Ep. 104 Transcription

Disclaimer: This is transcribed using AI. Expect (funny) errors. 

Mindy Peterson: [00:00:00] I’m Mindy Peterson, and this is Enhance Life with Music, a holistic look at the power of music in our everyday lives. My guest today is Dr. Kenneth Kosik, author of the book Outsmarting Alzheimer’s: What You Can Do to Reduce Your Risk. Dr. Kozik is co-director of the Neuroscience Research Institute at University of California, Santa Barbara. Before that, he was a professor at the Harvard Medical School. He has won numerous awards and his work has appeared in media outlets, including The New York Times, Wall Street Journal, BBC and CBS 60 Minutes. Welcome to Enhance Life with Music, Dr. Kosik.

Dr. Kenneth Kosik: [00:00:39] Thank you. Thank you very much.

Mindy Peterson: [00:00:41] Well, Dr. Kosik, starting out. Can you just clarify for us how much control do we have over our risk of Alzheimer’s? Are we at the mercy of our genetics or are there things that we can intentionally, proactively do to change our risk factor?

Dr. Kenneth Kosik: [00:00:58] There is no question that there are things we can do to reduce our risks. We do have to realize that even if you do all those things, you may still get it. They’re not perfect, but the data is so strong that we can reduce our risk if we do a few small medical interventions like, you know, know your numbers like blood pressure and lipids and keep them in the normal range. And a few lifestyle factors such as exercise, implementing a few changes can significantly reduce risk.

Mindy Peterson: [00:01:32] That’s good to know. I had a grandfather who died with Alzheimer’s. I think most of us have been touched by this. I have a loved one who’s living with Alzheimer’s right now, and most of us are in that position where we have close contact with a loved one who has had Alzheimer’s does have it. We’ve been a caregiver, perhaps, and it’s just one of those things we all have connection with and want to do whatever we can to reduce our risk of having that diagnosis ourselves.

Dr. Kenneth Kosik: [00:01:59] Absolutely. The disease is so common that, like you say, there is hardly anybody that hasn’t been touched. Mm hmm.

Mindy Peterson: [00:02:07] Well, when is the best time to take action to reduce our risk of Alzheimer’s disease?

Dr. Kenneth Kosik: [00:02:14] You know, do you really you can’t start too early. I would say that it definitely by middle age should start to think about reducing risk.

Mindy Peterson: [00:02:26] What exactly is middle age? And I know that my kids are coming home and talking about teaching, like how, you know, I’m trying to get a picture of their teacher. I’m like in my mind, I’m like, well, how old are they? They’re like, oh, yeah. And then it comes out, you know, it’s like probably in their 40s or maybe 50.

Dr. Kenneth Kosik: [00:02:49] So my I totally get it. Middle age does keep slipping back a little bit.

Mindy Peterson: [00:02:56] Doesn’t always what, like five, ten years older than whatever we are.

Dr. Kenneth Kosik: [00:03:01] So that’s right. Right, right, right. Just beyond what we are. But I think that we do have to start thinking about forming the lifestyle habits early on that are going to carry us through to successful aging. And really, you know, that means starting at least in your 30s or 40s, you can call it middle age or not, but that those are decades when, you know, the body begins to change. And by the time we’re in our 30s and 40s, some people are already developing some conditions that can eventually lead to dementia, like high blood pressure, high cholesterol. They may have poor dietary habits that would be much easier to limit if they adopted good lifestyle habits early on.

Mindy Peterson: [00:03:50] Well, your book includes 80 simple lifestyle prescriptions to slow the progression of symptoms as much as possible and improve quality of life. Are these one in the same prescriptions that we should be considering for decreasing our risk for Alzheimer’s?

