Dr. Mark D'Esposito: How to Optimize Cognitive Function & Brain Health

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford School of

Medicine my guest today is Dr and

Professor Mark

despasito Dr Mark despasito is a

neurologist and a professor of

neuroscience and psychology at the

University of California Berkeley he is

a world expert in the brain mechanisms

controlling executive function and

memory executive function is the way in

which we are able to designate and carry

out specific cognitive strategies and it

is fundamental to every aspect of our

daily lives and because so much of being

effective in daily life involves using

specific context relevant batches of

information in order to understand what

to do and when and what not to do and

when and to come up with strategies that

are very adaptive for us to move forward

in the context of relationships work

school and Athletics and on and on

there's really no separation between

executive function and memory and today

Dr desposito explains the neural

circuits controlling executive function

and memory how they interact the key

role of dopamine in executive function

and something called working memory and

teaches us ways to optimize executive

function and memory that is how to

optimize cognitive function in addition

to discussing how to optimize cognitive

function in the healthy brain today's

discussion also centers around how to

restore cognitive function in disease or

injury conditions that deplete executive

function in memory such as traumatic

brain injury concussion Alzheimer's

Parkinson's and attention deficit

disorders Dr desposito shares with us

research findings both about behavioral

and pharmacologic strategies to enhance

executive function and memory by the end

of today's discussion you will have

learned from Dr despasito a tremendous

amount about the modern understanding of

cognition that is thinking and memory

and the carrying out of specific

cognitive strategies you will also learn

a tremendous amount about how to

optimize brain function and brain health

before we begin I'd like to emphasize

that this podcast is separate from my

teaching and research roles at Stanford

it is however part of my desire and

effort to bring zero cost to Consumer

information about science and science

related tools to the general public in

keeping with that theme I'd like to

thank the sponsors of today's podcast

our first sponsor is Maui Nei venison

Maui Nei venison is the most new

nutrient-dense and delicious red meat

available I've spoken before on this

podcast and there's General consensus

that most people should strive to

consume approximately one gram of

protein per pound of body weight now

when one strives to do that it's

important to maximize the quality of

that protein intake to the calorie ratio

because you don't want to consume an

excess of calories when trying to get

that one gram of protein per pound of

body weight mauii venison has an

extremely high quality protein to

calorie ratio so it makes getting that 1

gram of of protein per pound of body

weight extremely easy it's also

delicious personally I like the ground

venison I also like the venison steaks

and then for convenience when I'm on the

road I like the jerky the jerky is a

very high protein to calorie ratio so it

has as much as 10 grams of protein per

jerky stick and it has something like

only like 55 calories so again making it

very easy to get enough protein without

consuming excess calories if you would

like to try Maui Nei venison you can go

to mauii venison decom huberman to get

20% off your first order again that's

Maui venison

docomond to get 20% off today's episode

is also brought To Us by ju juv makes

medical grade red light therapy devices

now if there's one thing I've

consistently emphasized on this podcast

is the incredible role that light can

have on our biology and of course I'm

always telling people that they should

get sunlight in their eyes as soon as

possible after waking on as many days of

their life as possible for sake of

setting circadian rhythm daytime mood

focus and alertness and improv sleep

now in addition to sunlight red light

and nearin red light has been shown to

have positive effects on improving

numerous aspects of Cellar and organ

Health including faster Muscle Recovery

improved skin health and wound healing

even improvements in acne or that is

removal of acne reducing pain and

inflammation improving mitochondrial

function and even improving Vision

itself what sets juv aart and why it's

my preferred red light therapy device is

that it has clinically proven

wavelengths meaning meaning it uses

specific wavelengths of red light and

near infed light in combination that

trigger the optimal seller adaptations

personally I use the handheld ju every

day the handheld ju is about the size of

a thick piece of toast and I also own a

ju panel that allows for full body

exposure and I use that one

approximately five times per week for

about 10 to 15 minutes per session if

you would like to try ju you can go to

j.com huberman to receive $50 off your

first purchase again that's ju spell

jv.com huberman to get $50 off your

first purchase today's episode is also

brought To Us by 8 sleep eight sleep

makes Smart mattress covers with cooling

Heating and sleep tracking capacity I've

spoken many times before in this podcast

about the fact that sleep is the

foundation of mental health physical

health and performance now a key

component of getting a great night's

sleep is that in order to fall and stay

deeply asleep your body temperature

actually has to drop by about 1 to 3°

and in order to wake up feeling

refreshed and energized your body

temperature actually has to increase by

about 1 to 3° one of the best ways to

make sure that those temperature changes

occur at the appropriate times at the

beginning and throughout and at the end

of your night when you wake up is to

control the temperature of your sleeping

environment and that's what eight sleep

allows you to do it allows you to

program the temperature of your mattress

and sleeping environment such that you

fall and stay deeply asleep easily and

wake up each morning feeling incredibly

refreshed and energized I've been

sleeping on an eight- Sleep mattress

cover for almost 3 years now and it has

dramatically improved the quality of my

sleep if you'd like to try eight sleep

you can go to eights sleep.com huberman

to get $150 off their pod three mattress

cover eight sleep currently ships in the

USA Canada UK select countries in the EU

and Australia again that's 8sleep.com

huberman and now for my discussion with

Dr Mark desposito Dr desposito welcome

hi Andrew thank you so much for inviting

me I'm really looking forward to

conversation yeah you may not remember

me but I remember you when I was a first

year graduate student and uh you showed

up at Berkeley one of the first people

to really bring functional Imaging of

the human brain to Berkeley bring a

neurology and a clinical

um emphasis to the Neuroscience studies

there and it's really just um blossomed

and it's been a real thrill for me to

see all the Magnificent work out of your

laboratory over the years and I know you

also still see patients so the topics

that are of interest to you I know are

of great interest to our audience maybe

we'll just start off with a few of the

basics and um do a little functional

neuroanatomy lesson for folks not to

scare anyone don't worry this will be

accessible to everyone and just talk

about the frontal lobes and prefrontal

cortex and a little bit of what those

structures do because many times on this

podcast I've said okay the neural real

estate right behind your forehead is

involved in context and planning Etc but

you're the real expert here um how

should we think about what the frontal

loes do and and they're very roles in

health and disease yeah so there's four

loes there's a frontal loes parietal

temporal occipital and the frontal loes

probably take up more do take up more

territory than the other Lo probably

about a third of of the uh cortex and

within the frontal loes uh I I don't I'm

going to use sort of frontal loes

probably in our conversation a lot but

what I really mean is the prefrontal

cortex So within the frontal loes

there's also Mo areas that important for

motor function as well um but when we're

talking about the frontal loes and

talking about it you know involved in

higher level cognitiv abilties we real

talking about the prefrontal cortex and

this is what's considered sort of the

highest level of Cortex in the brain and

so yeah when you think when you think

about it people assign it all sorts of

functions almost every function you

think of people sort of put into the

frontal lows but I think what we've all

kind of uh moved towards is this idea of

executive function this abil this

ability to to plan to

organize uh to really transfer our

thought thoughts you know into an action

and really to be guided by goals and and

intentions and not be kind of take you

know kind of ruled by sort of just

automatic behaviors and a word we use in

cob ner science is called cognitive

control so C control executive function

is what we attribute to the frontal L

and so you can think of it as you know

the CEO of the brain or the U you know

or the conductor of the orchestra really

the part of the brain that's that's

really controlling the the the rest of

the the brain so yeah if you had to

choose which part you wanted to not

leave home it's your front it's your

frontal opes speaking of which um what

are some of the uh symptoms of mild

frontal lobe damage um and severe

frontal lobe damage a damage brought

about either through uh neurod

degenerative disease or physical injury

I know we're going to talk a bit about

both today or a lot about both um but

how would lack of executive function uh

show up um and maybe on in kind of a

subtle level yeah I mean at first I

should say is that it it shows up all

the time because when when uh and and

frontal lobe behavior is probably much

more prevalent than than we realize

certainly we think about it when you

have a brain injury to the frontal loes

and there's lots of neurological

disorders like stroke and traumatic

brain injury and Alzheimer's disease

that can affect the frontal lobe and

there's a number of you know psychiatric

disorders obsessive compulsive disorder

and schizophrenia and depression that

are thought to be frontal l D function

but when you're sleep deprived and when

you're stressed and just normal aging

the frontal lobe seems to be the first

system that's affected because it really

is involved in the highest level so when

we're having a bad day when we're having

difficulty sort of setting priorities

when we're having difficulties achieving

the goal that we've set out when we get

distract you know when we get distracted

um you know when we're not able to sort

of adapt and be flexible these are all

the type of things that are reflect that

our frontal loes are not functioning

optimally approximately what age does

the frontal lobe

circuitry uh come online so to speak I

mean when I see a baby uh babies can

Orient their eyes towards things but

they're rather reflexive in and where

they'll Place their eyes but um by time

kids are three or four they can

certainly you know play with blocks or

interact with other children or their

parents but it seems that you know full

functionality the frontal loes is it's

really gradual at least that's my

non-clinically trained assessment yeah

yeah I mean it's a really tough question

to know when they're fully develop

because these studies haven't been done

when MRI was introduced and we were able

to sort of image the brain in a

non-invasive way uh then studies did

start to come out trying to sort of map

out at what age does your frontal loes

fully develop and it seemed like it was

early into your your 20s um you know I

always say that it's not surprising that

you can't rent a car until you're 25

that's insurance companies knew before

neur scientists did as to when your

frontal loes have you know when your

decision-making skills at their highest

and so that's probably about right into

your 20s um is probably before your

frontals are fully developed and it's

really interesting question is why why

does it take so long it's the area of

the brain that takes the longest to

develop and why is that and I think

there's a reason I think that this sort

of slow development of frontales allows

us to to explore allows us to think

about novel ways of solving problems

allows us to take in the world if they

were shut off

earlier uh it it would lead to maybe a

much more sort of rigid kind of you know

less flexible kind of uh behavior that

that we see things so I so I think that

that it helps to be uh it take a long

time to develop but also it obviously

leads to some problems sometimes in

adolescence as as as we see

sometimes can one see a la of frontal L

maturity in just the sheer number of

physical movements that a child makes um

so for instance in a classroom of you

know let's say um you know fourth

graders um oftentimes there'll be a

range of uh a parent of ability of kids

to sit still or to listen um do we think

that the kid that's having a hard time

