25Speaker 00

  Yeah.

• 18:25Speaker 01

  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.

• 18:35Speaker 00

  Yeah.

• 18:36Speaker 01

  So why is that? Is it genetic?

• 18:38Speaker 00

  Okay.

• 18:38Speaker 01

  Is it just?

• 18:39Speaker 00

  Yeah, so there are many issues here. So one of the, let's just go back 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.

• 18:50Speaker 01

  Exercise.

• 18:50Speaker 00

  Are really, really important.

• 18:52Speaker 01

  Low stress.

• 18:53Speaker 00

  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.

• 19:02Speaker 01

  Mm hmm.

• 19:03Speaker 00

  But, you know, protecting the mind is protecting the brain, from my point of view. 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, are now have left. You've got grandchildren, you don't have to look after anybody. What's your sense of purpose?

• 19:48Speaker 00

  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, in some ways as, as important as all the physical things you mentioned at the beginning.

• 20:08Speaker 01

  Yeah, I think for sure, that's what, it's a hundred percent, I would say that's true. Just from just practical, just by, by observation.

• 20:16Speaker 00

  Right, but I think I'm, I wouldn't want your listeners to just think we're talking about older people who are developing dementia. And this, this problem about motivation is about them. Because actually, what we've learnt from, from looking at people with, with this sort of problem is we've learnt about the brain systems that are involved. And in Oxford, we did a, 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 it or not, there are students at Oxford who are also really apathetic.

• 20:48Speaker 01

  Really?

• 20:49Speaker 00

  Yeah.

• 20:49Speaker 01

  Is that true?

• 20:50Speaker 00

  Well, it's everywhere.

• 20:51Speaker 01

  I guess that's true. I guess it's all relative, probably apathetic in relation to the other people there.

• 20:57Speaker 00

  No, no, no, no, they're, they're, you know.

• 21:00Speaker 01

  Did you go to Oxford yourself?

• 21:01Speaker 00

  I did, I did, yeah.

• 21:02Speaker 01

  Okay.

• 21:02Speaker 00

  Your cognitive abilities don't necessarily map to your, you know, behavioral levels of motivation.

• 21:07Speaker 01

  Yes, that is true. I have noticed that though, actually, in life.

• 21:11Speaker 00

  Yeah, of course. Um, 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

• 21:52Speaker 00

  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 were apathetic showed far greater activity in these areas than the students who were motivated. We just weren't expecting that, right? Their brain systems involved in motivation were more active than the students who were 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?

• 22:36Speaker 00

  Now, they might do, do it for us in the scanner.

• 22:39Speaker 01

  Right, right.

• 22:40Speaker 00

  But at home, they might go, oh 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?

• 22:48Speaker 01

  Yeah.

• 22:48Speaker 00

  So the default becomes inertia because the cost of working out, is it worth the effort or not?

• 22:55Speaker 01

  Right, they're constantly going, like, thinking back and forth.

• 22:58Speaker 00

  Right.

• 22:59Speaker 01

  Well, is dopamine the pleasure chemical or is it serotonin?

• 23:03Speaker 00

  Most people have said dopamine is the pleasure chemical and I'd like to debunk that.

• 23:07Speaker 01

  Okay.

• 23:08Speaker 00

  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.

• 23:48Speaker 00

  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.

• 24:02Speaker 01

  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.

• 24:10Speaker 00

  Hmm.

• 24:10Speaker 01

  Like constantly, that are we like going to be numbing ourselves to a place where we need so much dopamine to do something because we're so used to being constantly filled with so much that your body becomes acclimated or

• 24:26Speaker 00

  Well.

• 24:26Speaker 01

  or desensitized?

• 24:28Speaker 00

  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.

• 24:39Speaker 01

  Really?

• 24:39Speaker 00

  That's become a myth. And of course, you, you'll find some very popular books out there, which also

• 24:44Speaker 01

  Yeah, that's what I'm saying, yeah.

• 24:45Speaker 00

  perpetuate the myth. The evidence from the animal literature and humans is that dopamine is really important for motivation to act, right? It is not the thing that gives you the hedonic burst of pleasure. So that is

• 25:01Speaker 01

  Oh, that's interesting.

• 25:01Speaker 00

  actually very, very subtly different, right? This, 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.

• 25:12Speaker 01

  So what is the chemical that gives you that buzz or pleasure?

• 25:17Speaker 00

  So the evidence is that there are receptors in the brain for opioids.

• 25:21Speaker 01

  Right.