Dr. Kenneth Kosik: [00:04:05] Very much so, yes. These these are the prescriptions that can really help. There’s really good evidence. And sometimes people say to me, well, you know, is the evidence the same for all of them? And I would say no. If I had to narrow down. I know we’re going to talk some about music, which I am a great enthusiast for, but if we were going to focus on one of all the lifestyle interventions, I’d have to put exercise at the top of the list, though. It’s really, really something we should all be doing from the time we’re even children having regular exercise routines. It’s just good for the brain and the body in general,

Mindy Peterson: [00:04:46] Just that movement. Well, and one thing that’s so helpful about starting young is you just it becomes a habit and a lifestyle rather than having to change habits the older we get, which can become hard. Well, your book kind of group. These 80 lifestyle prescriptions into six categories, and you use the acronym Smarts ASS for social smarts and for meal A for a Robeck are for resilience, T for treating your brain and asks for sleep and that train your brain category, your prescription. No one is learning to play an instrument which I love. You tell us why you chose this as your number one prescription for the train your brain category.

Dr. Kenneth Kosik: [00:05:32] Well, the reason I put it there was because training the brain requires doing something that is a challenge. Some people say they’re training their brain when they do a crossword puzzle, but maybe they’ve been doing it for the last 20 years and it’s no longer really training their brain anymore. They’re doing something that they’ve done over and over and over again. I think that learning to play an instrument is really one of the two greatest challenges. The other one might be learning a foreign language. These are two very challenging undertakings that require the coordination of so many skills, physical skills, mental skills, connecting even eventually when you’re really good connecting emotionally to the music. All of that is part and parcel of what’s involved in playing the instrument. I think you know that. Yeah.

Mindy Peterson: [00:06:20] Talk to us about some of the other benefits besides that cognitive challenge piece. You kind of touched on the fact that it’s novel. It’s not something that becomes repetitive. I suppose if you get to a certain point and just let yourself plateau and repeat the same songs over and over, then that could happen. But for the most part, learning to play a new instrument, even just learning a new song, can really bring that novel new experience and challenge to us. What about some.

Dr. Kenneth Kosik: [00:06:48] Go ahead. Learning to play an instrument is a constant challenge, no matter how good you are. You know, there’s a very famous story from a famous violinist. You know, this is a concert violinist, one of the best in the world, who said that if I don’t practice even one day I noticed it. And if I don’t practice two days, the critics notice it. And if I don’t practice three days, the audience notices it. You really you have to keep up with it. And so playing an instrument is always engaging the brain in a very, very powerful way. The other thing that playing an instrument is helpful for is that, you know, when you play an instrument, you play a piece of music. One is always bringing a certain style to it. It isn’t just exactly the notes on the page. It’s the way you play them, how hard you press on the piano key, how long you hold a note. All of those things are interpretive. And that’s a very powerful piece of how music is different every time you play it right.

Mindy Peterson: [00:07:49] You’re right. I hadn’t really thought about that concept, but that reminds me of things I write about how playing a musical instrument, creating music in that way lights up the entire brain. And it’s one of, if not the only activity that does that.

Dr. Kenneth Kosik: [00:08:03] It lights up the entire brain. And we now have even data that shows how the brain gets activated when people improvise in a jazz musician, for instance, who is playing along. And they actually what they do is part of what the brain does is inhibitory. You know, if we actually said everything, we think we’d be in big trouble. So so we really have to have a certain amount of inhibition, improvisation in music and even in other realms is really releasing inhibition and allows you to just play as you feel without the constraints that we often have in our daily life.

Mindy Peterson: [00:08:47] I have for you. That’s really interesting, too. I hadn’t really thought about it like that. But there are certain songs. I have a song that I absolutely love. It’s the Revolutionary Etude in C Minor by Chopin, and it’s one of those songs that I remember playing as a teenager. And it was my venting song where I was frustrated with something my parents or whatever. It’s like I knew I could yell and scream and say certain things, but I could play the song and they don’t even know I’m feeling right now. But that’s what I am doing. And then when I became a new parent and had this brand new baby and, you know, there are times where I should cry and I would just be like, I don’t know what else to do. She’s fed, she’s dry. You get to that level of frustration, too. And finally, I remember thinking, OK, well, I don’t know what else to do, but I can put her in her crib, close the door. I know she’s safe there and I can go play this song and I’m screaming louder than she is. And you just, you know, you can kind of vent and vent in those ways that are socially acceptable and just as therapeutic.