focusing and listening to instructions

or steadying their body when they're

told to sit still um I don't know if

they still tell kids to sit still but

they were telling me to sit still when I

was a kid um is that um somehow

reflective of a you know slightly

lagging frontal frontal L function um

and maturity whereas that you know the

the kids that can sit you know still and

stoic and focus does that mean that

they're a little bit more accelerated

along that trajectory yeah it's hard to

say I mean the frontal lobe is B is a

big territory and we can get into it but

there's you know the frontal L probably

has 25 different sub regions within it

and and so grossly we think about the

frontal loopes as the lateral portion of

the frontal loopes which is involved in

these executive function probably

supports these exective function

abilities but then we've got another

part of the frontal loes called the

orbital frontal cortex which is probably

involved more in Social and emotional

Behavior so you know when we think again

when we think about frontal behaviors uh

they kind of you have to break there's

so many different type of frontal

behaviors so that type of behavior which

may be involved in sort of being able to

inhibit you know your motor movements or

maybe not being distracted May reflect

that that system is a little bit delayed

but it could be that another system the

one that's involved in planning and

organizes you know is more developed and

I do I do think they they develop at

different

trajectories so with the frontal loes

essentially um serving an executive or

CEO type function goal directed Behavior

intentions cognitive control uh these

are the terms you used

um where are the rules what do the rules

rules look like you know when I think

about brain function which I've spent a

lot of my life thinking about we think

about chemical and electrical signaling

between neurons different neurons

communicating more or less at a given

moment reflecting some sort of circuit

as we call it and then some Behavior or

some decision comes out and if I for

instance um I have to get my driver's

license renewed soon so if I go to the

Department of Motor Vehicles what a

lovely experience that is um the moment

I get there the I sort of lock into a

certain rule set um when I'm home I'm in

a different rule set when I'm in with my

friends versus when I'm with my parents

different rule sets and it seems that

the frontal lobe is really good at um

drawing on context based on knowledge of

where one is um and then coming up with

kind of algorithms that are appropriate

or inappropriate to run in that context

but what is the nature of these

algorithms are they um of the okay shut

down all all um cursing in this

environment um okay you're free to just

quote unquote be you I mean when when it

really comes down to it it has some

interesting philosophical aspects too

because uh just be yourself be authentic

be vulnerable you know all these things

make sense but of

course one needs to be appropriate with

the context so how how do does this work

like what what is the what are the

algorithms how how does this work right

because because that's a pretty common

example of our patients that they they

don't follow the rules um they they you

know if you're sitting in a someone's

the doctor's office and the phone rings

you you you know not to pick up his

phone but the patients don't and they

they may pick up the phone there there's

this Dr L who's a a neurologist from

France published these beautiful papers

in the 80s of all these things that

patients did that just that broke the

rules and and so and BR just kind of

pulled to the their environment without

having any context to it if you put a

pair of glasses on the table uh and

didn't ask him to put them on they would

put them on even if they had a pair of

glasses on already or he took them to

their apartment and they saw the bed and

they jump into the bed and go under the

covers or he saw he had a nurse and she

he put a blood pressure cuff there and

she picked up the blood pressure cuff

and just started taking his blood

pressure again not asking him to do any

of these things and so they they they

just don't follow sort of the social

rules but they're there they they

haven't lost rules if you ask these

patients was that the appropriate thing

to do they'll say no

they know it's not they know it's

appropriate yeah they say no I'm not

supposed to answer your phone but oh wow

so they know better but they can't

control the impulse exactly so it's it's

it's so it's not a breakdown that the

rules disappear it's that they can't

apply the rule they can't apply the

rules Pro properly and and and that's

true for a lot of PA patients even with

kids you know you tell them uh don't

have anything to eat before dinner

because we're having dinner and then

they're sitting there having a sandwich

and you say what did I just tell you you

said well don't eat but I'm I'm hungry

right as another sort of example sort of

the frontal Lo's not completely kind of

developed so when I think about rules I

I think about the brain you know the

brain processes information obviously

but it also stores information the most

important thing it does is store all

sorts of information all over the brain

and I think what the frontal loes do is

they store rules and what's interesting

uh about the way it stores rules they

seem to store the rules and hierarchical

fashion um and what I mean by that is

that there's different levels to rules I

like to give the example of uh playing

golf I tell a story a lot about my good

friend bob Knight when he hits a ball

into the you know off into the woods and

he has to try and hit the ball out of

the woods he's holding on to all

different levels of rules on how to

successfully get his ball back towards

the green so the most simplest one is

just like where you know where is the FL

you know I've got to maintain the uh

orientation to get to the flag you know

so he's holding that he also at a higher

level rules he knows that if he kicks

the ball it's a penalty so he's not

going to do that right and then another

higher level rule might be if I just

keep doing this you know then this is

going to be healthy for me so he's

storing all this information at sort of

at different levels of hierarchy and

he's apply he's applying it to

ultimately achieve this very simple Act

of or not so simple Act of of hitting

the golf ball

so yes so I just I think about sort of

the frontal cortex is able to call upon

the rule in the appropriate context and

if you don't have your frontal loes it

it it doesn't get pulled up properly and

those rules must be learned right that

it there's no way I can imagine that one

can be born into the world with these

rules sets intact um I think about the

the two marshmallow experiment that's

sort of famous now um where kids are

offered to eat uh one marshmallow right

way or defer and get two marshmallows

these uh adorable videos of the kid the

very strategies they use like Turning

Away poking the marshmallow and you know

there's some debate uh ongoing as to

whether or not uh success or lack of

success in deferring to the two

marshmallow reward is um predictive of

of other things in life but leaving that

aside um am I correct in assuming that

that task is a frontal lobe task the

kids are given a novel rule you can have

one marshmallow now or wait

um patiently and then uh with and

overcome the craving for that one

marshmallow and then you'll get two um

and presumably that um that experiment

is engaging the frontal loes and you

know we can only speculate but um some

kids are able to defer some are not um

and I can imagine that at that age

there's a lot of neuroplasticity um

strengthening and weakening of

Connections in the brain on in an

experience dependent way so does that

mean that um children and perhaps adults

as well can train up their prefrontal C

cortical abilities to strategize and

defer in a way that's adaptive

absolutely I mean definitely you can

learn strategies to not only sort of

learn rules um but but how to apply

goals when when you start to think about

that task in particular some of it has

to do with sort of maintaining a goal

and and maintaining a goal at different

you know time scales right and children

tend to sort of act on goals that are

much more short on a shorter time scale

you know I'm going to have the sandwich

right now because I'm hungry as opposed

to wait till till dinner which is a

longer longer term goal and so yeah this

default to sort of the shorter you can

you can learn that maintaining a longer

type goal uh can be much more beneficial

uh than than the short-term goal even

though it doesn't seem obvious and we

all learn that right we as we as we get

older most of us we keep our eye on the

ball sort long-term goals and that's

very predictive of how successful we can

we can be the farther out we can

maintain a goal and that's what the

that's what the prefrontal cortext does

it maintains goals and then applies

those goals and if you don't apply them

then you lose you know then you then all

of this executive function breaks down

do you think that these algorithms and

rules that the prefrontal cortical

circuitry can learn and indeed does

learn can generalize so for instance

when I my first year of college was this

disaster uh for reasons that aren't

interesting right now but then when I

came back my sophomore year really

spring of my freshman year I was like

okay it's on it was I had to rescue

myself and so one of the things I used

to do was I would study um and I would

set a timer so I refuse to get up even

if I had to use the the restroom very

very badly I would um set up all sorts

of Behavioral constraints um and I like

to think that I was building up my

prefrontal ability to refocus on the

material and fortunately for me there

were no smartphones back then it was

much easier internet now we had email

but no no real internet browsing to to

speak of and I like to think that the I

sometimes call it uh and this is

terrible um to call it this because it's

not uh nearly exhaustive of the

underlying function but I call it sort

of like lyic friction it's like there's

this friction that one feels mentally

like you want to get up you want to use

the restroom you want to eat something

you want to call a friend but you stay

focused on the task at hand do you think

that that business of quote unquote St

stay focused on the task at hand can

generalize because of the sensations it

generates in the body and then you oh

this is familiar this is just like

studying but in a different context one

is one stays focused or do you think

that the prefrontal cortex is is so

context specific that it needs to learn

a Ru the rules for every individual

situation and then this has all sorts of

implications for Behavioral restraint

and focus and attention deficit so uh if

you could just speculate um I know a

number of people are interested in how

they can be more focused and people

often defer to like what supplement what

drug okay that those are interesting

conversations but I think ultimately

we're talking about neural circuitry

yeah I mean it absolutely can generalize

it that's been a frustrating thing and

trying to develop what we call cognitive

therapy where we we teach we try to

improve someone's memory ability or we

try to improve someone's executive

function ability the the disappointing

early results was always that yeah they

get very good at the task that you've

trained them at but it doesn't seem to

generalize to anything else so if you

teach them a you know a task they can do

amazing things like match a finger to a

color to a shape and put together all

sorts of rules and then and they're

really good at that task very quickly

and then nothing's really changed in

their real life but but I think we've

learned on how to sort of on how to try

and make it uh translate to real life

and and so for example there's there's a

therapy called goal Management training

which is developed um by Brian LaVine

and colleagues at the rotman Research

Institute of Toronto where they've been

very successful

in teaching uh patients how to improve

your executive function uh and how to

make that translate into your real world

but it's it's very hard work it's it's

very therapist driven it requires um it

requires a series of of trainings for

example people learn uh they develop

individual projects like planning a meal

or planning a family vacation or

planning a podcast and then they work

through what's involved in that sort of

very specific project how you how you

stay focused how you don't just get

distracted how you you keep your eye on

the ball how you break it down to subg

goals how you um you monitor what you're

doing how you don't let anxiety and

procrastination get involved but it's a

it's a very active sort of process but

when you add all that to it in a very

disciplined way over the course of many

hours many weeks it does translate

patients and individuals just say yeah

I'm just better at doing things I mean

the whole goal is to do things right and

and just better at it I don't know what

it is but I'm I'm not just better at

what you taught me I'm just better at

other things so I do have a lot of hope