• 25:22Speaker 00

  And those opioids, we have our own endogenous opioids, which 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, it's a big deal. And of course, what I haven't mentioned to you is in David, the patient I was talking about at the beginning, right? We used a dopamine drug. And three months later, this man who you would, you would think is, you know, so untidy, so disheveled,

• 26:04Speaker 00

  comes back to our clinic. I didn't actually recognize him because he had a suit.

• 26:10Speaker 01

  Really?

• 26:10Speaker 00

  He had a haircut, uh, 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.

• 26:20Speaker 01

  Where did he meet the girlfriend?

• 26:21Speaker 00

  Well, because we had treated him with this drug.

• 26:24Speaker 01

  Which drug was it?

• 26:25Speaker 00

  It's a drug called Ropinrol, which works on dopamine receptors in the brain. And he, it wasn't that the Ropinrol 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 shower. It was motivating him to go out and get a job. It was motivating him to go and find a girlfriend.

• 26:52Speaker 01

  So why isn't, so is this also used now for antidepressants, like for an, for as an antidepressant?

• 26:58Speaker 00

  It's really, really interesting question. Dopaminergic drugs have not classically been used as antidepressants. The, the usually antidepressants work on the serotonin system.

• 27:08Speaker 01

  Why?

• 27:09Speaker 00

  Well, I'm just explaining that. So it, it turns out that there are about a third of people who have depression do not respond to the serotoninergic 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.

• 27:50Speaker 00

  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, we are beginning to use for apathy?

• 28:06Speaker 01

  Wow, that's really, that's fascinating to me because I would think that if, if, if David can change, um, what is, so 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?

• 28:23Speaker 00

  So there's different neurochemical systems, there are different circuits in the brain which use dopamine or serotonin.

• 28:29Speaker 01

  But does it manifest similarly or?

• 28:31Speaker 00

  I don't think so, yeah. So serotonin.

• 28:33Speaker 01

  You don't think so?

• 28:34Speaker 00

  No, I, I think serotonin is, the effects of serotonin, for example, are not necessarily in terms of reward, but in terms of what we call aversive responses. So something that you learnt is actually not very rewarding, unpleasant, costly in some way. And serotonin has an impact on behaviors where you need to have an aversive response. Is truly complicated in terms of how we map these neurochemical systems onto different components

• 29:04Speaker 01

  Right.

• 29:04Speaker 00

  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 behavior. You know, it's a sunny day outside. What could you do, Jen? I mean, you could probably come up with twenty potential alternatives, right?

• 29:39Speaker 01

  About, yeah.

• 29:41Speaker 00

  But imagine if you couldn't, if you couldn't even think of one, right? If you're the brain system that would generate those choices just was not able to do this.

• 29:52Speaker 01

  How much of this is genetic?

• 29:54Speaker 00

  Oh, I don't think we know about that at all, but the

• 29:57Speaker 01

  Like if your mom has it, do you get it?

• 30:00Speaker 00

  There's no evidence for that in this way.

• 30:02Speaker 01

  Really?

• 30:03Speaker 00

  Yeah, the, you know, they can be biases, but things like, for example, Alzheimer's disease is just a very common disease as we get older.

• 30:11Speaker 01

  Yeah.

• 30:11Speaker 00

  There are unusual genetic causes of Alzheimer's disease which run in families.

• 30:17Speaker 01

  Like what?

• 30:18Speaker 00

  Well, there are mutations in what we call pre-sinilin one or pre-sinilin two or amyloid precursor protein. They all affect amyloid, that protein that builds up

• 30:27Speaker 01

  Oh, right.

• 30:28Speaker 00

  Right?

• 30:29Speaker 01

  So it's like the, the thing that actually affects the chemical is what then affects that makes you get the Alzheimer's.

• 30:35Speaker 00

  Early.

• 30:36Speaker 01

  Not the genet- so right.

• 30:37Speaker 00

  Well, the gene, 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 four genotype puts you at a higher risk of developing Alzheimer's. So in that way, there could be familiar, familial risks. But in general, you know, the vast majority of patients who develop late onset Alzheimer's disease, we have not been able to pin down a genetic cause.

• 31:10Speaker 01

  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?

• 31:19Speaker 00

  Well, it depends on the age.

• 31:21Speaker 01

  Yeah. As you increase, yeah. Eighty.

• 31:23Speaker 00

  If, if you're going to eighty, you're getting towards twenty percent, twenty-five percent. And if you're going older and older, those percentages keep increasing.

• 31:30Speaker 01

  As you get older.

• 31:31Speaker 00

  Yeah. And of course, there are other causes of dementia, you know, like vascular dementia that 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. But that, that's just the increased risk as we get older because, you know, our brains weren't designed to live this long. We are living a huge

• 32:04Speaker 01

  Oh, that's right.

