Unlocking Brain Resilience: Insights from the POINTER Study

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Today we're going to dive a little bit deeper into a study, a series of studies that I have mentioned before in previous episodes called the finger study or pointer study.

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This is actually a worldwide series of studies that have been studied in Europe, in China, India, Australia, uh the United States.

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U.S.

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Pointer, Latin America, and originally it is called Fingers because the F stands for Finland, where was originally the investigators are from.

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But this is spanning 71 countries and 90 different teams, enrolling over 20,000 participants.

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to do what's called a multi-domain non-pharmacologic or no medication-based risk modification for preventing Alzheimer's disease and related dementia.

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The Alzheimer's Association is a major funder for worldwide fingers.

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And the Poynter study was the United States version of this multi-component behavioral changes that we can all implement.

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So the US pointer recipe was a combination of physical exercise, health monitoring, nutrition, and cognitive exercise.

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And I will break down each of this in detail after we talk about the key takeaway.

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So the study for pointer enrolled over 2,000 participants around the United States.

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and randomized them into two groups.

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The groups really only differed in terms of how much brain health coaching someone did and how frequent the meetings were with other people within the study.

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In the self-guided part of the study, those are the people who met pretty rarely.

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with others and really manage to implement the US Pointer brain health recipe on their own versus the structure group got a lot more frequent brain health coaching to help them implement the changes that are in the brain health recipe described earlier.

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What is notable is that both groups actually improved and their overall cognitive function, memory screenings and tests.

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But the structure group did better compared to the self-guided group.

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And this was translated to about one to two years younger in terms of having more resilience against memory changes.

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So this was a pretty big deal.

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Even in anti-amyloid drugs, that removed amyloid plaques, those drugs do not make your memory better.

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They only prevent the decline of changes that have already started to happen.

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But Pointer and the brain health recipe that is studied around the world is really getting at improving overall brain health.

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So let's break it down.

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How does exercise and how much exercise?

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The Pointer study really talks about 30 to 35 minutes of moderate to intense aerobic exercise four times a week, plus strength and flexibility exercises twice a week.

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So depending on if you combine those into the same day versus doing them on separate days, that is at least four times to six times a week.

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of exercise added up to be about 150 minutes of exercise.

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This is probably the right dose of exercise that we have seen in other studies looking at heart health.

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We know from the American Heart Association, most Americans do not reach 150 minutes of moderate exercise.

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And it doesn't matter what type of exercise, but the aerobic word means that people are having trouble with speaking uh because their breath is heavy and their heart is pumping and they may be sweating.

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uh Walking, if you power walk, can certainly be aerobic.

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It's just any sort of exercise that you enjoy and will be consistent with.

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So how does exercise improve brain health?

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Exercise is really one of those magic, I consider that magic interventions where if it's a pill, we would all sign up for it.

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But it is actually uh much better for us than any pill that I think our human's brains can dream of.

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So exercise actually increases the connectivity.

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or the relationship or the neuro pathways going between the neurons or the cells of the brain.

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It makes the brain more adaptable to changes and remodel.

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It certainly increases the blood flow in the brain and actually protects against inflammation.

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and inflammation is bad for our body and ourselves.

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Inflammation is a key driver to damaging the blood brain barrier, the barrier that blocks a lot of bad things from going into the brain.

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uh Exercise also help brain cells generate new ones, uh even in adulthood.

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uh We used to think that neurons are what you were born with and then you never make anymore.

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That is actually not the case.

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uh We can also see that it affects uh antioxidants and DNA repair throughout the body, but also in the brain where we have these lymphatic or glymphatic systems that help us get rid of toxins that build up in the brain.

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um And that system can be affected by both exercise and sleep.

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We also know that there is a lot of relationship between the microbiome that is happening in our mouth and in our gut, but I will talk more about that in the diet piece.

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There is also quite a lot of interaction between blood pressure and blood vessels, and we see this in the small blood vessels, especially of the brain.

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long-standing high blood pressure can cause tiny, tiny bleeds.

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It can make the blood vessel wall more stiff.

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We can see that in the heart as well.

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That is a concept called diastolic heart failure, which is really common, which means that the relaxation of the heart becomes limited because the heart muscle is stiff.

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And certainly people can have strokes, aneurysms, blockages, and the big blood vessels.

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But in the tiny blood vessels of the brain, I sometimes say that long-standing high blood pressure makes it so that like the strings at the very tail end of riverbed, it's not that there's a blockage to block the flow of blood.