that these kind of therapies will

generalize to the you know to people's

real life I throughout the term lyic

friction again not a technical or

clinical or official term in any way but

just a way to kind of capture um some of

the interactions of the frontal cortex

with other circuitry I mean there's far

more um involved in agitation and

challenges focusing than the lyic system

but it it certainly is involved

um when thinking about the frontal

cortex I often think about its

connections with other areas of the

brain so maybe we could talk a little

bit about those connections and and in

particular the connections from the

frontal cortex to let's call it um

circuitry that controls reflexive

behaviors um what are what is the nature

of that circuitry and um can we make any

generalate statements like does the

frontal cortex really serve to um

provide a

quieting um suppressive function on

reflexes or is it more of an Orchestra

conductor where it's saying okay A

little bit of that and a little bit of

that um and then what's what comes out

in Behavior or speech is something that

looks very organized but is actually the

the the reflection of a lot of selective

filtering yeah I mean the prefrontal

cortex what's so fascinating about it is

that it I would say it connects to every

part of the brain uh cortex and the

subcortex and almost every part of the

brain connects to it so that I mean that

right there tells you it's a pretty

important area and it has to if it's

going to be in this CEO you know

conductor type experience uh role and so

it's in this privileged position just

anatomically so that that gives us great

insight to how important it is and so it

is connecting and then of course we

could talk about it how it's connected

to the body as well how it controls

heart rate and respir ations as well so

it's not just just the brain so um but

it's really interesting like like you

said is is it really just sort of

maintaining telling you what's relevant

and what's not relevant or is it

allowing you to switch I think it does

all those things it it it definitely

what we call sends these top down

signals it's sending signals to the

other brain about what you should be

paying attention to and what you

shouldn't be paying attention to so for

example if you we've done studies with

functional Imaging where we have them

look at pictures of faces and scen

and that lights up the back of your

brain your visual cortex has areas that

are can process faces and process scenes

and um but sometimes we have you just

want to pay attention to the faces and

not the scenes and other times we want

you to pay attention to the scenes and

not the faces well you know even though

it's getting the same bottom up visual

input the prefrontal cortex will will

show greater activity to the relevant

information it it'll it'll sort it's

sending a signal say pay attention to

the faces ignore the scenes and uh or

vice versa so it's it's directing all of

this information that been bombarded

with to what's what's relevant but at

the same time it's also uh allowing us

to switch if if that we now have to go

switch to another task it says okay this

is not important now we're going to move

over to this this other other task so

there's many different components of how

I can you know how I can kind of control

Behavior but it does all of these things

in this incredible way that we still

don't completely understand but we know

that's the source of of all of this

control is coming from the prefrontal

cortex I'd like to take a brief moment

and thank one of our sponsors and that's

ag1 ag1 is a vitamin mineral probiotic

drink that also contains adaptogens I

started taking ag1 way back in 2012 the

reason I started taking it and the

reason I still take it every day is that

it ensures that I meet all of my quotas

for vitamins and minerals and it ensures

that I get enough Prebiotic and

probiotic to support gut health now gut

health is something that over the last

10 years we realized is not just

important for the health of our gut but

also for our immune system and for the

production of neurotransmitters and

neuromodulators things like dopamine and

serotonin in other words gut health is

critical for proper brain functioning

now of course I strive to consume

healthy Whole Foods for the majority of

my nutritional intake every single day

but there are a number of things in ag1

including specific micronutrients that

are hard to get from Whole Foods or at

least in sufficient quantities so ag1

allows ows me to get the vitamins and

minerals that I need probiotics

prebiotics the adaptogens and critical

micronutrients so anytime somebody asks

me if they were to take Just One

supplement what that supplement should

be I tell them ag1 because ag1 supports

so many different systems within the

body that are involved in mental health

physical health and performance to try

ag1 go to drink a1.com huberman and

you'll get a year supply of vitamin D3

K2 and five free travel packs of ag1

again that's a drink AG 1.com huberman

you mentioned connections between the

prefrontal cortex and the body um that's

the first I've heard of that um and I'm

not challenging that to the contrary I'm

just intrigued by it um I'm aware that

the hypothalamus and some of these

deeper brain structures associated with

more um let's call them primitive drives

um temperature regulation uh hunger Etc

connect to the body but uh what what's

the nature of some of the connections

with the front to the body yeah I was

just talking in terms of of our

knowledge of how you know changing I one

of your podcast you talked about how TMS

to the prefrontal cortex can slow heart

rate so I meant in that in that sort of

way got it that that that yeah by by

that by influencing cortical function

will obviously we can influence uh

organs like the got it so through some

intermediate stations yes yeah I mean

it's you know not to

um not to be hyperbolic but I mean it

seems like the prefrontal cortex what

here we're referring to as the frontal

loes um are essentially the seat of what

makes us human and What Makes Us

functional or dysfunctional in a given

context right I mean uh I recall there's

a syndrome cluver buy syndrome which has

some vague um uh similarities to how you

describe frontal cortex damage but there

as I recall humans or animals um with

that syndrome

will act in a way that's not appropriate

to context but more inappropriate like

they'll they'll try and eat a ceramic

cup or Draw with a piece of paper which

obviously won't work it seems like with

the frontal cortex it knows that a pen

is for writing it just the person might

say yeah I know I'm not supposed to

write this but I'm just going to or

write with it but I'm going to take your

pen and write something inappropriate

with it but it it's not that they people

forget that there's that it's a pen so

it seems like it's drawing on um rule

sets but that something intact it's like

it's not like cluver buy syndrome where

um like animals and people can try and

like mate within animate objects um

which is one of the more Salient um

symptoms I'll never forget that never

forget that from from my cognitive

Neuroscience course which you taught by

the way um just throw that in there so

yeah so how how should we think about

this and here I'm trying to get at a

kind of a broader understanding of brain

function and context specific behavior

um it so frontal cortex is like super

sophisticated um but it doesn't have all

the information right it seems like

someone without a frontal cortex

probably knows that you write with a pen

you don't write with a piece of paper

yeah I I think it's you know we think

about it as it's you know the frontal

CeX allows us to take thought and move

it towards action and there's this

disconnect between the knowledge and and

action and the separation of action from

knowledge and I guess I can reflect on

my patience you know when I seen a lot

of patients with damage all over the

brain and all of the families of

patients who have frontal Lo injury

always say the same thing they're

they're just no longer that person

they're no longer my spouse they're no

longer my best friend they're no longer

my father just something they can't put

it into words but they're not them

anymore there's something has changed

whereas if you talk to a patient with

brokus Aphasia who has this inability to

speak they can't get any words out you

know this is a devastating problem

there's still the same person they they

they their personality hasn't changed

they they feel the same person they just

can't speak the way they get around in

the world is different or if you take a

patient with prosopagnosic which is uh

his inability to recognize faces of

course the way they navigate around the

world is is is difficult and it's not

the same but they're still the same

person so there's something really

special about the frontal cortex that

allows us to be as you said sort of who

we are and that's the difficult part

like how does the frontal allow us to

sort of take um take who we are and

translate that into knowledge so we're

not I guess in other words saying just

just having knowledge isn't what makes

us who we are right it's to be able to

take that knowledge and and and present

it in a way that allows us to live life

based on our intentions and our goals

and our

desires so much of things like stoic

philosophy and um and even online

Wellness culture are about um having

routines um you know overcoming reflex

by just having recipes scripts to follow

each day um I certainly try to have my

mornings be as what I call linear as

possible and I find it's much easier in

the earlier part of the day to just

decide here's what I'm going to do write

out a list do things in a certain

sequence if I don't do that I go

nonlinear as I refer to it and we'll get

distracted and things of that sort but

um earlier you mentioned sleep

deprivation can impair frontal Lo

function it does seem that um as the day

progresses and certainly in the middle

of the night it just becomes much harder

to um control our our thinking maybe

even our Behavior but um and certainly

our emotions is there a frontal lob uh

regulation of emotional states as well I

know you have some recent work on this

so love toar more yeah I mean that's I

was saying earlier the frontal loes is a

big place and and half of it is involved

in these high level executive functions

but the other half of it is in is a part

of the lyic system or that we call it

the paralic system that's involved in

Social and emotional behavior and so uh

there's this intimate back and forth

between these two areas of the cortex if

you have just damage to these frontal to

these areas that are kind of in the

overal frontal lobe you will have many

different impairments that are we would

call sort of social or emotional

impairments and their executive function

will be quite normal and then you'll

have the the opposite where patients

with the model damage will have

executive functions but they seem

emotionally intact but but you know in

real life when we have both these intact

they're they're communicating with each

other so right emotion and contacts and

is going to influence our executive

function we make bad decisions in

stressful situations or situations we're

not comfortable with it's it's where we

might make a better decision if it's a

quiet you know kind of quiet place um

but it is something that we can I think

you're right you can you can sort of get

into a routine and learn how to do

things you know if you have very much

planned out but what's so unique about

us how we can be flexible and adaptable

right when when something novel comes up

or there's something something

unexpected comes up we can adapt to it

and that's really what the frontal

cortex is really important for um not

just sort of making these plans routines

and setting all the rules with being a

when things don't go right how to how to

write the ship right I will never ask

you to um demonize technology um I

certainly use a a smartphone um from

waking till sleep um generally not in

the middle of the night if I can avoid

it uh and I generally avoid it but I'm

trying to take what we've discussed this

far

and superimpose the the notion of

smartphones and ask what are the rules

what are the algorithms that we're

learning when we use these devices and

I'm not calling them adaptive or

maladaptive they're clearly here to stay

they've assisted in medicine I'm sure it

makes it easier for doctors to

communicate on the on the ward and and

for um clinic and it's so useful right

but contained in the small device um

there are things like uh for instance

text messaging where unlike 20 years ago

we can have four or five different

conversations very quickly while

boarding a flight um there's a task

switching element that was just not

present in our life um prior to that um

social media in particular this notion

of being able to scroll so move if we

really step back from this move one's

thumb and

access hundreds if not thousands of

video content from dist which Each of

which has a distinct

context um and so I have to imagine that

kids and adults have frontal coures that

are learning these rules and the rule