Dr. Kenneth Kosik: [00:09:54] Well, that’s a very interesting outlet that you have, because I would bet the kids, no matter how young they are, even even if. Newborn baby, they often feel what you feel, and I bet that your baby may be aware that you were a little bit frustrated and that piece of music, he is it a girl or a boy?

Mindy Peterson: [00:10:13] Well, the first was a girl. By the second, a son, I was broken in and didn’t experience so many of those extreme emotions!

Dr. Kenneth Kosik: [00:10:20] I think the girl probably heard the music through the closed door. Oh, yeah, definitely. It may be a deep memory for her as she grows up of associating that piece of music with calming influence on her.

Mindy Peterson: [00:10:34] You know, I’ll have to ask her about that. That’s a great question. And interestingly, when I would play that, she would usually she would calm down.

Dr. Kenneth Kosik: [00:10:42] You know, something interesting. Fascinating.

Mindy Peterson: [00:10:44] Yeah. We both come down right into back up. I had talked earlier, just a moment ago about how when we play a musical instrument and make music in that way, it lights up the entire brain. And I just wanted to clarify what we’re talking about when we say lighting up the brain is that the blood is flowing to all quadrants of the brain when it’s observed in a functional MRI. In those circumstances, when the participant is playing a musical instrument, you know much more about this than I do. Is there anything you would like to add to that to clarify?

Dr. Kenneth Kosik: [00:11:14] Well, yes, you said it very well. We say the brain is the most expensive organ in the body because it uses so much energy that weighs only three pounds, but it’s using twenty or twenty five percent of the energy in the body. It uses much more than our bones or kidneys. So it’s an expensive organ. And the way it uses energy is by regulating its blood flow and extracting oxygen out of the the blood as a source for the energy that it’s using to to function. You know, remember that we have to support in the blood flow to the brain something like 86 billion neurons there that are firing and using up energy all the time just to keep us to keep our minds active, even if we’re sleeping. So what the MRI can visualize is how that blood flow changes when one area of the brain gets activated versus another area of the brain

Mindy Peterson: [00:12:16] Going along with the same theme of the train your brain prescription cognitive challenge. Your book, I thought, has a really interesting series of questions to ask to answer the question, what is better for your brain in terms of that cognitive challenge, formal brain games or hobbies that you enjoy? And you mentioned a few questions to ask when considering this question asks, does the activity transfer benefits to everyday life? Does it get you out of your comfort zone? Is it novel, a new experience and is it challenging? And obviously I’m a little prejudiced, but when I think about those questions playing a musical instrument, Trump’s doing a crossword puzzle any day of the week. Any any other comments that you want to add to those questions about brain games versus hobbies and the relationship of music?

Dr. Kenneth Kosik: [00:13:10] Well, I think you nailed it there. They do have to be challenging. It cannot be routine. This is why one of the other points I discuss in the book is throwing a dinner party for your friends. You know, you have to be able to have a lot of social skills. You have to improvise during the conversation. You have to think about the planning of the meal when the different courses are coming out, who’s sitting where. These are all complex activities that may appeal to some people more than crossword puzzles or games. You know, I have to a lot of these games that people play Sudoku and crossword puzzles, you know, I would certainly endorse them. They they do help. But I personally don’t enjoy that stuff so much. So I really enjoy an activity that engages the brain in a way that is part of what we do in life, whether it’s trying to speak another language, throwing a dinner party, all of these things that actively engage the brain and are also fun to do. You have to enjoy it. If you enjoy it, there’s no point in doing it.

Mindy Peterson: [00:14:12] Sure. Well, and you probably won’t keep up with it as well.

Dr. Kenneth Kosik: [00:14:17] That’s exactly right.