• 32:05Speaker 00

  amount of time.

• 32:06Speaker 01

  So that's why there's a twenty percent, around approximately twenty percent of people after age of eighty get it.

• 32:12Speaker 00

  Yeah, and the numbers increase thereafter, yeah.

• 32:14Speaker 01

  Can you reverse cognitive decline or Alzheimer's, dementia? Is it true?

• 32:21Speaker 00

  So if we, 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.

• 32:38Speaker 01

  Right.

• 32:38Speaker 00

  And therefore it's been very controversial because the FDA approved it. People have been saying that that approval was based on a level of evidence which was not really sufficient to do this because it has huge implications. The, the treatment, it, I mean, it's intravenous, this drug.

• 32:56Speaker 01

  Called?

• 32:56Speaker 00

  One of them is something called lecanumab, for example. So it's a mon- lecanumab, it's a monoclonal antibody which mops up the amyloid. But, I mean, on the positive side, here is proof of principle that it could make a small difference.

• 33:12Speaker 01

  When you say small, two percent, five percent?

• 33:14Speaker 00

  Yeah, it's probably of the order of one percent, that kind of level.

• 33:17Speaker 01

  Very little though.

• 33:18Speaker 00

  Yeah.

• 33:18Speaker 01

  So would you, would, would it change someone's quality of life though, if it's only one or two percent?

• 33:23Speaker 00

  And that's exactly what people are saying, that that probably isn't going to make any huge difference. So why are you putting somebody through this? But on the other hand, you know, thirty 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?

• 33:50Speaker 01

  Yeah.

• 33:50Speaker 00

  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.

• 34:18Speaker 01

  So my, I guess, my question is, it's hard, you can't, you can't reverse Alzheimer's.

• 34:25Speaker 00

  We haven't got any evidence that we can reverse Alzheimer's.

• 34:27Speaker 01

  You know, there are people out there who say it is reversible.

• 34:31Speaker 00

  Yeah.

• 34:32Speaker 01

  I've yet to understand how and how this happens. I called this guy a couple of weeks ago, this man, who is a gerontologist and neuroscientist. And he's fairly known. And I was telling him about my mom and 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, help you prevent it? A li- like maybe a percentage?

• 35:10Speaker 00

  Mm-hmm.

• 35:11Speaker 01

  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.

• 35:23Speaker 00

  I think it is, yeah. And we don't have the clinical trial evidence for that. You know, on the other hand, what, one thing we do understand is

• 35:29Speaker 01

  Why do people say that? Where are they getting this from?

• 35:31Speaker 00

  I didn't say it.

• 35:32Speaker 01

  I know you didn't. I'm not blaming you. I'm not blaming you. I'm Oxford. Listen, someone from Oxford is not going to be saying that I can promise you.

• 35:39Speaker 00

  Yeah, on, you know, on the other hand, we've got to re- we, we've got to realize that, you know, people are very different. So these clinical trials just take

• 35:47Speaker 01

  Is there any evidence of this?

• 35:48Speaker 00

  Not for the things you've mentioned, yeah.

• 35:50Speaker 01

  What, what, what is there 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, part A, my question, to prevent it, to prevent Alzheimer's? And B, is to stop it from, from getting worse?

• 36:10Speaker 00

  Right. So now we're going back to the thing that we were talking about before.

• 36:13Speaker 01

  Yes.

• 36:14Speaker 00

  What are the physical things you can do?

• 36:16Speaker 01

  Yep.

• 36:16Speaker 00

  And what are the other kind of social things you can do?

• 36:19Speaker 01

  Right.

• 36:19Speaker 00

  To help?

• 36:20Speaker 01

  Purpose, isolate, purpose.

• 36:22Speaker 00

  Curiosity.

• 36:23Speaker 01

  Curiosity.

• 36:24Speaker 00

  Keeping a close, big connection with people as well as all those physical risk factors, you know, making sure your blood pressure's under control, you're doing physical exercise, you're eating well, if, if, uh, 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, a big difference in prevention if you are currently healthy.

• 37:01Speaker 01

  I want to take a quick break from this episode to thank our sponsor, Therasage. Their Trilite 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 it with me everywhere I go. And I personally use their red light therapy to help reduce inflammations in places in my body where honestly I have pain. You can use it on a sore back, stomach cramps, shoulder, ankle. Red light therapy is my go-to. Plus, it also has amazing anti-aging benefits, including reducing signs of fine lines and wrinkles on your face, which I also use it for.