rule is move your

thumbs stay

engaged emotions either positive veence

emotions or negative emotions I mean

it's it's a fairly limited um landscape

there when you really think about it but

but the algorithm that's learned is to

me doesn't seem exportable it doesn't

help me prepare for a podcast at all I

know that for sure doesn't help me go

for a run doesn't help me listen with

more focused attention to a family

member or a friend or a significant

other um it may make me more empathic or

more angry I you know we can we can

speculate but um again with no with no

intention of demonizing social media it

does it seem that the the

algorithms that are being run in our

brain I mean are they neutral are they

positive are they negative should we be

worried um it doesn't seem like they

translate to much else they W I can't

see a way in which they help us be

better people in other domains whereas

reading a book line by line and then

going back oh I didn't even remember

anything from that page going back line

by line um playing a game of squash or

something like that there I can see the

real value of the rule sets that

generalize yeah I mean I can you know

just historically I grew up in a world

when there was no smartphones as a

resident and and so one of the most

difficult things I do in practice is

have to take care of patients in the

emergency room and there's a real

emergency someone's having gun control

seizures or they're having a stroke and

you know doing this back in the 80s or

90s and early 2000s when you went down

there and you didn't have any smartphone

you you could only rely on what's what's

in your head and I could say now having

the smartphone it hasn't it doesn't help

me at all I I never you know it does not

help me at all in making the kind of

decisions that I have to make in the

emergency room I'm I'm trying to decide

you know what what what's the problem

here what's the differential diagnosis

what how should I treat it I'm just

trying to make very going through an

algorithm like you said in a common

sense way and there's nothing on my

phone that I can turn to to help me do

that it has helped with giving me

knowledge like back in the day I had to

remember what the Dilantin dose was and

have that in my head or go look for the

piece of paper in my pocket and so I can

quickly pull up you know I guess I'm a

little bit you know there's information

that I can access that I don't have to

worry about keeping every single dose in

my head or keeping everything in my head

just facts in my head but uh outside of

that there's nothing I can turn to that

it's it's making me you know better

making me make better decisions so I I

don't even need my cell phone I don't go

searching my for my cell phone if I'm

going to go to mer room or going to take

a take a phone call so I don't see how

it's helping sort of make your frontal

Lo it can't be your frontal loes I mean

it's another way of saying it but but on

the flip side can it help you optimize

frontal low function technology

certainly it can we can maybe talk about

it later there there certainly the

that's one way to get learn strategies

is through a through a device that

that's easily accessible and uh you know

to you as opposed to a book or or having

a therapist uh in your house yeah I

suppose I worry that um too much of my

time and other people's time and

especially young people's time is um

engaging in a algorithm that does not um

generalize for adaptive Behavior

elsewhere and and by comparison you know

like a a game of soccer with friends or

something right it's social social media

is social um it's physic social media is

not physical but we'll we'll rule that

that portion out but there's a rule set

um there's gold directed behavior um

presumably some of the things that

happen in a game of soccer with friends

translate to some other domain of life

um because it's a single context game of

soccer whereas with social media I don't

know anybody that goes and looks at One

account and that's it and absorbs the

information maybe comments has an

interaction and goes it's it's hundreds

or thousands of contexts so is there any

risk or perhaps benefit to being able to

um get this very detailed portal into so

many contexts per unit time I mean the

the forb brains never had done that in

the course of human history as far as I

know yeah I mean I think there is a risk

but what Pops to mind you know having

kids is is watching them navigate in

their cars to places totally dependent

on on Google Map Maps I think you're

probably old enough to remember real

Maps where you didn't I still have in my

I still I love paper maps I love Maps

right where you had to really figure out

you know you you had to go to a certain

place and you had to either look at the

map or or or ask stop at a gas station

and ask these the these skills were

something that you learned and you

developed and it was problem solving and

and uh and that's all gone now I mean

it's it's I I wonder even if sometimes

if if uh people even know the direction

they're going whether it's West North or

what set Town they're in because they're

just following the directions so I we

we'll see I I just can't imagine that

that learned skill is not going to be

detrimental to us at at some point and

generalize in the generalize in a bad

way right and as as opposed to a good

way um so I don't I yeah it does it does

definitely worry me but like you said

there's nothing on the phone that helps

you plan a podcast nothing that helps me

in the emergency room nothing helps a

profess when he's giving a lecture so I

agree with you that that the sort of

having your head buried in in a cell

phone I'm not yeah it's I don't see it

being healthy for your frontal

loves let's talk about working memory um

some years back but still now you use

working memory tasks and experiments in

your laboratory if you would um be so

kind as to explain what working memory

is and then I'd love to talk about um

some of the work you've done exploring

the role of dopamine in working memory

um because this is so critical to

everyday life and I know dopamine's a

bit of a buzzword these days but um the

listeners of this podcast anyway are are

um pretty sophisticated in terms of

knowing that dopamine is not just about

reward it's about motivation and go

directed behavior and I think dopamine

intrigues for a good reason that it does

govern a lot of our you know quality of

life so um what's working

memory yeah I mean working memory it's

interesting I start studying it about 30

years ago and I don't think I realized

how important it was when I started but

what we mean by working memory is this

ability to hold information in mind uh

when it's no longer accessible to us so

if you tell me your telephone number and

I'm have to put it into my phone you

know it's no longer there you just told

me but I'll hold it in my working memory

until I can punch it into my my phone it

doesn't have to be something that comes

from the outside world I could hold up a

you know I can pull up my own if I'm

filling out a form and I want to pull up

my social security number I can hold

that in mind too until I put it down so

um when you think about it it's a very

important uh you know ability that we

have that we do very flawlessly and what

I've learned more about working memory

is is the working part of it it's not

just this passive holding information of

mind but it's being able to do things

with the information it's being able to

um you know when we when we do a bath

problem which we don't do that much now

that we have calculators but if you do

that in your head you're able to to sort

of manipulate the information and do the

different parts of the problem or even

if you're you know you're trying to find

someone in a crowd and you're holding on

to some face you're able to hold that

face in mind and cross check it and

search and and so there's there's

operations to working memory is not just

you know it's not just this passive

maintenance so when we start to think

about working memory in that way we

start to realize how important it is for

it's you know I think of it as the

foundation for for cognition just think

about reading confer apprehension you

can't understand this conversation if

you can't hold in mind what's going on

you know earlier in the in the

conversation or when you're reading a

book you know remembering the sentence

uh before it so it just predicts all

these abilities that that allows us to

to read to to uh plan to organize and

all the sort of executive functions that

we're we're doing right we have to hold

in mind rules we have to hold in mind

goals we have to hold in mind all of

these things in order to carry out

behavior um you know so it's it's it's

it's really come a long way in terms of

how people are thinking about it I I I

know that uh Matt Walker said that like

you know sleep is our superpower but I

guess one way to sort of use his term

while we're awake working memory is is

really our superpower because it it

allows us to to translate as we said

sort of our knowledge into action by

holding this information uh in mind as

we're thinking about what we want to do

if we're going to think about dopamine

in the context of working memory is

dopamine an accelerator on working

memory is it a facilitator I mean what

is dopamine doing for working memory and

maybe we could talk a little bit about

the circuitry um I've talked about

dopamine before on this podcast but

there's a good chance that some of the

people listening to this haven't heard

those episodes so maybe we could just

quickly review the three major circuits

for dopamine and the one that's relevant

for working memory yeah let me start

with the working memory the circuitry

for working memory because one one of

the important things about working

memory is the other type of memory is is

long-term memory it's it's you you can

working memory shortlived it's only as

long as you're able to rehearse it and

then it disappears whereas what we call

long-term memory if I remembering what

you had for breakfast or your vacation

this is information that's gets

Consolidated and and gets put into a a

more durable form that we call longterm

memory and the interesting thing about

memory is that these are separate

systems everything from working memory

just doesn't pass into long-term memory

they're they're two completely different

systems and and two completely different

parts of the brain that seem to control

it um so working memory uh the frontal

cortex seems to be very important for

working memory when when we are holding

information in line the neurons the

brain cells in the frontal loes are

active and they stay kind of active as

long as we're holding on that

information and they're more active when

the information is relevant um and if we

uh we we get distracted they'll get less

active so it kind of the frontal Loops

kind of track your uh you know track the

memory that you're holding in mind

another important thing about the

circuitry is that if we're holding in

mind say digits you know the phone

number well that information is in your

back of the brain and so the the frontal

loes is sort of keeping information in

the back of the brain active because

it's connected to the visual areas it's

it's able to sort of keep that

information active and so what what

we've learned is that there's not these

buffers in the brain where oh you know

if you're holding verbal information

it's in this little buffer and if you're

holding visual information it's in

another buffer the whole brain acts as a

buffer and and the frontal lobe can call

up any part of the brain and keep that

part of the brain active as it's as it's

you know as it's trying to hold this

information in line so the mechanism for

working memory is just this persistent

neural activity within the frontal LS

and so then the question is what does

DOP mean do well dopamine is one of the

neuromodulators that are made in the

brain stem and IT projects up to

different parts of the brain there's a

system that goes up into the into the

what we call the basil gangula which is

important for motor function and there's

another dop neric system that goes up to

the

frontales and what was discovered was

that if you deplete DOP mean a working

memory drops you get a significant

impairment in working memory if if you

deplete dopamine and if you replace it

uh then your working memory will be

improved and so DOP mean seems to be a

modulator to help this persistent

activity

stay persistent uh you know during the

time that you need to keep this

information in mind am I reaching too

far to draw an analogy between

dopamine's role and working memory that

is to keep information online and the

other established role of dopamine which

is for movement for the generation of

smooth movement um as evidenced by

conditions like Parkinson's where people

lack dopaminergic neurons or have

damaged to dopam ergic neurons and have

a you know challenges in generating

smooth movement what I'm essentially

asking is can we think of dopamine as

facilitating physical movement through

one circuit but also kind of mental

movement thought movement kind of um I'm

thinking about for those uh just

listening and and not watching I'm kind