Mindy Peterson: [00:14:18] Well, as you’re talking about throwing a dinner party in some of these different things, I’m just thinking about this holistic aspect of music. And there are so many different aspects of what you mentioned that that music affects and also these other smarts that you mentioned. So we talked about how your number one prescription was learned to play an instrument in that category of the tree in your brain category. But music is affecting so many of these other areas, too. For example, the social smarts, resilience, aerobics, smarts. I think about aerobics. I’m sure that refers to movement and exercise. I think about exercising without music, you know, I mean,

Dr. Kenneth Kosik: [00:14:58] Right

Mindy Peterson: [00:14:59] Music. Yeah, music just impacts our ability to keep going and stay motivated and push through that last email or last two minutes of elliptical or whatever, it is so much. And when you’re talking about throwing the dinner party and there’s the social smarts, the ass in smarts that you use with that acronym, music is such a socially bonding phenomena. Talk to us a little bit about that and how music does relate to that social smarts.

Dr. Kenneth Kosik: [00:15:33] Well, if you want to put it all together into one activity that does exactly what you’re saying, it would be dancing. Now you’ve got you’ve got the the social activity. You’ve got the music. You’ve got the exercise. It’s all there. And I really think our culture really needs to do more dancing. Sometimes when I travel, I travel a lot to countries in Latin America and South America and people dance a lot. We don’t do, at least in the circles I travel. And we don’t do that quite as much. I believe in the USA and it’s a wonderful thing. It’s just a wonderful thing to have some music. Come on, feel the rhythm. We all do that, but don’t stay in your chair. Get up and move and really interact with other people and the music. And then when dancing becomes even a little bit more sophisticated, there are certain steps if you can do some sort of whether it’s ballroom dancing or salsa, the steps involved are you can get a little bit complex. And that’s also good for the mind

Mindy Peterson: [00:16:45] As well in what you’re talking about has a huge impact, too, for motor skills, visual skills, auditory skills, both gross motor skills and fine motor skills.

Dr. Kenneth Kosik: [00:16:55] Yes, I couldn’t agree more. I think it’s just amazing how much you combine by bringing the music and the motor skills and the social activity of dancing all together. It’s really a great activity. And, you know, some people like to dance even when they’re by themselves. Nothing wrong with that, you know, so you can eliminate if you if you hear the music, sometimes you just can’t help but move. And and that’s good to

Mindy Peterson: [00:17:24] Talk to us a little bit about playing a musical instrument affect on our brains, neuroplasticity and actually changing the brain.

Dr. Kenneth Kosik: [00:17:32] Well, there’s no doubt that happens when you, for instance, learn to play the piano. There are so many rewiring of the brain that have to take place as you get good at it. You need individual control of every finger. You need to be able to actually be able to use your fingers almost independently. And you need to be able to use, when you really get good, the right and left hand independently. Those are all skills that most of us are not just born with, they require training. And training means rewiring the brain.

Mindy Peterson: [00:18:11] Mm hmm. And how does playing a musical instrument cause that to happen? And what effect does that have on our Alzheimer’s risk?

Dr. Kenneth Kosik: [00:18:19] Yeah, well, one one way it causes it to happen is by repetition. As you practice every single day, the neurons that are going to your hands, the area, the brain that’s controlling the movement of the hands actually begins to enlarge. And there’s more of the brain that’s being used to implement the activities related to playing a piano or a clarinet or whatever. So this kind of wiring is is something that I think can actually enhance your abilities and enhance the connectivity in the brain. Now, the second part of your question was, well, what about Alzheimer’s? You know, the cells are are dying. We don’t know why exactly that’s happening in Alzheimer’s disease. We have an enormous amount to learn about the basics of that disease. But if you have created through years of playing an instrument enough rewiring enough connections in the brain, you are somewhat resistant to this sort of slow, insidious process of Alzheimer’s. Doesn’t mean it’s not happening. It just means that you have more reserve built up that allows you to continue in the face of the disease for sometimes many more years.

Mindy Peterson: [00:19:43] And if people are already experiencing some symptoms of Alzheimer’s, these activities that we’re talking about, dancing, playing a musical instrument and some of the other activities and prescriptions outlined in your book, they can slow the progression.