• 37:42Speaker 01

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• 38:22Speaker 01

  So if someone were to read your book, right, that's, you know, that you wrote, trying to get the, I want to make sure that I properly, our brains, ourselves, what are the top three themes that people will learn about?

• 38:36Speaker 00

  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, you know, behave in terms of whether we're impulsive or not, for example, those control mechanisms that, you know, 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,

• 39:18Speaker 00

  because we're also defined by our connections to other people, our affiliations to different groups, you know, our religion, place we grew up, where we went to school or university, the kind of job we did. But I also argue in the book that even our social identities really are a product of our brains' 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 enough and able enough to start learning this language, to understand the customs, the humor, the way things work in this, to be accepted.

• 40:02Speaker 00

  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, how motivated I am, or the concepts that I've developed about how things work, how societies work. If all, 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.

• 40:43Speaker 01

  But once this starts to happen, of course, everything's going to start changing, right? Like you're, but are you not, are you, but are you even aware of it to know that it's changing?

• 40:54Speaker 00

  Some, some people are, but there are, there are brain, some brain disorders, like something we'll call frontotemporal dementia, where people lose insight. They, 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?

• 41:26Speaker 01

  Right.

• 41:26Speaker 00

  Our control systems are making sure that we don't blurt out something we're thinking.

• 41:32Speaker 01

  Right.

• 41:32Speaker 00

  But in someone like Sue, those systems which would normally inhibit you and me from doing that are no longer functioning.

• 41:40Speaker 01

  Functioning.

• 41:41Speaker 00

  So she's a changed person in that way.

• 41:43Speaker 01

  I find it interesting because you're talking a lot about how, you know, it's not, people just perceive that when you get, when you, when you get dementia or Alzheimer's, that it's just, people just assume it's like your memory is the one to go. But a lot of times, it's actually not even the memory. 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, it's all this other stuff, the confusion, the, the, the, there are not lot, there's no logic behind anything you're doing. But they still know who you are. That's very common. Can that, does it stay like that? Or does it eventually?

• 42:21Speaker 00

  It's one of the most, you know, it's a thing that can last for a long time. Also, knowing who they are is also something that can last 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.

• 42:41Speaker 01

  What made you study this so thoroughly and really specialize in this?

• 42:47Speaker 00

  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 and 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.

• 43:10Speaker 01

  Right.

• 43:10Speaker 00

  So that's what's really attractive about it. And obviously, these are, if there are diseases that affect the brain, they have an enormous influence, not only on the people who suffer from them, but on the families, have a huge impact on the families. So this is where we can make the biggest inroads.

• 43:27Speaker 01

  What are some of the most surprising things that you've kind of turned? Like you've kind of learned about or, or that you found in your research that would surprise most people?

• 43:38Speaker 00

  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 angry.

• 43:58Speaker 01

  Yeah, the motivation part.

• 43:59Speaker 00

  But, but it, but it's really important because, you know, although we're talking about people with brain diseases, this, these are take, 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, there's 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, in people, our kids, our friends, whoever, 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've found useful is start.

• 44:42Speaker 00

  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,

• 44:57Speaker 01

  Me too.

• 44:57Speaker 00

  You know, if you, if you have those routines, it means when I'm having my coffee, I will do this, or nine o'clock in the morning, I will do this. Writing 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, 6:00 AM. 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.

• 45:27Speaker 01

  Right.

• 45:28Speaker 00

  But just starting, just starting means you get it, get it off on the page.

• 45:33Speaker 01

  Well, I was going to say, what was kind of stopping me in my tracks? You're talking about how high performers, when they get some issues with their cognitive abilities, they have the biggest crash, right? Because they have all these systems in place versus people who are more like type B personalities.

• 45:47Speaker 00

  Maybe, maybe.

• 45:48Speaker 01

  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 perform at such 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, you can answer that and I'm going to say something after, you know?

• 46:18Speaker 00

  Well, um, I mean, depends on how long you're planning to live, Jen, you know?

• 46:22Speaker 01

  I don't know. Hopefully a much longer, you know?

• 46:25Speaker 00

  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, at the age of 80.

• 46:37Speaker 01

  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. Meanwhile, like at the end of the day, from what I get is like, if we, if the high performers can crash, are the ones who crash the most severely, I'd rather just maybe not, what, what am I doing to myself?

• 47:05Speaker 00

  Well, it's a choice, but you know, our, our forefathers, generations before us, they weren't even, this is a luxury to be talking about this. It was survival for them, you know, making enough money to work, do all these things, right?

• 47:17Speaker 01

  Okay, okay.

• 47:17Speaker 00

  So we, we are in a luxury position where we're thinking, contemplating, how am I going to do this? How, which hack am I going to use?