of rubbing my um index and middle finger

against my thumb just keeping something

online um it's sort of a movement of

thought or information and then you kind

of Chuck it away and bring out the next

information is that is that yeah I think

that's a good way of thinking about it

and one might wonder well how can dop me

be important for memory but also be

important for movement and and it's

really simple it's just that it's acting

at different circuits the the the

neurons that go to the motor areas that

carry dope mean will will when dope mean

is expressed there then and boosted

there then it will be involved in

movement and lack of don't mean in the

basil ganging will lead to neurological

disorders like Parkinson's disease that

has severe mve movement uh difficulty

but when it's acting in the frontal

cortex uh and Express in the frontal

cortex then it's going to improve

working memory so it's it's just a the

nature of where the circuits are where

the DOP mean is that's that's allowing

it to have different kinds of actions

and that's all for all transmitters the

reason why osal Coline seems to be more

important for long-term memory is

because it it's projecting to the

hippocampus which was we know is another

area that's important for memory and

that's why Asel doesn't boost your

working memory but DOP mean does and

vice versa I'd like to take a quick

break to acknowledge our sponsor element

element is an electrolyte drink that has

everything you need and nothing you

don't that means zero sugar and the

appropriate ratios of the electrolytes

sodium magnesium and potassium and that

correct ratio of electrolytes is

extremely important because every cell

in your body but especially your nerve

cells your neurons relies on

electrolytes in order to function

properly so when you're well hydrated

and you have the appropriate amount of

electrolytes in your system your mental

functioning and your physical

functioning is improved I drink one

packet of element dissolved in about 16

to 32 ounces of water when I wake up in

the morning as well as while I exercise

and if I've sweat a lot during that

exercise I often will drink a third

element packet dissolved in about 32

ounces of water after I exercise element

comes in a variety of different flavors

all of which I find really tasty I like

the Citrus I like the watermelon I like

the raspberry frankly I can't pick just

one it also comes in chocolate and

chocolate mint which I find tastes best

if they are put into water dissolved and

then heated up I tend to do that in the

winter months because of course you

don't just need hydration on hot days

and in the summer and spring months but

also in the winter when the temperatures

are cold and the environment tends to be

dry if you'd like to try element you can

go to drink element spelled elm.com

huberman to try a free sample pack again

that's drink element.com

huberman so drilling a little bit more

deeply into the role of dopamine in

working memory uh you did some really

lovely experiments uh showing that if um

people who have low levels of dopamine

um increase their dopamine uh

pharmacologically I think the drug that

was used was bromocryptine um that

working memory improves um conversely if

one depletes dopamine

pharmacologically dop uh working memory

gets worse um but as I recall there was

an

important Baseline that

is important because it really mattered

in terms of the Alca meaning if somebody

already had relatively high levels of

dopamine in this circuit increasing

dopamine further with bromocryptine

didn't impart a benefit and might have

even made their working memory worse so

there's a kind of inverted u-shape

function to this um how does one know

whether or not their Baseline dopamine

is low medium or high Ergo how do they

know whether or not that they would uh

want to explore going about increasing

dopamine through any number of different

approaches right well most people

probably have optimal DOP mean but

there's a significant percentage that

probably have too little or maybe too

much and it's unfortunately we can't

measure it in the blood um there isn't a

blood test that I'm aware of that can

can measure uh dop me because it's stuck

in suck in the brain um peripheral

dopamine in the blood doesn't is not a

good readout it's not a good readout

yeah and and especially when you're

talking about dope mean in in areas like

prefrontal cortex and um so we don't

have a good read out there there's

there's invasive procedures like

positron amission tomography where we

can inject a radioisotope um and that

tags DOP mean and then we can measure

how much we can do a scan that actually

shows us how much dope mean this scan

was originally developed to show

Parkinson's disease that that you can

diagnose Parkinson disease by showing

that there's there's less DOP mean in in

patients that have Parkin dis by looking

at this this scan um obviously it's

invasive you're injecting a r isotope

it's expensive and it's not something we

could all do but we had used it to show

that it correlates very strongly with

your working memory capacity so how much

information you can hold online if you

can hold four or five or six letters

when I do a a span task um correlated

with how much doping we can see in the

pet scan so that that would be a a way

that we could do it um so if you were to

read out a string of a few numbers or

letters

um and I can remember all of those a few

moments later um Perhaps Perhaps my

Baseline dopamine levels are U moderate

um in the in the normal range whereas if

I couldn't keep that online um that

might be might be reflective of lower

Baseline dopamine levels is that right

yeah it's a it's a very strong proxy for

dopamine so if you're your working

Maring capacity is seven letters when or

numbers when I say 4 3 7 1 5 56 if you

get them 437 get all back pretty quickly

you probably have more dope Baseline

dope mean than than someone who has five

there so it's it's a proxy for measuring

One open so that that's one way of do it

and that's actually how we did it in our

original studies we we actually um

grouped individuals based on whether

their capacity based on this behavioral

measure was high or low and like you

said those who were that can only hold

five or six letters if we gave them

bromocryptine which was the Doper neric

Agonist we improved their working memory

uh we got them into sort of an optimal

level but but those who were already

high we actually made them we were we

got them worse and the moral of that

story was that more is just not better

we're trying to get people optimal and

so the real question is is you know if

we want to get people optimal like you

were

inferring you have to know what their

dope mean is where where are you on this

inverted you curve another way of doing

it uh is through um gen through genetic

studies so we have don't mean uh all

neurotransmitters have to be broken down

and reuptake into the into the brain

cell in order to be used again and

there's different ways of doing it in

some cells uh it gets transported back

into the brain cell and other other

places there's an enzyme that that

breaks it down well there's an enzyme

called compt uh that is breaks down dope

Bean in the prefrontal cortex

specifically in a large percentage of

individuals that enzyme is either

overactive or underactive probably about

25% of individuals it's overactive and

another 25% it's underactive so probably

half the population now this is going to

vary depend on other where you live and

where you come from and things but it

but but maybe half the population either

has an underactive enzyme or overactive

enzyme if you have an underactive enzyme

actually more dopamine sits around and

you you actually have more dopamine than

others and if you have an overactive

enzyme it's the opposite so we've

actually shown that if you now go and

genotype people with a simple saliva

test and figure out do they have this

genetic what we call polymorphism where

just one amino acid gets changed and the

enzyme becomes either active or

underactive we can we can do the same

thing as as grouping them by their

capacity those that have the low dope

mean we will make them better and those

who have sort of Baseline High dope mean

we we'll make them

worse super interesting um maybe we

could talk about bromocryptine a little

bit and I'm not encouraging people to

run out and take bromocryptine

um bromocryptine as you mentioned is a

dopamine Agonist um relatively short

acting yeah four five hours six hours so

kicks in about 90 minutes after as I

recall you saying I've never taken um

how do people feel when they're on

bromocryptine I mean when I hear

dopamine Agonist I mean there a lot of

ilicit drugs like cocaine

methamphetamine that are increased

dopamine but then again chocolate sex

and food increased dopamine but the

kinetics the time course and the levels

are are different for each of those

things um dopamine of course being a

currency of motivation and reward not

not um directly related to any one

compound but

um I would think that based B on the

data you just described that um and

given the fact that there are a number

of people out there with challenges in

working memory attention task switching

Etc that there would be a strong

interest on the part of the

pharmaceutical companies at least and

certainly the general public um in

things like bromocryptine to increase

dopamine to increase working memory

given it it is our

superpower yeah I mean one of the most

disappointing things to me in my career

has been that pharmaceutical companies

have not picked up on this idea that we

could improve cognition and very

specifically improve C process with very

specific neuromodulators the the

discovery that depletion of DOP mean and

not other transmitters and pairs working

memory was made in

1979 um when I heard uh Pat G he's talk

about this as a resonant I was just

amazed that there could be a single

transmitter can change a single Behavior

I was seeing very complicated behavioral

deficits and it just seemed impossible

to me that there could be be such a

tight link between a single you know a

single neurom modulator and a single Cog

process and just open the door for me

that this really could be a incredibly

beneficial therapy for for any anyone

with executive function or frontal low

function so but unfortunately there's

never been a pharmaceu company that's

tried to develop a drug for improving

cognition to this to this day CRA and

they I mean it's crazy for several

reasons one is that the data are clearly

there uh two these drugs are already

established it's not like they have to

go through safety trials again that

that's already been done but mostly

because regardless of whether one is a

fan of the pharmaceutical industry or

hates it the pharmaceutical industry in

principle can make a ton of money doing

this so I would think that they'd be

heavily incentivized to do it so why

have they um Turned a blind eye on this

I'm not sure I mean when I realized um

that I could test these drugs in in

healthy individuals that that they were

s if I gave them in low enough doses

they were safe and and I had so much EXP

experience of him in patience that I

felt comfortable doing it um then I

started asking pharmaceutical companies

you know do you want to get involved

here we we can we this should be done I

can't do this by myself we need to have

real trials and real studies of how this

will help you know and just was you know

their eyes would always cross and never

never got any any sort of traction it

always went back to sort of disease you

know what what disease are you um curing

you know what what's the market for it

is it a parking disease thing is an

Alzheimer's disease thing and this has

been a general problem with Neurology

it's very disease Centric it's always

sort of F and it's always focused on you

know how can we develop a treatment for

Alzheimer's or traumatic brain injury or

stroke as opposed to how can we develop

a treatment for working memory

dysfunction which is a problem lacrosse

diseases so the answer to your earlier

question is these drugs are very safe

they we give them in such low doses to

healthy individuals they don't even know

they can't even tell the difference

between the placebo in the drug really

they don't even know which one they're

on so they're not buzzing thinking like

oh this feels good and my working memory

is better they have no idea they don't

even know their working memor is better

until we we show them that their working

memory is better so love it yeah so

they're truly blind to what's going on

um bromocryptine is but one of the

dopamine agonists um can think of a few

other um koline like other things like

that um do any of these dopamine Agonist

um exert this uh impact on working

memory or is it um does it vary by drug

because different dopamine agonists uh

sort of hit different receptor Pathways

and things like that yeah no it's not

specifically the drug I mean the the

reason for bromocryptine is that it's

the oldest and it's the one I was most

comfortable with I had to be comfortable

with it clinically before I'd give it to

undergraduates at at pener Berkeley so

there's nothing special but other

