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The Livelong Newsletter: Feature Edition
Issue 12 | August 6, 2024

Hi everyone,
Thinking about the aging brain can be overwhelming. Dementia and Alzheimerβs disease are daunting conditions that we all want to prevent but canβt (yet!), and even facing βnormalβ age-related cognitive decline can be unpleasant.
The good news is that youβre probably already doing things to promote better brain health, according to Mark DβEsposito, MD, a neurologist and professor of neuroscience and psychology at the University of California, Berkeley.
DβEspositoβan expert on cognition, prefrontal cortex function, and aging who was featured on the Huberman Lab podcastβjoins Livelong for a discussion on aging and brain health.
He offers a grounded, optimistic, and realistic approach to a better brain that you do not want to miss.
In todayβs newsletter, you will learn:
Basic brain biology (I swear, youβll get it).
The cost of memory.
How to tell if your brain is actually getting better.
Brain health optimization strategies.
And so much moreβ¦
BRAIN HEALTH
Building a better brain

Erin: Could you deconstruct the main functions of the frontal lobe region?
Mark DβEsposito: There are 4 lobes in the brain. The frontal lobes are the largest and the most important. We actually can divide the frontal lobes into 3 parts as well.Β
The medial section: This is very important for our motivation and our drive.Β
The orbital part: That's important for emotion and social behavior.Β
The lateral part: Probably the most important part of the frontal lobes.Β
The lateral part is important for executive functionβthis includes higher-level skills like working memory, cognitive flexibility, and behavior control. It is the βCEO of the brainβ [and] allows us to translate our thoughts into actions based on rules, intentions, and goals.Β
Erin: How does aging impact the structure and function of the brain?
Mark DβEsposito: There seem to be two parts of the brain that are most affected by normal aging: the frontal lobes (especially lateral part), and the hippocampus (important for memory). These 2 regions are very biologically costlyβthey're the ones that are working the hardest in the brain. They need more:
Energy
Glucose
Oxygen
It's not surprising that they're undergoing the most wear and tear as we age. You can think of them [the lateral part of the frontal lobes and hippocampus] as hubsβ¦important hubs in the brain that are keeping the engine going.Β
Erin: What are normal signs of cognitive decline, and how does it impact executive function?
Mark DβEsposito: With healthy aging, there are changes in both the frontal lobes and the hippocampus.
What we mostly see is that the brain not only shows decreased function, but a kind of compensatory function.
For example, if a young brain is used to just using its left frontal lobe to perform a task, an older individual will use both frontal lobes to perform the task.
The brain is plastic [and] it's trying to rewire itself [to] compensate for changes.
Not all cognitive abilities are going to decline with age. Wisdom, for example, will presumably improve with ageπ¦.
But executive functionβhow fast we process information, switch back and forth, inhibit irrelevant information, and remember esoteric things (i.e., names)βdoes change and decline.Β

Erin: Do these compensatory actions contribute to long-term brain health?
Mark DβEsposito: Absolutely. The brain is organized by these networks. What changes is not that we get new neurons, but the way neurons interact with each other so new networks form.
We see that compensation is just a reflection of the brain's plasticity, and it's the way that it reorganizes.Β
Erin: What is cognitive therapy and how could it be beneficial to the aging brain?
Mark DβEsposito: Older individualsβ¦have trouble with not suppressing what's irrelevantβdampening out distracting information. Cognitive therapy tries to build exercises that enhance that very specific ability.Β
There's a group of exercises that have been built by a group from U.C. San Francisco. It's called Brain HQ (brainhq.com), and they have a series of brain exercises that are based on very specific mechanisms of how the brain works. You can target very specific cognitive abilities.
Erin: With cognitive training, is there a barometer to know when your brain and executive function are improving?
Mark DβEsposito: That's a great question [and] thatβs the problem we've hadβwe've never had a brain health index.
βHow would you know if you're healthier after you do brain exercises?β
There's something called the Brain Health Project, which has been developed by the University of Texas at Dallas, [and] they've developed a brain health index, a very comprehensive tool that assesses all aspects of brain health.Β
If you participate in the study, you will take the brain health index and get a real number. Then they have interventions (i.e., cognitive therapy). What's exciting is that, [with] the interventions they offer, brain health does go up.
Erin:Β What are some common myths about brain health and cognitive function?
Mark DβEsposito: I think the biggest myth that's starting to be overturned is the idea that our brains don't change as we get older; that the brain is not plastic.
π Any intervention on the brainβreading a book or learning a new skill or having new relationshipsβwill change networks in the brain.Β
πͺ Everyone seems to believe that we can get physically better if we exercise, so there really should be no reason to think that if we exercise our brain, we can't improve as well.Β
But people need feedback that their brain health is getting better, otherwise it'll be very hard to sustain all of these things we're talking about.
Erin: What are strategies to optimize long term brain health?
Mark DβEsposito: There's not some magic bullet that's going to optimize brain health and prevent dementia.
I think we should be focusing on the holistic approach that there are many different things that we can do that will make our brain healthier.
Everything we do probably does improve brain health.
Improving sleep, nutrition, exercise, decreasing stress, seeking social connections, and maintaining cognitive gains will all lead to better brain health.Β
Erin: It seems to me like consistently making changes in your life coincides with good changes in your brain.Β
Mark DβEsposito: I think that's a great message.Β
As we get olderβhaving trouble processing information as fast or having trouble filtering out distracting informationβthere are very specific things that you can do with brain exercises (just like if you wanted to build certain muscles) to target specific areas.
But in general, if you're just trying to get networks to integrate and form and change, just lead an engaging, meaningful lifeβit will do the same thing.
What does DβEsposito do for his own brain health?

The researcher has an active professional and family life and he is always doing new things. These are the core things that can help to build and sustain new networks in the brain.Β
Every time we do things that are meaningful and engaging and aren't just rote (just doing the same thing every day), we're:
Taking on new problems
Being creative or curious
Engaging in lots of things
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π Catch up on last weekβs newsletter
We all know about the Paris Olympics, but do you know about the Rejuvenation Olympics?
We canβt wait to cover more trending topics in longevity in our next newsletter. Stay tuned.
-Erin
Longevity Media LLC
Be your own expert. Optimize your health. Look beyond conventional.