Dr. Kenneth Kosik: [00:19:57] That’s where it gets tricky there. The data is less clear because you’re countering two factors. One is that, yes, you’re right, you would like to be able to slow the progression by practicing and building more connections in the brain and doing all that stuff. But as you well know, Alzheimer patients can easily become frustrated by their inability to do something. And this is something that we talk about a lot in the field, what are called catastrophic reactions, where you try to say, oh, he or she is unable to put the key into the lock and no more than that ability has been lost. And the caregiver would say, well, you should learn how to do it. But the Alzheimer patient is not learning anymore. And to avoid frustration, I sometimes think that maybe we don’t want to push too hard on learning new things. Playing an instrument, learning a new instrument would be very hard for an Alzheimer’s patient and could cause more frustration than it’s worth. By the time the person has overt Alzheimer’s disease, what we really want to do is to discover the skills that still remain and bring them to the fore so the person has trouble, say, doing some gardening because they can’t figure out how to use the tools, but they can still play golf. That’s what they should be doing.

Mindy Peterson: [00:21:23] It’s been really interesting for me to see a lot of research showing that the part of the brain that remembers music is one of the last to fade away in patients with Alzheimer’s. Oliver Sacks did so much work on that. Can you speak much to some of these Alzheimer’s patients who aren’t able to remember very much, but you take them to a piano and they’re able to play these songs that they learned and have played for decades?

Dr. Kenneth Kosik: [00:21:49] Absolutely. I think that’s such an interesting question that we don’t fully understand. But music is clearly encoded in the brain in a very different way than many of our other memories. And it’s there in a very deep way that I agree with you. We see this over and over again is been is somewhat more resistant to that insidious process of Alzheimer’s disease and music remains. And it’s fascinating to see that even a rather debilitated patient still has the ability to to perform music. I saw this firsthand. I saw a patient who was had advanced Alzheimer’s, was already bedridden, could no longer talk. But when his family got him up out of bed and put a harmonica in his hand, he played he started playing beautifully. It was really remarkable to see that.

Mindy Peterson: [00:22:40] Well, what if listeners don’t have musical training in their background now? Is it ever too late to learn? It sounds like if someone already has advanced Alzheimer’s symptoms, it may be too frustrating to have them try to learn a musical instrument at that point. So what’s your thought on the timing? When is it too late to learn? When is it too late to reap the benefits of of learning to play a musical instrument?

Dr. Kenneth Kosik: [00:23:04] The person has been diagnosed with Alzheimer’s disease. I would think that trying to get them to learn an instrument at that point may not be the wisest thing to do. But what most of us have, almost everybody, is appreciation of music. So by that time, I think what we want to do is really expose the patient, provide for the patient the kind of music they really enjoy so they can sing, they can dance, they can listen, and they can activate the memories that they associate with that music.

Mindy Peterson: [00:23:37] One topic that I am also hearing a lot about recently is epigenetics. And I heard staying with our music theme here, I heard this described recently and I’m trying to remember who it was. It was described as almost like having a piano embedded deep within us. And those piano keys are there in terms of our genetics are there, but we can choose which ones are pressed and played. And that’s kind of the theory of epigenetics. Talk to us just a little bit about that topic of epigenetics and how it affects our ability to control our risk of Alzheimer’s.

Dr. Kenneth Kosik: [00:24:18] So what epigenetics means for scientists is that we let’s start with genetics. Genetics means that you have some information encoded in your genes and the DNA. That’s the genes that are the instruction book for how you’re you’re going to be it’s going to be the color of your eyes, whether you’re going to go bald. All of these are encoded in the genes, all the DNA that you have, the actual DNA, the genetics is not going to change from the time you’re conceived to the time you die, your genes are more or less the same. But then we have epigenetics. So epigenetics are. A lot of the things that don’t actually change the genes themselves, they just simply chemically modify them a little bit. When I say chemically, I don’t mean that in a bad way. I mean chemically in terms of that’s a biological modification. They may change the one component of a gene just by a little bit. And the way that happens and when that happens, it changes whether that gene is going to be turned on or not. If you have a gene that somehow controlling your you know, you know, there’s no one gene that does this. But let’s say there was a gene that related somehow to music and you wanted to turn it on. Well, the gene hasn’t changed very much. But if you hear music, maybe that gene would then be modified slightly so that now you have you have more desire to hear music again. That’s probably not a great example because, you know, listening to music and enjoying music is more complex than any single gene. But the idea of epigenetics is basically that while the actual DNA doesn’t change, it can get modified a little bit during life based on your experiences that will alter whether that gene is turned on or not.