agonists work similarly um there's a

there's a drug that's developed par

which is a comp inhibitor which actually

inhibits this this enzyme that we're

talking about and that that also will

improve uh we'll have the same uh

function there's been some future work

that nor upan nephrine also seems to be

helpful with working memory uh it's not

as uh maybe not as um potent as as the

dope energic and that that's the point I

want to make another another

disappointing thing about this whole

field of the pharmacology of

cognition um you know I I wrote a paper

as a resident you know sometimes you're

tending to say hey can you write this

review paper for us and and I wrote one

as a resident called the pharmacology

cognition where I just looked at all the

animal literature on you know uh giving

neuromodulators Aline BR um dop me or

whatever and and there was a lot of

there was a lot of animal literature

sort of supporting that this would work

in humans but was more striking to me

was that it wasn't always just a single

a neurotransmitter there were studies

where you'd give DOP mean and it

wouldn't do anything you give acid

Coline it wouldn't do anything but if

you gave a low dose of both it would it

would be really effective so these you

know these n trans systems don't act in

isolation so we need to also study sort

of how the combinations work and that's

where another you know where the

pharmaceutic companies have the

infrastructure to do these kind of

studies it's very hard to do in a single

lab to to do multiple drugs at at at one

time you know and then try and look at

try and determine all the different

interactions maybe we could talk about a

couple of other drugs um that are legal

or have and have FDA approval are known

to be safe in the right context that um

it seems would fit the bill here uh for

improving working memory one is um

Wellbutrin BR

bron bron uh I can never pronounce that

um as far as I know it's a uh um

epinephrine or norepinephrine Agonist

you just mentioned that increasing

epinephrine may have a positive impact

in working memory and to some some

extent a dopamine Agonist is there any

evidence that um Wellbutrin can improve

working memory yeah anything that um

boosts norepinephrine can do it the one

that we've used that's most used is

guanfacine which is actually a blood

pressure medication so that's starting

to gain some Traction in fact I think

there was a study with Co with brain fog

for covid showing that improved uh

symptoms with it so there's actually

some trials now that are are looking at

guanfacine and so I would say anything

that boosts norepinephrine would be be

helpful um but then again I don't I

don't want to leave out the other

transmitters Ser serotonin you know

increasing serotonin increasing asine

boosts other cognitive processes and

then you know in a way they can help

working memory we talked about working

memory being being this Foundation well

if if you give veloline and it kind of

boosts memory well that can indirectly

help your executive function or if you

give a a drug that improves your focus

then that can indirectly help you know

working memory so what I'm really

pushing for is is not just a single you

know it's going to be one drug you know

one drug it's going to be a cocktail and

we have to not only figure out what the

cocktail is but also figure out who

we're giving it to what's to you know

link it to the person's own makeup of

their own neurochemistry when we get to

a point where we'll know we can map out

sort of everyone's dope me nephrine

serotonin levels and then we'll make

real progress in in helping them because

right now I sort of say with my students

what we're doing is just it's just like

cutting open the skull and just sort of

pouring it onto the brain it's we're not

actually doing that we're not actually

doing it but it seems that way we're not

the Precision is not there yet well you

it's great that you developed this um

cognitive task that can be a proxy for

dopamine levels the cognitive task again

being um how many number letter strings

somebody can remember um basically

working memory performance um there are

a lot of tests out there that claim um

they can assess dopamine and serotonin a

cocoline levels from a blood draw um

I've heard of the Dutch test I've never

taken it um but a few Mo minutes ago you

said that really we one needs to do

Patron emission tomography Imaging which

is fairly labor intensive most people

don't have access to one of those um

it's a clinical tool um so there are

behavioral proxies there's

neuroimaging but also to my knowledge I

I don't know that there's any blood draw

that will say hey your serotonin levels

are low your dopamine levels are are

moderate your uh Etc there are a lot of

companies that market these but are you

aware of any clinical or other tools for

getting an accurate read of

neurotransmitter levels in in a person's

brain aside from

neuroimaging no and it and it's it's

even more complicated than it seems

because the Dober ner system is

complicated because it's not only just

the prefrontal cortex as we talked about

it's also the basil ganglia and um so

not only do we have to measure dope mean

just levels we have to measure the

balance of the dop me in this Statum and

the and the prefrontal cortex there's

there's a model of dop me um function

and its relation ex executive function

that has to do with sort of the balance

between these two systems that do mean

in the prefrontal cortex is promoting

sort of stability it's it's keeping

information in mind it's keeping these

representations stable whereas the dope

mean in the basil ganglia what it's

doing is is allowing you to update and

refresh you know the information that

you're that you're holding in mind this

sort of stability versus flexibility so

if you have too much do and frontal

cortex it could lead to a very rigid

state where you you don't let anything

in and and if you have too much dop me

in the strum and you get too flexible

then you can get very distractable so

there's a sort of balance of dope mean

so it's not just how much dope mean you

have in your brain it's it's how much

what's the balance of the dope mean so I

don't see a blood test as ever giving us

that information but I do see there

being uh a brain test that that can that

can give us this kind of of information

of of the two or at least a proxy for it

so what I was thinking about when you

were talking about asking this question

you know for example if you measure

pupilary pupil dilation that's a pretty

good proxy for neur for the neurogenic

system right so at a given people will

wonder what um how to do it we're not

going to um go into too much detail here

but at a given brightness in the room

what we call luminance uh the p pool

tends to be smaller when it's bright and

larger when it's um you're in a dim room

that's sort of obvious um but at a given

luminance the more alert aroused

somebody is um arousal is a general term

here um not not talking about a

particular kind of arousal then the

pupil tends to be more dilated it gets

bigger the more um norrine is is in the

system so if somebody's pupils are

really big in bright light

that person's got a lot of epinephrine

adrenaline right in their system do you

use this clinically like when someone

comes in and they those big old pups pup

and you're like okay they're probably on

a stimulant yeah I mean a lot of what

neurology does is is try to look for

these windows into the brain and so I

think there are a number of Windows into

the brain that we're going to be able to

develop that can reflect these

neuromodulatory systems so that's why

I've been so interested in developing

biomarkers because really what a neural

biomarker is is is trying to uh develop

something you can measure easily and

simply and cheaply with you know but

gives you uh information about how the

brain is working and so that's a bio you

know that's a neuropen biomarker working

Maring capacities adult mean biomarker

and and we're getting better at that but

again we're not putting enough emphasis

on it in my opinion to really sort of

help you know improve brain health have

you ever tried bromocryptine

very early on but it's it's such a low

do you know the at the dose that the my

subjects were getting but like I said it

doesn't it's so low you don't feel

anything and I should say with even with

patients um that take it they they

rarely get any side effects sometimes uh

with these drugs because of this

peripheral DOP mean they can get a you

nause volume but it's extremely well

tolerated you don't get any any anything

feeling from it does it change reaction

time it does and that's always the

question of of how much of this is that

we're just sort of speeding up we're

just sort them faster but for all the

work we've done it's it's pretty

convincing that it's it's not just how

fast you're doing it you're doing it

better uh you might find this

entertaining um some years ago uh I

learned that athletes uh we taking

bromocryptine uh pre- Olympics and in

the Olympics I think it's a band

substance now um and the athletes that

were taking it don't ask me how I know

this but I could tell you offline um and

I'm not one of these athletes nor was I

supplying the Brom crype were using it

because uh they were sprinters and it

turns out that a lot of the sprint races

are won by being first out the blocks

there are other factors as well but that

reaction time you know hundreds of

milliseconds are the difference between

Podium and no Podium um and

bromocryptine was one of the drugs used

it was not on the band substance list uh

just a reminder that every Olympics you

see there are lots of things being used

that are not on the band substance list

and I'm not trying to be disparaging I

think there's just a lot of interest in

augmenting neurom modulation for nervous

system function bromocryptine was top of

the list at that time I think it's on

the band list now um there's a lot of um

use of pharmacology now on college

campuses and in high school and even in

elementary schools and sometimes by

parents for their kids to try and

improve cognitive function most

typically the use of adderal viance rlin

and other stimulants which are NORAD

energic dopaminergic

Agonist okay so

um with the

uh disclaimer caveat whatever you want

to call it that you know those decisions

should always be made with a a trained

psychiatrist um monitoring

things what are your thoughts about um

pharmacology for enhancing cognitive

function given that the landscape of

society is challenging and people want

to perform well they need to be able to

focus we've got smartphones distracting

us and um to some extent um you know one

could say oh well it's cheating to use

pharmacology but a cup of coffee is a

bit of a noradrenergic Agonist

absolutely and um certainly can improves

my focus as long as I don't drink too

much of it right um yeah what are your

thoughts and just yeah I think it you

know it kind of gets back

to what we talked about there being an

optimal you know optimal level of of dop

me in your brain I I think if you think

about it as just more and more and more

is better and that more is better then

there's really no end there really know

how do you know how much you should be

taking there's sort of no that

experiment was run in the ' 80s it's

called the cocaine uh culture of of Wall

Street in the 80s that we there movies

about it and it doesn't lead to good

places right right so so I'm all for

optimizing function uh I want to

optimize brain health and if you have an

underactive you know enzyme that's not

that that makes your don't mean levels

then I'm all for trying to optimize that

along with everything else we need to

optimize in the brain so if we could

figure out who uh yeah who is sort of on

the lower end and boost them up I'm all

for that the problem is we don't know if

they're on the high end and some of

these athletes were actually making

themselves worse we know for sure I mean

these are healthy pen and Berkeley

undergraduates that we made them worse

on working memory tests You knowre by

increasing their dopamine just a little

amount just tip them over just a little

little amount and uh and so we we you

know without the knowing then it just it

seems like it's it's not well informed

you're going to be taking it the other

thing is I I I if we're going to do this

we should do it right I think drugs like

Aderall and Rin you know they were

developed because they helped patients

but they weren't necessarily developed

with knowing how exactly they worked I

mean that's how the pharmaceutical

company worked too yeah I mean it just

it works so let's do it I'm all for that

as a physician um but if I had my choice

uh you know drugs that boost up multiple

s all the catac colines the ones that

boost up dopamine epinephrine and or

maner and I I would steer away from

those because you have no control over

how you're modulating the system uh

again I was sort of talking about a

cocktail it's it may be a little bit of

dope mean and a little more norrine but

if you give take something like riddle

anderol you're just getting the same

amount so it's it's kind of if I was to

start to sort of experiment uh then i'