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It just does those riverbeds run dry.

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And that causes a breakdown in the blood-brain barrier.

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And uh there's a very complicated set of reactions that happen that really causes inflammation as well.

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And this brain-blood vessel-immune function uh interaction is what drives a lot of not just Alzheimer's disease, but you can also see it in COVID as well, where COVID infections really causes, drives up the inflammation in people who are at risk for having changes to their memory from perhaps their underlying genetic risk factors or other vascular risk factors.

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So how does How does eating a Mediterranean diet affect our health?

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The MIND diet, which is the Mediterranean and DASH diet, emphasizes dark leafy greens, berries, nuts, whole grains, olive oil, and fish, and really limits sugar and unhealthy fats.

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um So the MIND diet has multiple studies that shows that it is good for our memory.

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And specifically, we think that the short-chain fatty acids that are in this mostly plant-based diet drives a lot of good bacteria in the gut.

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And this actually causes changes in those amyloid plaques and tau tangles in the gut.

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So how does the gut and the brain communicate Um, before I go there, I, the interaction between bacteria and, um, the gut is really fascinating.

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Uh, we know that the American diet, so highly processed foods, um, fried foods really drive up these gram negative bacterias in our gut.

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And these bacteria produce proteins that.

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drive up inflammation, actually drive up both amyloid plaques and towel tangles.

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So how does this, these changes in the gut actually go into the brain?

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We know that there are um kind of a bi-directional uh relationship between the gut and the brain, and they communicate through the vagus nerve.

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um The vagus nerve is a very big nerve that goes from our neck down to our gut.

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The vagus nerve tells the brain when we sense that we have eaten and nutrition and acid and the microbiomes in the gut.

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And the brain also tells through the vagus nerve, you know, how fast to move the gut.

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Immune functions secreting all the proteins that we need to digest the food.

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We know in people who are APOE-4 carriers, they actually have um more buildup of these amyloid plaques and tau tangles, but the tau actually first appear in the gut and then go up to the brain.

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We can also see that in mouse models and uh very tiny models of the gut and the brain um studies.

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the tau tangles first build up in the gut of the mouse and that increases the inflammation in the gut and go up via the vagus nerve all the way up to the brain.

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I'm still mind blown about that.

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And we have also seen in people through other studies in that inflammatory bowel disease, people who have Crohn's disease, oh chronic colitis that actually really increases the risk of Alzheimer's disease as well.

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And then not uncommonly, sometimes we see in my patients where they have both a GI issue that it seems like a lot of doctors cannot figure out what's happening around the same time as or even before people get diagnosed with Alzheimer's disease.

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I think there's a lot more that we can learn about the gut and the brain phenomenon.

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I think our gut is probably the first brain and our brain is the second brain.

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in terms of uh the relationship between the two and how much information goes between.

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So this is why I think whenever I think about how food is medicine, the mind diet actually does a lot to change these underlying amyloid plaques and towels.

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The part about cognitive exercise Within the pointer study, they used a computer-based brain training program three times a week for 30 minutes, plus other regular engagement in social and intellectually challenging activities.

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This is where I say staying home watching TV all days, not good for your brain, doesn't take a scientist to know that.

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But it also doesn't need to be one specific type of brain exercise.

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A lot of times really well intentioned family members ask me if it would be helpful for their loved one who's having memory problems to do more crossword puzzles and like to say that please don't force someone who don't enjoy doing crossword puzzles to do crossword puzzles.

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Myself included.

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I've never liked crossword puzzles.

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Doing them would just make me more frustrated.

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Word search, however, on the other hand, I can do, but only if it's something that they would enjoy.

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ah And then the heart, the health monitoring, these are regular check-ins in terms of blood pressure, weight, cholesterol, diabetes, the common things that we all need to do to monitor for not only brain health, but also heart health.

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So I hope that you have enjoyed today's talk in diving deeper into the pointer and the finger study results.

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I hope you feel empowered that a lot of these things are within our power to do, particularly if you're someone who's worried about your own risk of developing Alzheimer's disease and Alzheimer's dementia and other related diseases.

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We may say that we don't have time, but I think what we really prioritize is what we can find the time to do.

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And there's no perfect, know, perfection is overrated.

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uh Consistency is what's most helpful.

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I know with my personal snow in the past uh couple of weeks, that has really interrupted my usual exercise routine, but we can all get back to it, um even if there are periods when we're not doing as much healthy habits as we want to.

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So hang in there and thank you for listening.