• 47:24Speaker 01

  True. Okay. So I have a few, I have a bunch of questions. I'm going to, I haven't even asked any of my question, questions yet, but like, what would you say, I'm going to ask them to you and then you can just answer them as quickly as you can, like as concisely as you can, because there's so much information.

• 47:37Speaker 00

  Yeah.

• 47:37Speaker 01

  And I, I, I know we're kind of, we're tight on time, kind of, so here we go. Okay, what's the biggest misconception people have about how the brain actually works?

• 47:48Speaker 00

  Hmm. Well, probably it's to do with things like these dopamine bursts and detoxes that people are doing. I think in the current generation, that's probably the biggest misconception.

• 47:59Speaker 01

  Tell, talk about that again in a way that, so you said that earlier, that like, people think that if you're on your social media, people are getting these bursts of dopamine. That's actually not in the literature or research doesn't back that up.

• 48:12Speaker 00

  Yeah, there's no real evidence for that. I'm not saying it's a bad thing to do. It's a bad habit to keep scrolling.

• 48:17Speaker 01

  Yeah.

• 48:18Speaker 00

  But there's no evidence that we can link that to dopamine.

• 48:21Speaker 01

  So what, what can we, what does that do to our brain then? If it's not about the, about that, people just scrolling, doom scrolling forever, what is that doing to our brain?

• 48:30Speaker 00

  So 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?

• 48:41Speaker 01

  Right.

• 48:42Speaker 00

  Start.

• 48:42Speaker 01

  And by the way, I'm a big routine person, obviously. So don't, don't get me wrong. I'm still gonna do it because it makes me feel good.

• 48:48Speaker 00

  So I'm talking about doom scrolling is probably a bad habit. Um, that for most people, they realize it's a bad habit, that they shouldn't be doing it 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 lusting after dopamine.

• 49:05Speaker 01

  So what is it? What is bringing us back?

• 49:07Speaker 00

  We, 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.

• 49:16Speaker 01

  Okay.

• 49:16Speaker 00

  And it's definitely no evidence that it's.

• 49:18Speaker 01

  So we 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, 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.

• 49:39Speaker 00

  But.

• 49:39Speaker 01

  It's okay to not have the answer.

• 49:40Speaker 00

  We're just being honest.

• 49:41Speaker 01

  Yeah, exactly. I love that. If you could teach everyone one thing about their brain, what would it be?

• 49:48Speaker 00

  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, I've learned that brains are capable of multitasking in a way that we, most of us wouldn't even think about doing.

• 50:17Speaker 01

  Well, that, there's a lot of, uh, there's a lot of, um, conversation around that, right? Some people say multitasking is really not great. Some people think it's excellent. So you think multitasking is.

• 50:28Speaker 00

  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 cost, from going from one cognitive problem to another, right? So going, let's say you're doing a math 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, I had no idea that I could be capable of doing that when I was younger.

• 51:03Speaker 01

  Well, does multitasking make your brain sharper or less sharp because you're constantly have to do the switcheroo back and forth and then neither task gets done well?

• 51:13Speaker 00

  Oh, well, I'd like to think I'm doing them perfectly.

• 51:15Speaker 01

  Yeah. Good to know. Yes.

• 51:17Speaker 00

  But no, I, 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 had been submitted to the journal that I edit in brain. Or I'm having to deal with some university problem that's arisen. And I quite like it. I quite like the fact that these are different types of problem.

• 51:45Speaker 01

  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?

• 51:53Speaker 00

  I don't think it's a myth. I think it is something that some people have.

• 51:56Speaker 01

  Okay.

• 51:57Speaker 00

  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 say 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 distractibility, their ability to sustain attention. That's one of the key markers is that they're just variable in their response times. Let's do something very simple, like pressing a button. If you see a flash of light.

• 52:42Speaker 00

  We 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 doubt.

• 52:49Speaker 01

  Well, it's 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 par 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, and ADD is a very big piece of that.

• 53:05Speaker 00

  Right.

• 53:05Speaker 01

  Do you not know, like, do you notice that?

• 53:07Speaker 00

  Yeah. And you could, you could argue that some people who are very creative have that ability to jump, right? From this problem and suddenly think, actually, I can sometimes also use, use principles in one area to, and apply them to another area. That's another important ability to be able to do. Seeing something you've learnt 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.

• 53:41Speaker 01

  So I guess my, my question was more, you were 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, is there anything to back that the brains are chemically different than people who don't have ADD?

• 53:59Speaker 00

  Yeah, there's, there are research studies which show that, either, either in terms of brain activation.

• 54:04Speaker 01

  Yeah.