Mindy Peterson: [00:26:10] I think that is a fascinating topic that I’m sure I could do an entire episode.

Dr. Kenneth Kosik: [00:26:16] It is it’s a little bit complicated because these you know, I can see someone else coming back to me and challenging me and say, well, you just told me that the DNA doesn’t change, but then you’re saying it’s being modified. That sounds a little contradictory, but it’s not because the actual letters of the DNA don’t change, but they can get small modifications that affect what they do.

Mindy Peterson: [00:26:38] Well, it’s not completely unlike a muscle. You have a muscle you can choose if you’re going to strengthen it or not, or even a personality trait. Some people tend to be very disciplined by nature, but they still can choose whether or not they’re going to just let that go and not exercise that trait and lay on the couch and watch TV and eat potato chips all day, or if they’re going to continue to develop that natural bent toward being disciplined and and strengthen it like a muscle. And I see the epigenetics as being somewhat related.

Dr. Kenneth Kosik: [00:27:13] I like that analogy a lot. The muscle is there, but how you use it depends on, you know, if you lift weights, how big it gets, how strong you get. And I think that’s a wonderful way of communicating the idea.

Mindy Peterson: [00:27:27] Well, it plays into something that we as humans all want, and that’s the sense of self efficacy where we have some control over our destiny. We are in the driver’s seat to some extent. And yes, there are things that are beyond our control, but we do have a level of control should we choose to take advantage of that and utilize it?

Dr. Kenneth Kosik: [00:27:48] That’s exactly right. This is you know, we we all talk about nature and nurture. Right. So genes interact with the environment and that is where the action is.

Mindy Peterson: [00:27:58] Uh huh. Well, and I like a phrase you used earlier in our conversation, successful aging. And we all want that. And it’s comforting to know that there are lifestyle changes that we can implement now that are enjoyable and will increase our odds of quality of life decades down the road. Is there anything that I haven’t already asked related to music and outsmarting Alzheimer’s that you’d like to mention before we close things out?

Dr. Kenneth Kosik: [00:28:26] Only in the fact that your questions are really on target. I think this is that this topic is really wonderful. And I would really like to see more attention paid to the relationship between music and successful aging and Alzheimer’s and all the questions that have been our topic today.

Mindy Peterson: [00:28:40] Wonderful. Well, I ask all my guests to close out our conversation with a musical ending a coda by sharing a song or a story about a moment that music enhanced your life. Is there a song or a story you can share with us today?

Dr. Kenneth Kosik: [00:28:55] Absolutely. So I have a friend. Her name is Cristina Pato. She plays the bagpipes. She’s from Spain, where they bagpipes are not only played in Scotland, they’re also played a lot in many countries in the world, including in Spain. She comes from Galicia and she approached me one day with a situation she faced. Her mother was developing dementia and she was at my university where she told me a very moving story about her mother. It was losing the ability to remember and to speak. And she being that her outlet was music, very much like you said earlier, about going to the piano and being playing the Chopin piece. Her outlet was also playing the bagpipes, and she composed the piece of music that related to the story of her mother, both kind of a mixture of music and words that in which as it unfolded, you could actually see what was happening to her mother and her feeling. It was extremely poignant, and I remember she performed this once for a large group of families in which there was a genetic form of Alzheimer’s in these families, many of them had relatives that suffered from the disease and her performance, it just brought tears to everyone in the audience. It was so moving to see the way she could interlace the music and the story of her mom and engage the audience that I saw firsthand what what music could do.


Transcribed by Sonix.ai