i' i' se you I wouldn't use adol oralin

as the as the drug that I think would

helpful even though they're clinically

sort of useful I use things like

bromocryptine and guanosine where they

can modulate a very specific drug and

then and then yeah then the goal is to

to optimize and and that's what we're

trying to do with cognitive the therapy

and everything sleeping better and

better nutrition all these are aiming to

optimize not you know reach some super

human uh potential right just bring out

the best in in people's abilities right

um and I'm I'm so glad you mentioned

sleep um I would say you know sleep is

the the Bedrock it's the foundation of

Mental Health physical health and

performance I mean without that

pharmacology might Bridge you for an

afternoon but you're going to pay the

piper somehow um our friend and

colleague Matt Walker obviously has uh

been beating that drum for a while um

what about drugs like modafanil which

are thought to be true cognitive

enhancers um as opposed to um drugs that

just kind of designed to ramp up levels

of alertness as many of the drugs we're

discussing do yeah it's hard to know I

mean I think certain um drugs just

improve General abilities either they

speed how fast you can process it or how

efficient you can process or or narrow

the focus of your attention and that

just helps all abilities so it's so so

it's hard to say I think this just has

to be more work on really understanding

what

specifically uh you know these drugs are

doing that's why Broc crypting the

doener story has been so interesting

because it's a very specific effect with

a very specific mechanism I'd like to

see that be done with with other neurom

modulators maybe we could talk a bit

about some of the disease conditions

that you treat and the role of working

memory and dopamine in those conditions

as well as other transmitter systems you

know one subject that we haven't talked

about on this podcast uh previously but

is of tremendous interest to people is

traumatic brain injury or concussion

even mild concussion and um before we

we're recording today we were talking

about football but just want to remind

people that football is just one

instance of an opportunity to get a

concussion or traumatic brain injury

most traumatic brain injury and

concussion is not due to football it

just gets a lot of the attention but

you've got bicycle accidents car

accidents playground accidents um uh

maybe you could list off a few more um

but how common is TBI in concussion and

and maybe you could just perhaps list

out some of the other situations where

you see a lot of this um that it's a bit

more cryptic that people wouldn't

necessarily think that sport or that

that population gets TBI but they do

yeah I think concussion uh is much more

prevalent than we we realize and and the

numbers have gone up and up not because

it's becoming more common just it's

becoming more recognized and I think uh

you know we we underestimated and

trivialized sort of what a concussion is

you know is is that it's just a you know

something that is um you know just

you're going to recover from it I mean

still the old school Thinking by a lot

of neurologists is that everyone gets

better within a couple of months you

know just just wait it out and you'll

get better that's just the normal time

course of concussion but as we've

studied it more uh we realized that

there's actually quite a large

percentage of people who a year out

they're still suffering problems they

still feel like they're not mentally

clear and they still are sensitive to

light and they still feel feel a little

dizzy and and just the sympt you know

there a host of symptoms that just one

year later after a concussion where they

didn't even lose Consciousness you know

that something that they may not have

even talked to their doctor about is is

uh is is lingering um and so it's a real

this we call this persistent

postconcussion syndrome and that's the

most worrisome to me because it is true

that most concussions will recover

luckily the brain is incredibly

resilient incredibly plastic and it will

heal itself um but there are a lot of

patients where it just it just persists

and those are the most worrisome to me

because we don't have very good

interventions to try and help that and I

don't think we take these patients very

seriously when they're complaining of

something that seems very vague and not

very specific to most most doctors what

do you tell a patient who comes in and

has clearly had a concussion um mild or

severe concussion you know maybe car

accident maybe a sports injury Maybe

were knocked out cold maybe not but

they're having some headaches some

photophobia you know sensitivity light

just feeling not right I I've had a

couple of these um unfortunately and you

just feel off you don't feel quite right

um and some of that manifests as Focus

issues this was some years ago I like to

think I'm through it I've had scans and

I'm good um so thank thank goodness um

but what do you tell them besides don't

get another one yeah well first of all

all I I explain what a concussion is

what I found in neurology a lot of What

patients want to know is just they just

want to understand their problem not

walking in expecting a cure just just

understanding what it is having someone

understand what what happened to them is

is very helpful and comforting so what

we mean by concussion and we in the

clinical world we use M traumatic

brainery kind of synus with with

concussion uh it it's it basically is is

a tearing of axons it's the brain the

brain cells have these long fibers that

communicate with each other and they're

called axons and when the brain

violently moves forward and backwards if

you're in a car accident and you have

your seat belt on and you suddenly hit

you go from 50 to zero your head

violently goes forward and violently

goes backwards and that angular Force

actually tears and stretches axons in

the brain so if you've had a concussion

you have torn some axons I mean luckily

we have billions of them and so if you

tear a couple of th you you will Rec you

will recover but you you have torn axons

it's a real neurological it's a real

brain uh injury even if if even if you

haven't lost uh Consciousness and you've

only had symptoms for a couple of days

um but there and there's a correlation

the longer you've lost Consciousness and

the longer your symptoms last the more

axons you've you've torn there kind of a

direct relationship between the two so

the so the mechanism is is these torn

axin so now nurse those don't

communicate with each other and you know

that the brain different brain regions

are not communicating with each other um

so and it turns out the most common

place for axon tears in the in the

frontal loes and so now we talked about

all these things that the frontal loes

do to orchestrate the rest of the brain

while it doesn't it has some injured

Pathways and that's why a lot of the

symptoms that patients have are these

kind of mild executive symptoms this

this mental fog that they're describing

is this ability just this ability to to

to get things get things done they don't

lose knowledge of who they they don't

forget their name or you know forget

where they live or lose memories from

the past or anything like that but they

just they don't officially get things

done as well as they used to it only

takes a little bit of a drop right you

people think you have to have a big uh

drop in performance to have it have a

real life impact just a 1% drop and

you're you're having a hard time doing

your podcast or teaching a lecture or

whatever you might do 1% drop sounds

like a um a frighteningly small change

um required to to negatively impact life

so um how about a poor night's sleep I

mean what kind of drop in prefrontal

cortical function are we looking at um

from a let's say I normally get seven or

eight hours or six to eight hours and I

suddenly only get three or four are we

talking a significant detriment I I do

think so I I do think that yeah that

that

that the it is significant this a poor

night's sleep and and and we all know we

all notice that I mean it's very it's

very obvious I mean um and you and and

you know it's hard to sort of quantify

I'm a baseball fan so I can quantify it

like if you think about it in a picture

and how fast they throw you know a small

drop for them someone who's throwing 100

miles an hour just a small drop turns

them you know from really Elite to

someone mediocre maybe it's more of a

10% drop but but but it's still

relatively small drop can have a a huge

impact I think people think that just

because you're a little bit off that's

not going to that's not a big deal you

kind of you kind of work through it and

that's what most doctors say you just

just just plow through it just just work

your way through it you're going to get

better and um as opposed to saying yeah

you really had a brain injury um this is

what happened we need to rehabilitate

you just like we would do if you tore

your anterior crucial ligament I don't

know why tearing your

ligament or your kiles tendon gets more

interest than than tearing axons in in

your brain it's it's it's amazing to me

that that there's more emphasis on

Orthopedic injuries than than brain

injuries yeah I don't know why that is

either I think the brain is mysterious

enough that um most people and and um

many clinicians just kind of back away

with hands raised but if you are in the

field of Neurology or Psychiatry I

suppose that then one has officially

signed on to try and resolve these

matters um so for somebody that um has a

traumatic brain injury or or lowlevel

con concussion excuse me um would part

of the uh primary advice be to try and

get one's sleep as as good as possible

given that sleep deprivation can

compound um traumatic brain injury uh

induce deficits in working memory and

who knows maybe a good portion of the

deficits in working memory due to um

traumatic brain injury and concussion is

because of the sleep deprivation that it

can cause so it get it can get circular

yeah not only that but one of the most

common symptoms that patients my patient

with C have is is their sleep is

disruptive they they they're and that's

true in neurology it's fascinating

almost every neurological disorder my

patients complain their sleep and and I

started asking you know not a lot of

neurologists ask you how your sleep you

know but I I remember back from my

residency one of the first things my

attending would do when we got to the

ward is said I just sleep last night and

just across the board you know patients