• 54:04Speaker 00

  And it turns out it's the, you know, areas of the brain include the basal ganglia we were talking about, as well as the frontal and parietal regions of the brain, which seem to work differently in people with ADD. Uh, and that maps on to our ideas also of the attention networks in human brains. You know, we were talking about circuits for motivation. There are also circuits for attention. And 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 that we have circuits in the brain, which do different things. They can be affected by different disorders, whether it's ADD

• 54:46Speaker 00

  or we were talking about stroke or neurodegenerative illnesses like Alzheimer's disease. It's what affects those circuits and how they're affected leads to the manifestation of the cognitive deficit or the behavioral deficit.

• 55:00Speaker 01

  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, putting together sales strategies, decks, building websites. Are, are our brains actually getting lazier? Is that actually a thing that can happen?

• 55:19Speaker 00

  Um, I think if you.

• 55:20Speaker 01

  Like what happens to our brains if we're just like not using them? That's why they said when you're getting older, it's important to do crossword puzzles and, and, and stimulate your brain.

• 55:30Speaker 00

  I agree. And in general, I think that's what the evidence might suggest, but I'm gonna be, you know, boring and say to you, we don't know if AI is gonna make our brains so ineffective at doing the things that we used to do very well. I mean, you remember using maps to.

• 55:47Speaker 01

  Well, that's what I'm saying. I mean, 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, not let alone any other phone numbers at this point because I haven't had to.

• 55:59Speaker 00

  Yeah, but that's, that's, um, whether you'd be bad at it if we started all over, right? Whether you, um, now had to use a physical map to navigate.

• 56:07Speaker 01

  I don't know. I would have, I have no clue.

• 56:09Speaker 00

  Well, you, you, we could give it a try.

• 56:11Speaker 01

  It's like brains become, it's become, it's, it's atrophied. I, 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. It's like my muscles, if I'm not working out, even for a week, I feel it. I'm not as strong. I'm not as, you know, toned.

• 56:30Speaker 00

  But the question would be.

• 56:31Speaker 01

  My brain is getting.

• 56:32Speaker 00

  Could you regain it?

• 56:33Speaker 01

  Chunky.

• 56:33Speaker 00

  Could you, could you, could you regain it, those skills?

• 56:38Speaker 01

  Muscle memory.

• 56:39Speaker 00

  Yeah. Could you regain it, you know?

• 56:41Speaker 01

  But if we actually do it. So what I'm concerned about, like what I think is interesting is like, ah, when we were kids, we had to remember, like memorize our friend's phone number or 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 a phone number, who don't have to do all these basic things, are they gonna have like a lazy brain?

• 57:06Speaker 00

  No, I don't think so. I mean.

• 57:07Speaker 01

  Or they start learning new things. Okay, like what? Tell me.

• 57:10Speaker 00

  Well, the new technology, like how to use.

• 57:12Speaker 01

  How to use Snapchat? Wonderful. They can use Snapchat.

• 57:15Speaker 00

  How, how?

• 57:15Speaker 01

  TikTok. Great. They're gonna be brilliant. They're gonna be professors at Oxford because of it. Hardly.

• 57:21Speaker 00

  No, no. I mean, I don't, I don't think there's, uh, any reason to fear that human ability, cognitive abilities are gonna be killed because this is what everybody said when any new technology came along, right?

• 57:33Speaker 01

  Hmm. Yeah. I mean, listen, you can learn how to prompt better. Like, it basically is 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.

• 57:50Speaker 00

  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'll, you know, so we have to learn new techniques to solve the problems of the modern world. And your kids are gonna be able to do that. That's, that's gonna happen.

• 58:06Speaker 01

  Okay, I understand that.

• 58:09Speaker 00

  Cultures have changed in technology, right? Human culture has just gone in leaps and bounds.

• 58:15Speaker 01

  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 use Postmates. Like, everything's become so easy.

• 58:29Speaker 00

  I agree with you on that, yeah.

• 58:30Speaker 01

  It's like, what are we gonna, we could just all sit at home all day, twenty-four hours a day, watch TV, order our food, like, like, our society is becoming a very lazy, unless you, unless you make a very consorted effort

• 58:44Speaker 00

  Yeah.

• 58:45Speaker 01

  to not be, which is why these habits and routines and creating structures where, you know, you do things are like put out there, or else it's very easy to become like literally a plate of mush.

• 58:58Speaker 00

  I'm, I'm remembering the recommendation you quoted right at the beginning of the show, that you have no filter.

• 59:04Speaker 01

  Yeah, well, no, it's true. Well, listen, I haven't even started yet. I don't have any filter. That's a hundred percent 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 gotta, I have a question that I think are, what you kind of touched upon too, which were, which I think is very important, 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 made it so easy not to socialize, not to deal with people, that like.

• 59:43Speaker 00

  Including the tech.

• 59:44Speaker 01

  And, yeah, well, I'm saying tech has actually made it easier. Like, in, in some ways, yes, they've taken the burden off of repetitive tasks, taken the burden off of, you know, sending an email with thinking about what to say, because if I use ChatGPT, I sound smarter. Meanwhile, I'm more stupid, because I use ChatGPT and I wouldn't have thought of it. But the, like, the, 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?

• 1:00:27Speaker 00

  So I think the, the evidence for that comes from psychology rather than from neuroscience, because we don't have enough evidence to do this. But the, the psychology suggests that it's really important in terms of even simple things like communication abilities, right?

• 1:00:43Speaker 01

  Yeah.

• 1:00:44Speaker 00

  So if you are isolated, you lose the ability to have a conversation.

• 1:00:49Speaker 01

  Right.

• 1:00:49Speaker 00

  In this way.

• 1:00:50Speaker 01

  A hundred percent.

• 1:00:50Speaker 00

  From, everything's simple, from turn-taking in this conversation, to being curious enough to take that conversation beyond the simple, hello, how are you?

• 1:01:00Speaker 01

  Right.

• 1:01:00Speaker 00

  How are you doing? To take it to something where you're actually discussing a, a current event, or something that you've 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, of being well. Now, exactly what, what is happening in the brain when that happens, we don't know.

• 1:01:30Speaker 01

  We don't know. Okay, so can loneliness actually impair your decision-making then? And your cognitive performance?

• 1:01:36Speaker 00

  I think that's completely possible, yeah, and the, the cognitive performance for sure.

• 1:01:41Speaker 01

  Yeah.

• 1:01:42Speaker 00

  Um, in terms of everyday decision-making, I'm not sure about the evidence for that.

• 1:01:47Speaker 01

  Okay, is there, is there a best, now, these are gonna be very rapid fire, so just best exercise for the brain?

• 1:01:54Speaker 00

  Yeah, I think I would say aerobic exercise, it would be better, you'd be, if you can do thirty-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.

• 1:02:09Speaker 01

  But give me something specific, would you say, what's better? Weight training or walking for your brain?

• 1:02:16Speaker 00

  Uh, if you had to, if you had to decide, I'd go walking or running.

• 1:02:21Speaker 01

  Running, because it actually elevates your heart rate?

• 1:02:24Speaker 00

  Yeah.

• 1:02:25Speaker 01

  Okay, um, would you say Pilates or Stairmaster?

• 1:02:30Speaker 00

  Uh, Stairmaster, yeah.

• 1:02:32Speaker 01

  Because you're against, so you like the things that are much more rigorous.

• 1:02:36Speaker 00

  It has to be physical.

• 1:02:36Speaker 01

  Rigorous for your brain to be activated. I could have told you that, but I'm glad that a professional is saying it. Um, best food for cognition?

• 1:02:46Speaker 00

  Uh, I'm not sure, there is much evidence, apart from the fact that, you know, you shouldn't, you, 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.

• 1:03:00Speaker 01

  It's interesting you say that, because if you're a biohacker, they say, oh, that's nonsense, and that cholesterol is actually good for you.

• 1:03:07Speaker 00

  Oh, cholesterol is important in the sense that lipids, fats are important in terms of making the neurons.

• 1:03:14Speaker 01

  No, but like, but like, you know, like, it used to be when, again, when I was younger, right? Like, but butter was like the Antichrist, right? Butter and like eating too much saturated fat, like red meat.

• 1:03:26Speaker 00

  Yeah.

• 1:03:27Speaker 01

  Now, it's like talked about to be the, like, the panacea for health and wellness. What do you say?

• 1:03:32Speaker 00

  In all of these things, you have to have a, you know, you gotta be reasonable about this stuff. I eat butter, I eat red meat, but I'm just saying, people who have a, a, a raised cholesterol level have a higher risk of developing vascular changes in the brain, and therefore a higher risk of developing vascular dementia.

• 1:03:49Speaker 01

  So people who say, oh, you need to eat blueberries and a lot of omega threes for salmon, I guess, does it do anything? Will it, will it actually?

• 1:03:57Speaker 00

  I don't, I don't know the evidence that it does anything.

• 1:03:59Speaker 01

  You, really? Because like, for thirty-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 have this for your brain.

• 1:04:10Speaker 00

  It might make a difference, but I don't know the evidence that it makes a difference.

• 1:04:13Speaker 01

  You haven't seen the evidence?