are not falling asleep they're not

staying asleep and it's it's uh we still

don't understand why just brain injury

does that so almost every concussion

patient says I'm not sleeping well which

then compounds you know compounds the

problem so optimizing sleep obviously

optimizing nutrition um there's a a

question about activity it used to be

that uh we used to recommend you know

you had a concussion you should you

should don't go to work you know know

just sleep you know just just take it

easy for a while don't exercise keep the

BL blind strong but now it's it's it's

the idea is that you should really get

up and moving as best you got to you got

to do what you can tolerate you don't

want to give yourself a you you don't

want to give yourself more of a headache

or more light sensitivity but as much as

you can tolerate is is the the thought

these days about sort of promoting

recovery and then really getting your

brain back working I think you know a

lot of my patients they're off from work

for a couple weeks and they feel fine

and they think they're pretty much

normal and then the first day of work is

a complete disaster because until you

actually test it in real life you don't

know how what kind of troubles you have

so I don't recommend going back full

steam but I do recommend going back

trying to build up these these Stills

skills again and then I think we you I

think we need to develop therapies that

people will will use um you know things

like go Management training which

involves a therapist and you know health

insurance doesn't pay for this so

99% of my patients don't get any help

you know by any kind of intervention uh

unfortunately but now we talked about

technology things like um brain

HQ do you know about brain HQ so Mike

Merck um which I know you've talked

about with with Eddie um developed a a a

company called posit science were were

developed these brain training games

that that can help improve specific

cognitive functions and they're very

easy to do because they're online and

they you know they're there's science

behind them and and you can you can do

them so that in that way you don't have

a therapist in your room but you can

online sort of do these sort of things

that are targeting specific Mech

mechanisms to trying to improve the kind

of things that we think are impaired by

concussion and I'd like to see more

patients get started on some of those

things unfortunately if you go on the

web and just say I won't do brain

training you'll be overwhelmed with

things and you don't know what works and

what doesn't work yeah I I think the

work that merenik and colleagues have

done we'll provide a link to that I

don't have any Financial stake in his in

his work or products um trainings that

is um but I will say I think Mike's work

has been um tremendous I mean he is so

far ahead of the curve 20 years ago

everyone was talking about

neuroplasticity in critical periods um

they gave a Nobel Prize to it to my

scientific great-grandparents David

Hubble and toron weasel um and they

deserved that Noble prize but there was

a kind of a central tenant of

neuroscience at that time was that

critical period plasticity ends around

adolesence or On's early 20s and that is

simply not true and merenik really I

think one of the people who deserves

credit for um making it clear that

plasticity is ongoing uh it takes some

focus and and work to access it in

adulthood but that we can all access

neuroplasticity but it it takes it's

there so I don't know they should give

merenik a Nobel too but you know I'm not

on the committee so um just a little

editorial

there the description of specific

cognitive trainings that can improve

working memory in people that have had

traumatic brain injury or concussion as

well as our earlier discussion about the

development of frontal lob function and

plasticity of frontal lob function makes

me

wonder is the working memory circuitry

and frontal lob function a use it or

lose it kind of circuit meaning if

somebody you know goes to high school

graduates high school and then gets into

a lifestyle or college and then

graduates College as well and then gets

into a lifestyle where they're not

reading very many books they're

definitely scrolling social media

they're carrying out their daily tasks

with you know apparently uh High degree

of functionality um but they're not

really pushing these forbrain

circuits do we imagine that some of

those forbrain circuits regress um AKA

use it or lose it um seems to me that a

few years back maybe 10 15 years back

there was a lot of interest in you know

how to maintain cognitive function in

fact one of the most common questions I

would get even as a neuroscientist

primarily focused on the visual and

autonomic nervous system was how do I

keep my memory as I age it seems to me

that training it up and then continuing

to use those circuits is would be a

really good way reading books without

forcing oneself to finish the chapter

even though distractions jump into one's

head things like that um for me it's

when I go to the gym I try not to bring

my phone and if I do I'll listen to one

album of music but I won't allow myself

to play on my phone I try I mean not

interrupting a conversation with text

messaging I mean basically the the

landscape I'm trying to uh draw here is

seems like the world is designed to to

disrupt the the modern world is designed

to disrupt working memory and cognition

of the frontal loes right right and we

need to do some real training just like

muscles and atrophy and cardiac Fitness

atrophies if we're not doing ready uh

you know resistance and cardiovascular

training is that set yeah I think that's

fair I think you know of all the systems

uh that decline with aging not every

brain system declines but certainly the

frontal executive system we're talking

about is one that takes more of a

decline than others that's just how it

is with with healthy aging um not

surprising it's it's the most

complicated system and it's probably the

most biologically costly and so you know

the more complicated system is going to

uh take more of a hit than than other

systems and so certainly um I don't know

about regressing but certainly we're not

we're we maybe accelerating this this

this uh decline that we know exist and

but a way I would think about it though

is is that not just um trying to prevent

the decline but what we talked about

before there's no reason not to optimize

I mean if if everything is couched and I

don't want to get dementia and don't

want to get Alzheimer's disease and I

don't want to get this and that I think

that's not the the way we should be

looking about it we want to look about

optimizing health and and uh brain

health and and and getting up to our

optimal levels um because otherwise

we're always playing defense instead of

playing playing offense and that's

really hard for neurologists we we have

a hard time thinking about brain health

even though we're the brain Specialists

we think about brain disease and we're

just now as a field start thinking about

preventative neurology which seems and

and thinking about it not just like

stopping Alzheimer's disease but uh

promoting healthy Health in a healthy

brain neurologist you know neurologists

don't talk to patients about or healthy

patients about being

healthier I love how candid you are

about the medical profession um and I

like to think it's changing I don't know

something happened in the in the 2020

2021 um era I think I feel is just my my

bias but I feel that the general public

started becoming more aware of the

things they might do to support their

mental and physical health maybe they

had more time on their hands but I think

there was just more foraging for

information um I love the idea that

through simple practices like forcing

oneself to read a book chapter start to

finish without looking at one's phone um

even if it takes twice as long as one

would like um redirecting one's focus

when what Focus moves away is it's a way

of keeping working memory and cognitive

function online maybe even strengthening

it as you said optimizing it

um you know I think that there so much

emphasis now on physical health which I

think is great sleep thanks to Matt

Walker you know you really you know

brought that torch in on sleep um and

now others like myself are are really

you know trying to amplify the message

of the critical role of sleep but also

you know most people realize they should

probably at least walk um as you know

the 10,000 steps thing is not a bad idea

um getting some heart rate up a few

times a week or more maybe doing some

resistance training a few times a week

or more and then and not just for

athletes but for elderly folks men and

women you know um I feel like we need

the same for cognition for me for uh

brain function and there just isn't a

structure to that no one can say right

now you know you need to do uh three

chapters of reading you know fiction per

week or uh you got to read a you got to

learn a few new vocabulary words and

then write sentences with them they do

it in school but then we're just you

know set into the general population

and right and most people I think

regress right yeah I mean I I think the

big problem uh with brain health is is

trying to have a measure of what brain

health is and it's interesting to me

again as a physician um thinking about

it from a neurologist standpoint um when

you go to your family doctor your

primary care physician every year from

your yearly

physical uh they examine every organ in

your body

except your brain your lungs your heart

you know your skull system your skin but

what what do they do for you you know

outside of having a conversation with

you yeah no cognitive task there's

nothing no working memory task they

don't measure your your brain at all and

and it's not their fault there we

haven't provide the field has not

provided them with a test of of of brain

health right and so part of the problem

is we don't have a measurement of brain

health I I'm involved in something

called the brain health project which is

at UT Dallas um which is their goal as a

study uh to enroll 100,000 people in uh

and they've been developing a brain

health index and uh that's a complicated

thing to do but I I really believe

they're on to something because it's not

just cognition it's cognition it's it's

social it's it's lifestyle like sleep

and and it's it's um well-being you the

brain a brain health index is going to

cover all of these aspects so they've

developed quite a interesting uh

important index which which can um which