• 1:04:14Speaker 00

  No.

• 1:04:15Speaker 01

  Oh, wow. Okay.

• 1:04:17Speaker 00

  I'm not, I'm not sure anyone's seen the evidence.

• 1:04:19Speaker 01

  Well, then where did this all come from?

• 1:04:20Speaker 00

  It's, it's interesting.

• 1:04:22Speaker 01

  Rhetoric that's just out there.

• 1:04:23Speaker 00

  Yeah, things, things take fashions, as you said.

• 1:04:27Speaker 01

  Okay, so one brain myth you wish would disappear?

• 1:04:30Speaker 00

  Well, I don't want to go back to the dopamine one for you, but I would say that one myth is that you, you have a limited capacity to do things. I think, as I said, you have far bigger capacity than you think.

• 1:04:42Speaker 01

  One most underrated brain habit?

• 1:04:44Speaker 00

  Sleeping well, that's a brain habit, yeah.

• 1:04:48Speaker 01

  So if you don't sleep well, I mean, people know this already, does that, does that actually create over time, like, a sleepy brain? You know, excuse the pun, but like, does it actually, like, weaken 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, you know?

• 1:05:06Speaker 00

  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.

• 1:05:27Speaker 01

  Well, yeah, that's, I, I meant it more chronic, like, not just, because everyone's wearing, of course, I'm wearing my Oura ring, it just gives me more stress than ever, than anything else, because I'm always like, did I sleep okay? Did I not sleep okay? And?

• 1:05:40Speaker 00

  A third of the people who come to see me in my clinic with memory problems have either problems with poor sleep, anxiety, or low mood. So they've, it's got to the point where 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.

• 1:06:09Speaker 01

  A lot of these things, though, I find are like, a lot of times, it's like life that's happening, right? Like, if someone is anxious and not sleeping well.

• 1:06:18Speaker 00

  Of course, it's not their fault.

• 1:06:19Speaker 01

  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, if you have like, an, you know, a, a sick child or a sick parent and you're financially struggling and you have all these problems, it's very hard to get those things in check.

• 1:06:36Speaker 00

  I completely understand, but we don't put it like that. I don't, I'm not gonna say that.

• 1:06:39Speaker 01

  Oh, I know you're not, I'm just saying, it's funny how like, that's, of course, these things will make it easier, that's why.

• 1:06:44Speaker 00

  Right, but it's also reassuring for someone to think, oh, my goodness, it's not because I'm developing dementia.

• 1:06:50Speaker 01

  It's lifestyle.

• 1:06:51Speaker 00

  It's something that I might be able to do, or a doctor may be able to help me with, right?

• 1:06:55Speaker 01

  Well, what I was gonna 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 itself? That was like the, the bottom line.

• 1:07:08Speaker 00

  Yeah, sometimes it becomes so chronic that it's very difficult to reverse naturally, unless some environmental change happen, you know? There were things that were making you really.

• 1:07:17Speaker 01

  You made ten million dollars and you're like.

• 1:07:19Speaker 00

  Well, that isn't always.

• 1:07:20Speaker 01

  Prince Charming or whatever, you know what I mean? Like, yeah, I guess that would be great. But for most people, it's like, as you age and life becomes hard, it's very easy to be like, oh, yeah, I'll just like sleep better, when it's really kind of not an easy thing for most people.

• 1:07:35Speaker 00

  There are, there are ways in which you could do it, right? But first of all, identify that it's a problem.

• 1:07:39Speaker 01

  Ambien? I'm joking.

• 1:07:42Speaker 00

  Yeah, identify it's a problem first, right?

• 1:07:44Speaker 01

  I know. So, all right, well, listen, I, I appreciate your time. I mean, you're the, you're, 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, what they can, what they can do?

• 1:08:00Speaker 00

  Sure, we, we have a website, if you go to masudhusain.org, M A S U D H U S A I N dot org, you'll find the kinds of research we do, the books I've published, the papers we've published, and other resources, yeah.

• 1:08:15Speaker 01

  Well, I really appreciate you coming on here, thank you very much. You guys, grab a copy of his book if you want to know anything or more about your brain, and, uh, wait, you don't even have a copy here, I was gonna show it for the camera, but that's okay. Um, I'll just, we can just.

• 1:08:32Speaker 00

  Yeah.

• 1:08:32Speaker 01

  Basically, it's called Our Brain, Ourselves, and, um, that's it. Thank you so much for being on the show.

• 1:08:39Speaker 00

  Thanks, thank you very much.

• 1:08:40Speaker 01

  Don't forget to, to subscribe. Thank you, bye.